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
{"title":"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。","authors":"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","doi":"10.1161/CIRCOUTCOMES.124.011425","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusions: </strong>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.</p><p><strong>Registration: </strong>URL: https://www.clinicaltrials.gov; Unique identifier: NCT02721446.</p>","PeriodicalId":49221,"journal":{"name":"Circulation-Cardiovascular Quality and Outcomes","volume":" ","pages":"e011425"},"PeriodicalIF":6.2000,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Enhancing Stroke Awareness and Activation Among High-Risk Populations: A Randomized Direct Mail Intervention in Diverse Healthcare Settings.\",\"authors\":\"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\",\"doi\":\"10.1161/CIRCOUTCOMES.124.011425\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusions: </strong>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.</p><p><strong>Registration: </strong>URL: https://www.clinicaltrials.gov; Unique identifier: NCT02721446.</p>\",\"PeriodicalId\":49221,\"journal\":{\"name\":\"Circulation-Cardiovascular Quality and Outcomes\",\"volume\":\" \",\"pages\":\"e011425\"},\"PeriodicalIF\":6.2000,\"publicationDate\":\"2025-03-24\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Circulation-Cardiovascular Quality and Outcomes\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1161/CIRCOUTCOMES.124.011425\",\"RegionNum\":2,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"CARDIAC & CARDIOVASCULAR SYSTEMS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Circulation-Cardiovascular Quality and Outcomes","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1161/CIRCOUTCOMES.124.011425","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}
Enhancing Stroke Awareness and Activation Among High-Risk Populations: A Randomized Direct Mail Intervention in Diverse Healthcare Settings.
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.
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.
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