{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,12]],"date-time":"2026-09-12T16:56:21Z","timestamp":1789232181008,"version":"build-2803163510"},"reference-count":39,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"1","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Circ: Cardiovascular Quality and Outcomes"],"published-print":{"date-parts":[[2018,1]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Disparities of care among stroke survivors are well documented. Effective interventions to improve recurrent stroke preventative care in vulnerable populations are lacking.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and Results<\/jats:title>\n                    <jats:p>In a randomized controlled trial, we tested the efficacy of components of a chronic care model\u2013based intervention versus usual care among 404 subjects having an ischemic stroke or transient ischemic attack within 90 days of enrollment and receiving care within the Los Angeles public healthcare system. Subjects had baseline systolic blood pressure (SBP) \u2265120 mm\u2009Hg. The intervention included a nurse practitioner\/physician assistant care manager, group clinics, self-management support, report cards, decision support, and ongoing care coordination. Outcomes were collected at 3, 8, and 12 months, analyzed as intention-to-treat, and used repeated-measures mixed-effects models. Change in SBP was the primary outcome. Low-density lipoprotein reduction, antithrombotic medication use, smoking cessation, and physical activity were secondary outcomes. Average age was 57 years; 18% were of black race; 69% were of Hispanic ethnicity. Mean baseline SBP was 150 mm\u2009Hg in both arms. SBP decreased to 17 mm\u2009Hg in the intervention arm and 14 mm\u2009Hg in the usual care arm; the between-arm difference was not significant (\u22123.6 mm\u2009Hg; 95% confidence interval, \u22129.2 to 2.2). Among secondary outcomes, the only significant difference was that persons in the intervention arm were more likely to lower their low-density lipoprotein &lt;100 md\/dL (2.0 odds ratio; 95% confidence interval, 1.1\u20133.5).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>This intervention did not improve SBP control beyond that attained in usual care among vulnerable stroke survivors. A community-centered component could strengthen the intervention impact.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Clinical Trial Registration<\/jats:title>\n                    <jats:p>\n                      URL:\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/clinicaltrials.gov\">https:\/\/clinicaltrials.gov<\/jats:ext-link>\n                      . Unique identifier: NCT00861081.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1161\/circoutcomes.116.003228","type":"journal-article","created":{"date-parts":[[2018,1,10]],"date-time":"2018-01-10T20:30:51Z","timestamp":1515616251000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":35,"title":["Efficacy of a Chronic Care\u2013Based Intervention on Secondary Stroke Prevention Among Vulnerable Stroke Survivors"],"prefix":"10.1161","volume":"11","author":[{"given":"Eric M.","family":"Cheng","sequence":"first","affiliation":[{"name":"From the Department of Neurology (E.M.C., F.B., S.M.D., L.H., M.A.-R., B.G.V.) and Department of Medicine (W.E.C., H.L.), UCLA David Geffen School of Medicine; Department of Neurology, Rancho Los Amigos National Rehabilitation Center, Downey, CA (A.T.); Department of Neurology, Keck School of Medicine of USC, Los Angeles (N.S.); Department of Medicine, Olive View-UCLA Medical Center, Sylmar (R.J.B.); Department of Medicine, Harbor-UCLA Medical Center, Torrance (T.L.A.); Los Angeles County Department..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"William E.","family":"Cunningham","sequence":"additional","affiliation":[{"name":"From the Department of Neurology (E.M.C., F.B., S.M.D., L.H., M.A.-R., B.G.V.) and Department of Medicine (W.E.C., H.L.), UCLA David Geffen School of Medicine; Department of Neurology, Rancho Los Amigos National Rehabilitation Center, Downey, CA (A.T.); Department of Neurology, Keck School of Medicine of USC, Los Angeles (N.S.); Department of Medicine, Olive View-UCLA Medical Center, Sylmar (R.J.B.); Department of Medicine, Harbor-UCLA Medical Center, Torrance (T.L.A.); Los Angeles County Department..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amytis","family":"Towfighi","sequence":"additional","affiliation":[{"name":"From the Department of Neurology (E.M.C., F.B., S.M.D., L.H., M.A.-R., B.G.V.) and Department of Medicine (W.E.C., H.L.), UCLA David Geffen School of Medicine; Department of Neurology, Rancho Los Amigos National Rehabilitation Center, Downey, CA (A.T.); Department of Neurology, Keck School of Medicine of USC, Los Angeles (N.S.); Department of Medicine, Olive View-UCLA Medical Center, Sylmar (R.J.B.); Department of Medicine, Harbor-UCLA Medical Center, Torrance (T.L.A.); Los Angeles County Department..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nerses","family":"Sanossian","sequence":"additional","affiliation":[{"name":"From the Department of Neurology (E.M.C., F.B., S.M.D., L.H., M.A.-R., B.G.V.) and Department of Medicine (W.E.C., H.L.), UCLA David Geffen School of Medicine; Department of Neurology, Rancho Los Amigos National Rehabilitation Center, Downey, CA (A.T.); Department of Neurology, Keck School of Medicine of USC, Los Angeles (N.S.); Department of Medicine, Olive View-UCLA Medical Center, Sylmar (R.J.B.); Department of Medicine, Harbor-UCLA Medical Center, Torrance (T.L.A.); Los Angeles County Department..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert J.","family":"Bryg","sequence":"additional","affiliation":[{"name":"From the Department of Neurology (E.M.C., F.B., S.M.D., L.H., M.A.-R., B.G.V.) and Department of Medicine (W.E.C., H.L.), UCLA David Geffen School of Medicine; Department of Neurology, Rancho Los Amigos National Rehabilitation Center, Downey, CA (A.T.); Department of Neurology, Keck School of Medicine of USC, Los Angeles (N.S.); Department of Medicine, Olive View-UCLA Medical Center, Sylmar (R.J.B.); Department of Medicine, Harbor-UCLA Medical Center, Torrance (T.L.A.); Los Angeles County Department..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas L.","family":"Anderson","sequence":"additional","affiliation":[{"name":"From the Department of Neurology (E.M.C., F.B., S.M.D., L.H., M.A.-R., B.G.V.) and Department of Medicine (W.E.C., H.L.), UCLA David Geffen School of Medicine; Department of Neurology, Rancho Los Amigos National Rehabilitation Center, Downey, CA (A.T.); Department of Neurology, Keck School of Medicine of USC, Los Angeles (N.S.); Department of Medicine, Olive View-UCLA Medical Center, Sylmar (R.J.B.); Department of Medicine, Harbor-UCLA Medical Center, Torrance (T.L.A.); Los Angeles County Department..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Frances","family":"Barry","sequence":"additional","affiliation":[{"name":"From the Department of Neurology (E.M.C., F.B., S.M.D., L.H., M.A.-R., B.G.V.) and Department of Medicine (W.E.C., H.L.), UCLA David Geffen School of Medicine; Department of Neurology, Rancho Los Amigos National Rehabilitation Center, Downey, CA (A.T.); Department of Neurology, Keck School of Medicine of USC, Los Angeles (N.S.); Department of Medicine, Olive View-UCLA Medical Center, Sylmar (R.J.B.); Department of Medicine, Harbor-UCLA Medical Center, Torrance (T.L.A.); Los Angeles County Department..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Susan M.","family":"Douglas","sequence":"additional","affiliation":[{"name":"From the Department of Neurology (E.M.C., F.B., S.M.D., L.H., M.A.-R., B.G.V.) and Department of Medicine (W.E.C., H.L.), UCLA David Geffen School of Medicine; Department of Neurology, Rancho Los Amigos National Rehabilitation Center, Downey, CA (A.T.); Department of Neurology, Keck School of Medicine of USC, Los Angeles (N.S.); Department of Medicine, Olive View-UCLA Medical Center, Sylmar (R.J.B.); Department of Medicine, Harbor-UCLA Medical Center, Torrance (T.L.A.); Los Angeles County Department..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lillie","family":"Hudson","sequence":"additional","affiliation":[{"name":"From the Department of Neurology (E.M.C., F.B., S.M.D., L.H., M.A.-R., B.G.V.) and Department of Medicine (W.E.C., H.L.), UCLA David Geffen School of Medicine; Department of Neurology, Rancho Los Amigos National Rehabilitation Center, Downey, CA (A.T.); Department of Neurology, Keck School of Medicine of USC, Los Angeles (N.S.); Department of Medicine, Olive View-UCLA Medical Center, Sylmar (R.J.B.); Department of Medicine, Harbor-UCLA Medical Center, Torrance (T.L.A.); Los Angeles County Department..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Monica","family":"Ayala-Rivera","sequence":"additional","affiliation":[{"name":"From the Department of Neurology (E.M.C., F.B., S.M.D., L.H., M.A.-R., B.G.V.) and Department of Medicine (W.E.C., H.L.), UCLA David Geffen School of Medicine; Department of Neurology, Rancho Los Amigos National Rehabilitation Center, Downey, CA (A.T.); Department of Neurology, Keck School of Medicine of USC, Los Angeles (N.S.); Department of Medicine, Olive View-UCLA Medical Center, Sylmar (R.J.B.); Department of Medicine, Harbor-UCLA Medical Center, Torrance (T.L.A.); Los Angeles County Department..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeffrey J.","family":"Guterman","sequence":"additional","affiliation":[{"name":"From the Department of Neurology (E.M.C., F.B., S.M.D., L.H., M.A.-R., B.G.V.) and Department of Medicine (W.E.C., H.L.), UCLA David Geffen School of Medicine; Department of Neurology, Rancho Los Amigos National Rehabilitation Center, Downey, CA (A.T.); Department of Neurology, Keck School of Medicine of USC, Los Angeles (N.S.); Department of Medicine, Olive View-UCLA Medical Center, Sylmar (R.J.B.); Department of Medicine, Harbor-UCLA Medical Center, Torrance (T.L.A.); Los Angeles County Department..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sandra","family":"Gross-Schulman","sequence":"additional","affiliation":[{"name":"From the Department of Neurology (E.M.C., F.B., S.M.D., L.H., M.A.-R., B.G.V.) and Department of Medicine (W.E.C., H.L.), UCLA David Geffen School of Medicine; Department of Neurology, Rancho Los Amigos National Rehabilitation Center, Downey, CA (A.T.); Department of Neurology, Keck School of Medicine of USC, Los Angeles (N.S.); Department of Medicine, Olive View-UCLA Medical Center, Sylmar (R.J.B.); Department of Medicine, Harbor-UCLA Medical Center, Torrance (T.L.A.); Los Angeles County Department..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sylvia","family":"Beanes","sequence":"additional","affiliation":[{"name":"From the Department of Neurology (E.M.C., F.B., S.M.D., L.H., M.A.-R., B.G.V.) and Department of Medicine (W.E.C., H.L.), UCLA David Geffen School of Medicine; Department of Neurology, Rancho Los Amigos National Rehabilitation Center, Downey, CA (A.T.); Department of Neurology, Keck School of Medicine of USC, Los Angeles (N.S.); Department of Medicine, Olive View-UCLA Medical Center, Sylmar (R.J.B.); Department of Medicine, Harbor-UCLA Medical Center, Torrance (T.L.A.); Los Angeles County Department..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea S.","family":"Jones","sequence":"additional","affiliation":[{"name":"From the Department of Neurology (E.M.C., F.B., S.M.D., L.H., M.A.-R., B.G.V.) and Department of Medicine (W.E.C., H.L.), UCLA David Geffen School of Medicine; Department of Neurology, Rancho Los Amigos National Rehabilitation Center, Downey, CA (A.T.); Department of Neurology, Keck School of Medicine of USC, Los Angeles (N.S.); Department of Medicine, Olive View-UCLA Medical Center, Sylmar (R.J.B.); Department of Medicine, Harbor-UCLA Medical Center, Torrance (T.L.A.); Los Angeles County Department..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Honghu","family":"Liu","sequence":"additional","affiliation":[{"name":"From the Department of Neurology (E.M.C., F.B., S.M.D., L.H., M.A.-R., B.G.V.) and Department of Medicine (W.E.C., H.L.), UCLA David Geffen School of Medicine; Department of Neurology, Rancho Los Amigos National Rehabilitation Center, Downey, CA (A.T.); Department of Neurology, Keck School of Medicine of USC, Los Angeles (N.S.); Department of Medicine, Olive View-UCLA Medical Center, Sylmar (R.J.B.); Department of Medicine, Harbor-UCLA Medical Center, Torrance (T.L.A.); Los Angeles County Department..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Barbara G.","family":"Vickrey","sequence":"additional","affiliation":[{"name":"From the Department of Neurology (E.M.C., F.B., S.M.D., L.H., M.A.-R., B.G.V.) and Department of Medicine (W.E.C., H.L.), UCLA David Geffen School of Medicine; Department of Neurology, Rancho Los Amigos National Rehabilitation Center, Downey, CA (A.T.); Department of Neurology, Keck School of Medicine of USC, Los Angeles (N.S.); Department of Medicine, Olive View-UCLA Medical Center, Sylmar (R.J.B.); Department of Medicine, Harbor-UCLA Medical Center, Torrance (T.L.A.); Los Angeles County Department..."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_3_2_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIR.0000000000000350"},{"key":"e_1_3_3_3_2","doi-asserted-by":"publisher","DOI":"10.1161\/circ.113.10.e409"},{"key":"e_1_3_3_4_2","doi-asserted-by":"publisher","DOI":"10.1002\/14651858.CD009103.pub2"},{"key":"e_1_3_3_5_2","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0b013e318203e952"},{"key":"e_1_3_3_6_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.STR.0000153065.39325.fd"},{"key":"e_1_3_3_7_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.clineuro.2008.06.009"},{"key":"e_1_3_3_8_2","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.115.010678"},{"key":"e_1_3_3_9_2","doi-asserted-by":"publisher","DOI":"10.1186\/s13063-015-0703-4"},{"key":"e_1_3_3_10_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCOUTCOMES.114.000950"},{"key":"e_1_3_3_11_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.288.19.2469"},{"key":"e_1_3_3_12_2","doi-asserted-by":"publisher","DOI":"10.1001\/archinte.164.15.1641"},{"key":"e_1_3_3_13_2","doi-asserted-by":"publisher","DOI":"10.1212\/01.WNL.0000140493.83607.F1"},{"key":"e_1_3_3_14_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCOUTCOMES.110.951012"},{"key":"e_1_3_3_15_2","unstructured":"American Heart Association. Controlling Your Risk Factors: Our Guide to Reducing Your Risk of Heart Attack and Stroke. 2008."},{"key":"e_1_3_3_16_2","unstructured":"Partners in Care Foundation. https:\/\/www.picf.org\/. Accessed November 18 2017."},{"key":"e_1_3_3_17_2","unstructured":"Healthy African American Families. https:\/\/haafphasetwo.squarespace.com\/. Accessed November 18 2017."},{"key":"e_1_3_3_18_2","doi-asserted-by":"publisher","DOI":"10.1097\/MBP.0b013e3282feebd5"},{"key":"e_1_3_3_19_2","doi-asserted-by":"publisher","DOI":"10.1097\/MBP.0b013e3280858dcf"},{"key":"e_1_3_3_20_2","unstructured":"American College of Cardiology American Heart Association. ASCVD Risk Estimator. http:\/\/tools.acc.org\/ASCVD-Risk-Estimator-Plus\/#!\/calculate\/estimate\/. Accessed November 18 2017."},{"key":"e_1_3_3_21_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.STR.20.7.864"},{"key":"e_1_3_3_22_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.STR.30.8.1538"},{"key":"e_1_3_3_23_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.279.16.1288"},{"key":"e_1_3_3_24_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.289.3.343"},{"key":"e_1_3_3_25_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1475-6773.2003.00190.x"},{"key":"e_1_3_3_26_2","doi-asserted-by":"publisher","DOI":"10.1097\/00005650-199912000-00010"},{"key":"e_1_3_3_27_2","unstructured":"RAND Health. HIV Cost and Services Utilization Sutdy (HCSUS). Module 9: Social Support and Coping. Section A: Social Support. http:\/\/www.rand.org\/health\/projects\/hcsus\/Base.html. Accessed November 18 2017."},{"key":"e_1_3_3_28_2","doi-asserted-by":"publisher","DOI":"10.1007\/s11606-007-0265-6"},{"key":"e_1_3_3_29_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.289.19.2560"},{"key":"e_1_3_3_30_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.str.0000126208.14181.dd"},{"key":"e_1_3_3_31_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(02)11911-8"},{"key":"e_1_3_3_32_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(01)06178-5"},{"key":"e_1_3_3_33_2","first-page":"277","article-title":"Information measures and model selection.","volume":"1","author":"Akaike H","year":"1983","unstructured":"Akaike H. Information measures and model selection. Bull Int Statist Inst. 1983;1:277\u2013291.","journal-title":"Bull Int Statist Inst"},{"key":"e_1_3_3_34_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2011.1650"},{"key":"e_1_3_3_35_2","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.115.008821"},{"key":"e_1_3_3_36_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2013.11.002"},{"key":"e_1_3_3_37_2","doi-asserted-by":"publisher","DOI":"10.1161\/JAHA.113.000251"},{"key":"e_1_3_3_38_2","doi-asserted-by":"publisher","DOI":"10.1002\/ana.23972"},{"key":"e_1_3_3_39_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12883-017-0792-7"},{"key":"e_1_3_3_40_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCOUTCOMES.111.961573"}],"container-title":["Circulation: Cardiovascular Quality and Outcomes"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ahajournals.org\/doi\/full\/10.1161\/CIRCOUTCOMES.116.003228","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,2,6]],"date-time":"2025-02-06T03:27:07Z","timestamp":1738812427000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ahajournals.org\/doi\/10.1161\/CIRCOUTCOMES.116.003228"}},"subtitle":["A Randomized Controlled Trial"],"short-title":[],"issued":{"date-parts":[[2018,1]]},"references-count":39,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2018,1]]}},"alternative-id":["10.1161\/CIRCOUTCOMES.116.003228"],"URL":"https:\/\/doi.org\/10.1161\/circoutcomes.116.003228","relation":{},"ISSN":["1941-7713","1941-7705"],"issn-type":[{"value":"1941-7713","type":"print"},{"value":"1941-7705","type":"electronic"}],"subject":[],"published":{"date-parts":[[2018,1]]},"assertion":[{"value":"2016-08-25","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2017-11-16","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2018-01-10","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e003228"}}