Ischemic Stroke, Acute, Stroke, Acute
Conditions
Keywords
stroke education, ischemic stroke, stroke knowledge
Brief summary
The goal of this multicenter randomized trial is to evaluate the impact of a personalized video-based stroke education platform on patient-centered and health system-centered outcomes. The main questions this study aims to address are: 1. Does a personalized, video-based educational platform improve stroke knowledge? 2. Does a personalized, video-based educational platform reduce post-discharge health system utilization? 3. Do different strategies of nudging improve engagement with educational material after hospital discharge? In order to determine the effect of this personalized stroke education strategy, researchers will compare subjects who receive standard stroke education with those who receive the personalized stroke education platform in addition to standard standard education. Patient knowledge will be assessed 90-days after discharge. Study participants will include both stroke patients and caregivers, who will: 1. Receive standard education during the stroke hospitalization 2. Complete a survey on the day of hospital discharge to assess their baseline knowledge. 3. Half of the subjects will be randomly assigned to also receive access to the personalized stroke education platform on the day of discharge. 4. All subjects will complete two follow-up study visits (7 and 90 days after discharge) in order to complete surveys.
Detailed description
Stroke education represents a unique opportunity to empower stroke survivors (and caregivers) to promote self-management, augment adherence, and reduce post-stroke healthcare utilization. Despite being a key quality metric for stroke centers, most patient and caregiver education is poorly retained and a common source of dissatisfaction. In fact, most survivors are unaware of the cause of their stroke, their modifiable risk factors, and how to properly respond to future stroke symptoms. Although there is no gold standard, most centers rely on a combination of bedside verbal communication and standardized printed materials. Prior work has clarified that effective and durable educational interventions benefit from engaging content, personalization, accessibility, and low cost/burden. Retention is very poor during the stroke hospitalization, but this can be overcome by promoting ongoing engagement after discharge. To that end, our group developed a web-based educational platform (MyStroke) that leverages the electronic health record to personalize video-based educational content for each stroke survivor. Simple but engaging videos are curated to address each patient's stroke etiology, individualized risk factors, prescribed stroke prevention medications, and post-stroke lifestyle issues. This approach transforms point-of-care stroke education, and integrated nudges reveal opportunities for re-education and re-engagement after hospital discharge to achieve a durable impact. In a recent single-center pilot trial, MyStroke improved patient and caregiver satisfaction and improved key elements of stroke knowledge. The objective of this proposal is to build upon our encouraging preliminary experience and conduct a multicenter randomized trial to evaluate the impact of MyStroke on both patient-centered (stroke knowledge, self-efficacy, satisfaction, quality of life) and health system-centered outcomes (medication adherence and health system utilization). Electronic nudges will leverage principles of behavioral economics (i.e. enhanced nudges) to promote ongoing engagement. Our preliminary data indicate that even bland nudges promote engagement, but here we propose to use both bland nudges and enhanced nudges, such that platform analytics will compare the influence of different nudge types. Use of technology in this context stands to bridge geographic distances, connect stakeholders, and increase access to information, but it important to recognize the potential to exacerbate inequities for elderly patients and those with limited access to technology. Issues of digital inclusivity will be evaluated to reveal opportunities for platform improvement. The MyStroke platform offers a scalable solution stroke education which imposes no burden on the clinical team due to its reliance on a limited number of input fields which can be harvested from the electronic health record to individualized content for each patient.
Interventions
BEHAVIORALMyStroke
MyStroke is a video-based educational platform that curates brief educational videos to inform patients and caregivers about key aspects of their stroke. Upon registering a user, information regarding the patient's stroke etiology, relevant stroke risk factors, and stroke prevention medications are used to populate educational content that is relevant to the individual. Users receive automated nudges to revisit MyStroke after hospital discharge on day 1, 3, 5, 7, and weekly thereafter.
Sponsors
University of Pennsylvania
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
TRIPLE (Caregiver, Investigator, Outcomes Assessor)
Masking description
Given the nature of the intervention (an educational platform), masking of participants is not feasible, but other key study members (and clinicians) will be blinded to the study assignment.
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* At least 18 years old * Admitted to hospital with clinical diagnosis of acute ischemic stroke (imaging confirmation not required) * Stroke symptom onset within 30 days of enrollment * Being discharged to either home or an acute rehabilitation facility * Access to internet enabled device (smartphone, tablet, computer) * Fluent in either English or Spanish (does not need to be native or primary language) * Willingness and ability to sign informed consent
Exclusion criteria
* Severe aphasia (score of ≥2 on NIHSS item 9) * Ischemic stroke that is attributed to a surgical procedure * Resides in a skilled nursing facility prior to admission * Being discharged to skilled nursing facility or long-term acute care facility * Unwillingness or inability to participate in remote/virtual study visits * A terminal or advanced condition that raises the possibility the subject may not survive 90 days * Any other illness or condition that the investigator feels would pose a hazard to the subject from participation in the study
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| The Stroke Patient Education Retention (SPER) survey | 90 days | Total score from the 5-question SPER (scale 0-10; higher score reflects better knowledge) |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Patient satisfaction with stroke education | 90 days | 5-point Likert-scale (Q: I am satisfied with the quality of my stroke education; Answers range from strongly disagree to strongly agree) |
| Stroke etiology awareness | 90 days | The proportion of patients who correctly identify their stroke etiology (multiple choice) |
| Stroke risk factor awareness | 90 days | The proportion of patients who correctly identify at least one of their vascular risk factors (select all that apply) |
| Antithrombotic medication awareness | 90 days | The proportion of patients who correctly identify all prescribed antithrombotic medications (free response) |
| Stroke Self-Efficacy Questionnaire (SSEQ) | 90 days | Total score from the 13 item questionnaire (each item scored 0-10; total score 0-130; higher scores represent higher levels of self-efficacy) |
| EuroQoL EQ-5D-5L | 90 days | A standardized measure of health-related quality of life across 5 domains. Each domain is scored using a 5-point ordinal scale (1-5), and the Level Sum Score (LSS) is calculated as the sum of the 5 scores (LSS range is 5-25, lower scores represent higher quality of life). |
| Medication adherence | 90 days | This will be assessed based on pharmacy record review to quantify the Proportion of Days Covered (PDC). PDC is calculated by dividing the number of days with medications available by the total number of days in question (scored between 0 - 1; higher numbers represent more favorable adherence) |
| Emergency Department utilization | 90 days | The number of Emergency Room visits will be summed in the first 90 days following hospital discharge |
| Urgent outpatient visits | 90 days | The number of urgent outpatient visits with primary care and neurologist will be summed in the first 90 days following hospital discharge |
| Outpatient provider communication | 90 days | The number of communications with primary care or neurology providers via telephone or provider communication apps will be summed in the first 90 days following hospital discharge |
Countries
United States
Contacts
CONTACTChristopher G Favilla, MD
CONTACTNichole Gallatti
PRINCIPAL_INVESTIGATORChristopher G Favilla, MD
Assistant Professor of Neurology at the University of Pennsylvania
Outcome results
None listed