title: Randomized, controlled trial of an intervention to enable stroke survivors throughout the Los Angeles County safety net to "stay with the guidelines".
abstract: BACKGROUND
  Stroke is the leading cause of adult disability. Inpatient programs optimize secondary stroke prevention care at the time of hospital discharge, but such care may not be continued after hospital discharge.
  
  
  METHODS
  To improve the delivery of secondary stroke preventive services after hospital discharge, we have designed a chronic care model-based program called SUSTAIN (Systemic Use of STroke Averting INterventions). This care intervention includes group clinics, self-management support, report cards, decision support through care guides and protocols, and coordination of ongoing care. The first specific aim is to test, in a randomized, controlled trial, whether SUSTAIN improves blood pressure control among an analytic sample of 268 patients with a recent stroke or transient ischemic attack discharged from 4 Los Angeles County public hospitals. Secondary outcomes consist of control of other stroke risk factors, lifestyle habits, medication adherence, patient perceptions of care quality, functional status, and quality of life. A second specific aim is to conduct a cost analysis of SUSTAIN from the perspective of the Los Angeles County Department of Health Services by using direct costs of the intervention, cost equivalents of associated utilization of county system resources, and cost equivalents of the observed and predicted averted vascular events.
  
  
  CONCLUSIONS
  If SUSTAIN is effective, we will have the expertise and findings to advocate for its continued support at Los Angeles County hospitals and to disseminate the SUSTAIN program to other settings serving indigent, minority populations. Clinical Trial Registration- URL: http://www.clinicaltrials.gov. Unique identifier: NCT00861081.
authors.affiliation: Department of Neurology, David Geffen School of Medicine, University of California, and Department of Neurology, VA Greater Los Angeles Healthcare System, Los Angeles, CA 90073, USA. eric.cheng@va.gov
authors.forename: Eric M
authors.initials: EM
authors.lastname: Cheng
authors.forename: William E
authors.initials: WE
authors.lastname: Cunningham
authors.forename: Amytis
authors.initials: A
authors.lastname: Towfighi
authors.forename: Nerses
authors.initials: N
authors.lastname: Sanossian
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Bryg
authors.forename: Thomas L
authors.initials: TL
authors.lastname: Anderson
authors.forename: Jeffrey J
authors.initials: JJ
authors.lastname: Guterman
authors.forename: Sandra G
authors.initials: SG
authors.lastname: Gross-Schulman
authors.forename: Sylvia
authors.initials: S
authors.lastname: Beanes
authors.forename: Andrea S
authors.initials: AS
authors.lastname: Jones
authors.forename: Honghu
authors.initials: H
authors.lastname: Liu
authors.forename: Susan L
authors.initials: SL
authors.lastname: Ettner
authors.forename: Jeffrey L
authors.initials: JL
authors.lastname: Saver
authors.forename: Barbara G
authors.initials: BG
authors.lastname: Vickrey
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003365:Costs and Cost Analysis; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000517:prevention & control*; D008019:Life Style; D015141:Los Angeles; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D010349:Patient Compliance; D012307:Risk Factors; D055502:Secondary Prevention; D012648:Self Care; D057566:Self Report; D012657:Self-Help Groups; D020521:Stroke / Q000191:economics / Q000517:prevention & control* / Q000628:therapy*; D016896:Treatment Outcome