U01NS135533

The SDOH-homecare intervention focus team (SHIFT) trial to mitigate SDOH in stroke outcomes and build community capacity - project summary

Closing the gap in stroke disparities cannot be accomplished without addressing the upstream factors driving them. Structural racism and discrimination (SRD) produces adverse social determinants of health (SDOH), which have been shown to increase stroke risk in a dose dependent manner.

The present application focuses on mitigating the effects of SDOH to improve stroke outcomes in underserved minority populations, using a multi-level approach that includes the community, healthcare institution, interpersonal, and individual levels. Our rationale is that the burden of mitigating the multi-level impact of SDOH on social and health inequities should not fall solely on disenfranchised patients, which in our case is the economically disadvantaged African American and Hispanic stroke patient.

Our 4 specific aims intervene on major downstream health effects arising from adverse SDOH. Stroke is the leading cause of adult disability in the US with the greatest burden on communities of color, and it is not surprising that SDOH is a major driver of stroke disparities. Currently, there is a dearth of effective SDOH interventions for stroke prevention and recovery.

Our proposal seeks to address this gap by developing a racial equity-trained, multidisciplinary homecare team, or SHIFT (SDOH-homecare intervention focus team). SHIFT comprises a local community based organization (CBO)-affiliated community health worker, a community nurse, and a community social worker. We hypothesize that by targeting patient-specific SDOH risk factors on a community, health systems, interpersonal and individual level with SHIFT, we will mitigate the adverse effects of SDOH factors to improve functional and physiological outcomes after stroke in vulnerable race-ethnicity groups.

Specifically, we will examine the effect of the SHIFT approach on post-stroke outcomes of African American and Hispanic patients with > 3 SDOH risk factors compared to usual care in a randomized controlled trial (RCT) embedded within a hybrid type I implementation effectiveness design. The primary outcome will be the stroke impact score (SIS 3.0) -- a measure of disability and health-related quality of life after stroke -- measured at 6 months and 1 year (Aim 1A).

Secondary outcomes will assess the effect of the intervention on blood pressure control and cognitive status (Aim 1B) and explore the role of allostatic load – a measure of physiological weathering – on our outcomes of interest (exploratory Aim 1C). Aim 2 will test the hypothesis that improvement in functional and physiological stroke outcomes as measured in Aim 1 is associated with reduction in specific SDOH variables.

In Aim 3, at the healthcare system level, we will examine the effect of the SHIFT intervention on health system process variables (Aim 3A) and stroke patient re-admission rates (Aim 3B). At the community level, guided by a standardized organizational capacity measure and scoring matrix, we will engage in CBO capacity building of a local CBO partner to support the sustainability of its SDOH-mitigating activities, while gathering multi-level contextual data influencing patient outcomes using a racism-conscious adaptation of the consolidated framework for implementation research (Aim 4).

The Trustees Of Columbia University In The City Of New York

(1) TO SUPPORT EXTRAMURAL RESEARCH FUNDED BY THE NATIONAL INSTITUTE OF NEUROLOGICAL DISORDERS AND STROKE (NINDS) INCLUDING: BASIC RESEARCH THAT EXPLORES THE FUNDAMENTAL STRUCTURE AND FUNCTION OF THE BRAIN AND THE NERVOUS SYSTEM; RESEARCH TO UNDERSTAND THE CAUSES AND ORIGINS OF PATHOLOGICAL CONDITIONS OF THE NERVOUS SYSTEM WITH THE GOAL OF PREVENTING THESE DISORDERS; RESEARCH ON THE NATURAL COURSE OF NEUROLOGICAL DISORDERS; IMPROVED METHODS OF DISEASE PREVENTION; NEW METHODS OF DIAGNOSIS AND TREATMENT; DRUG DEVELOPMENT; DEVELOPMENT OF NEURAL DEVICES; CLINICAL TRIALS; AND RESEARCH TRAINING IN BASIC, TRANSLATIONAL AND CLINICAL NEUROSCIENCE. THE INSTITUTE IS THE LARGEST FUNDER OF BASIC NEUROSCIENCE IN THE US AND SUPPORTS RESEARCH ON TOPICS INCLUDING BUT NOT LIMITED TO: DEVELOPMENT OF THE NERVOUS SYSTEM, INCLUDING NEUROGENESIS AND PROGENITOR CELL BIOLOGY, SIGNAL TRANSDUCTION IN DEVELOPMENT AND PLASTICITY, AND PROGRAMMED CELL DEATH; SYNAPSE FORMATION, FUNCTION, AND PLASTICITY; LEARNING AND MEMORY; CHANNELS, TRANSPORTERS, AND PUMPS; CIRCUIT FORMATION AND MODULATION; BEHAVIORAL AND COGNITIVE NEUROSCIENCE; SENSORIMOTOR LEARNING, INTEGRATION AND EXECUTIVE FUNCTION; NEUROENDOCRINE SYSTEMS; SLEEP AND CIRCADIAN RHYTHMS; AND SENSORY AND MOTOR SYSTEMS. IN ADDITION, THE INSTITUTE SUPPORTS BASIC, TRANSLATIONAL AND CLINICAL STUDIES ON A NUMBER OF DISORDERS OF THE NERVOUS SYSTEM INCLUDING (BUT NOT LIMITED TO): STROKE; TRAUMATIC INJURY TO THE BRAIN, SPINAL CORD AND PERIPHERAL NERVOUS SYSTEM; NEURODEGENERATIVE DISORDERS; MOVEMENT DISORDERS; BRAIN TUMORS; CONVULSIVE DISORDERS; INFECTIOUS DISORDERS OF THE BRAIN AND NERVOUS SYSTEM; IMMUNE DISORDERS OF THE BRAIN AND NERVOUS SYSTEM, INCLUDING MULTIPLE SCLEROSIS; DISORDERS RELATED TO SLEEP; AND PAIN. PROGRAMMATIC AREAS, WHICH ARE PRIMARILY SUPPORTED BY THE DIVISION OF NEUROSCIENCE, ARE ALSO SUPPORTED BY THE DIVISION OF EXTRAMURAL ACTIVITIES, THE DIVISION OF TRANSLATIONAL RESEARCH, THE DIVISION OF CLINICAL RESEARCH, THE OFFICE OF TRAINING AND WORKFORCE DEVELOPMENT, THE OFFICE OF PROGRAMS TO ENHANCE THE NEUROSCIENCE WORKFORCE, AND THE OFFICE OF INTERNATIONAL ACTIVITIES. (2) TO EXPAND AND IMPROVE THE SMALL BUSINESS INNOVATION RESEARCH (SBIR) PROGRAM; TO INCREASE PRIVATE SECTOR COMMERCIALIZATION OF INNOVATIONS DERIVED FROM FEDERAL RESEARCH AND DEVELOPMENT; TO INCREASE SMALL BUSINESS PARTICIPATION IN FEDERAL RESEARCH AND DEVELOPMENT; AND TO FOSTER AND ENCOURAGE PARTICIPATION OF SOCIALLY AND ECONOMICALLY DISADVANTAGED SMALL BUSINESS CONCERNS AND WOMEN-OWNED SMALL BUSINESS CONCERNS IN TECHNOLOGICAL INNOVATION. TO UTILIZE THE SMALL BUSINESS TECHNOLOGY TRANSFER (STTR) PROGRAM; TO STIMULATE AND FOSTER SCIENTIFIC AND TECHNOLOGICAL INNOVATION THROUGH COOPERATIVE RESEARCH AND DEVELOPMENT CARRIED OUT BETWEEN SMALL BUSINESS CONCERNS AND RESEARCH INSTITUTIONS; TO FOSTER TECHNOLOGY TRANSFER BETWEEN SMALL BUSINESS CONCERNS AND RESEARCH INSTITUTIONS; TO INCREASE PRIVATE SECTOR COMMERCIALIZATION OF INNOVATIONS DERIVED FROM FEDERAL RESEARCH AND DEVELOPMENT; AND TO FOSTER AND ENCOURAGE PARTICIPATION OF SOCIALLY AND ECONOMICALLY DISADVANTAGED SMALL BUSINESS CONCERNS AND WOMEN-OWNED SMALL BUSINESS CONCERNS IN TECHNOLOGICAL INNOVATION.

93.853 - Extramural Research Programs in the Neurosciences and Neurological Disorders

National Institute of Neurological Disorders and Stroke (NNDS) [HHS - NIH]

New York, New York 100323726 United States

Single Zip Code

Research Project Grant (Parent R01 Clinical Trial Required) (PA-20-183)

Amendment Since initial award the total obligations have increased 197% from $1,243,167 to $3,690,914.