About this trial
The goal of this clinical trial is to evaluate whether our transitional care program helps stroke survivors better manage their risk factors for stroke to lower the risk of a repeat stroke. The main question it aims to answer is:
\- Does the program help participants meet the targets set by the American Heart Association clinical guidelines for control of risk factors associated with stroke?
Researchers will compare participants enrolled right after being discharged from the hospital to participants enrolled around 3-5 months after being discharged to examine whether timing differences in enrollment affect the efficacy of the program.
Participants will:
* Keep track of their medications, their exercise, and their health information using smart devices provided by the study * Answer questions about their health and lifestyle * Meet with our team of healthcare providers
Eligibility criteria
Qualifiers
Age 30 or above
Evidence of ischemic stroke documented on CT or MRI
Modified Rankin score of 3 or less
Admission for ischemic stroke at a participating site
Disqualifiers
Participants determined to have hemorrhagic or periprocedural stroke based on hospital EMR review will be excluded.
Participants determined to have an ischemic stroke due to dissection based on hospital EMR review will be excluded.
Participants who lack capacity determined by the care team during their hospitalization (for the early enrollment group) or their most recent clinical encounter (for the late enrollment group) will be excluded.
Participants with a diagnosis of dementia will be excluded.
Trial design
Treatments tested in this trial
- Transitional Care Program