Video-based Intervention to Reduce Treatment and OUtcome Disparities in Adults Living with Stroke or Transient Ischemic Attack (VIRTUAL) - A. SUMMARY AND SPECIFIC AIMS OF FUNDED PARENT GRANT Hypertension is the most important risk factor for ischemic and hemorrhagic stroke, and reduction in blood pressure (BP) after stroke is associated with reduced risk of stroke recurrence. For the majority of stroke survivors (SS), hypertension remains poorly controlled early after an incident stroke. In the United States, Black and Hispanic SS are more likely to have poorly controlled risk factors after stroke compared to White SS, and Black and Hispanic SS have higher rates of stroke recurrence compared to White SS. Prior efforts to reduce racial disparities in BP control among SS have been uniformly unsuccessful. Multicomponent care models that include multidisciplinary approaches show promise for improving risk factor control after stroke. Social determinants of health (SDOH) help to explain racial disparities in BP control and stroke recurrence, therefore multidisciplinary post-stroke care models that target SDOH may be key to decreasing disparities in BP control. Limited access to post-stroke outpatient care contributes to challenges in developing system-level interventions for post-stroke BP control. Telemedicine and telemonitoring may be ideal approaches for improving access to care in SS. The COVID-19 pandemic has led to rapid expansion of telemedicine for post-acute care in stroke survivors; however, its effectiveness is unproven. Based on preliminary data at our center, we propose a randomized trial testing an integrated multidisciplinary telehealth intervention, the Video-based Intervention to Reduce Treatment and Outcome Disparities in Adults Living with Stroke or Transient Ischemic Attack (VIRTUAL), in SS recently discharged home after inpatient hospitalization for ischemic stroke, hemorrhagic stroke, or transient ischemic attack. The intervention will include post-discharge telehealth visits by a multidisciplinary team, social risk assessments to facilitate social risk-targeted and social risk-informed care, and home BP telemonitoring and management. The care team includes neurology providers (physician and nurse practitioner), a pharmacist, and a social worker. Standard care will include follow-up with a neurologist and primary care provider and pharmacist-assisted BP adjustment. Aim 1: We will enroll 534 stroke survivors in a randomized comparative effectiveness trial of a 6-month multidisciplinary telehealth intervention to test the impact of the intervention on key clinical outcomes, relative to standard care. Aim 1a: To examine the impact of the intervention on the primary outcome of BP control (24-hour ambulatory BP <125/75 mmHg) assessed with ambulatory BP monitoring (ABPM) 6 months after hospital discharge. Aim 1b: To evaluate the impact of the intervention on disparities in BP control at 6 months by examining heterogeneity of effects on the primary clinical outcome (BP control) according to SS race and ethnicity. Aim 1c: To assess the sustainability of intervention effect by examining the proportion of SS with BP control after hospital discharge. Aim 1d: To examine the impact of the intervention on a composite outcome of recurrent vascular events (stroke, vascular death, coronary revascularization, myocardial infarction, heart failure) 12 months after hospital discharge. Aim 2: We will examine the impact of the intervention on care access and utilization, relative to standard care. Aim 2a: To examine the impact of the intervention on the proportion of uninsured SS who have obtained insurance coverage (including Medicaid, state programs, or commercial insurance) by 3- and 6-months following hospital discharge. Aim 2b: To examine the impact of the intervention on acute healthcare utilization (emergency department and urgent care visits and hospital readmissions) 3 months, 6 months and 12 months after hospital discharge. Aim 2c: To evaluate heterogeneity of effects of the intervention on care access and utilization at 3 months, 6 months, and 12 months acco
