Enhancing Stroke Awareness and Activation Among High-Risk Populations: A Randomized Direct Mail Intervention in Diverse Healthcare Settings.

IF 6.2 2区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Circulation-Cardiovascular Quality and Outcomes Pub Date : 2025-03-24 DOI:10.1161/CIRCOUTCOMES.124.011425

Christine C Groves, Teresa M Damush, Laura J Myers, Fitsum Baye, Joanne K Daggy, Anthony J Perkins, Holly Martin, Layne Mounsey, Daniel O Clark, Linda S Williams

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引用次数: 0

Abstract

Background: Many patients are unaware of their stroke risk. The purpose of this research was to compare the effect of behaviorally tailored mailed messages on patient activation to reduce stroke risk.

Methods: Randomized parallel group clinical trial. We used electronic health records to construct Framingham Stroke Risk Scores in primary care patients from 1 Veterans Health Administration (VA) and 1 non-VA healthcare system, Eskenazi Health System (EHS). Four stroke risk messages were developed through patient interviews: standard, incentive ($5 gift card), salience, and incentive plus salience. The standard message served as the comparison group. Patients in the highest Framingham Stroke Risk Score quintile were randomly assigned to receive one of the messages. All letters asked the patient to call a stroke prevention coordinator, the primary outcome. Response to the messages was modeled separately in the 2 cohorts using logistic regression.

Results: In total, 2084 EHS patients (mean age, 65.6; 36% male; 68% Black; mean Framingham Stroke Risk Score, 13.1) and 1759 VA patients (mean age, 75.6; 99% male; 86% White; mean Framingham Stroke Risk Score, 18.6) received a letter. Rates of calls to the coordinator were 13% among the EHS and 23% among the VA cohort. The EHS cohort was significantly more likely to respond to the incentive message compared with the standard message (odds ratio, 1.97 [95% CI, 1.17-3.09]), and the VA cohort was more likely to respond to the incentive plus salience message (odds ratio, 1.50 [95% CI, 1.02-2.22]). Among individuals calling the coordinator, 31% of the EHS cohort and 27% of the VA cohort were unaware they had stroke risk factors.

Conclusions: A mailed message including a $5 incentive was more effective than a standard message in engaging high-risk patients with their healthcare system, including a salience message may also be important in some patient populations. Many primary care patients are unaware of their stroke risk.

Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT02721446.

查看原文本刊更多论文

在高危人群中提高卒中意识和激活：不同医疗机构的随机直邮干预。

背景：许多患者没有意识到他们的中风风险。本研究的目的是比较行为定制的邮件信息对患者激活的影响，以降低中风风险。方法：随机平行组临床试验。我们使用电子健康记录来构建来自1个退伍军人健康管理局（VA）和1个非VA医疗保健系统Eskenazi卫生系统（EHS）的初级保健患者的Framingham卒中风险评分。通过对患者的访谈，研究人员得出了四种中风风险信息：标准信息、奖励信息（5美元礼品卡）、显著信息和奖励加显著信息。标准信息作为对照组。Framingham卒中风险评分最高的五分之一的患者被随机分配接受其中一条信息。所有信件都要求患者打电话给中风预防协调员，这是主要结果。在两个队列中分别使用逻辑回归对消息的响应进行建模。结果：EHS患者共2084例，平均年龄65.6岁；男性36%;68%是黑人;平均Framingham卒中风险评分，13.1)和1759例VA患者(平均年龄，75.6；男性99%;86%的白人;平均弗雷明汉中风风险评分，18.6)收到一封信。EHS组和VA组分别为13%和23%。与标准信息相比，EHS队列更有可能对激励信息做出反应（优势比，1.97 [95% CI, 1.17-3.09]），而VA队列更有可能对激励加显著性信息做出反应（优势比，1.50 [95% CI, 1.02-2.22]）。在打电话给协调员的人中，31%的EHS队列和27%的VA队列不知道自己有中风风险因素。结论：包含5美元激励的邮件信息比标准信息更有效地吸引高危患者与他们的医疗保健系统，包括显著信息对某些患者群体也很重要。许多初级保健患者不知道他们的中风风险。注册：网址：https://www.clinicaltrials.gov；唯一标识符：NCT02721446。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Circulation-Cardiovascular Quality and Outcomes CARDIAC & CARDIOVASCULAR SYSTEMS-

CiteScore

8.50

自引率

2.90%

发文量

357

审稿时长

4-8 weeks

期刊介绍： Circulation: Cardiovascular Quality and Outcomes, an American Heart Association journal, publishes articles related to improving cardiovascular health and health care. Content includes original research, reviews, and case studies relevant to clinical decision-making and healthcare policy. The online-only journal is dedicated to furthering the mission of promoting safe, effective, efficient, equitable, timely, and patient-centered care. Through its articles and contributions, the journal equips you with the knowledge you need to improve clinical care and population health, and allows you to engage in scholarly activities of consequence to the health of the public. Circulation: Cardiovascular Quality and Outcomes considers the following types of articles: Original Research Articles, Data Reports, Methods Papers, Cardiovascular Perspectives, Care Innovations, Novel Statistical Methods, Policy Briefs, Data Visualizations, and Caregiver or Patient Viewpoints.