CC BY-NC-ND 4.0 · Appl Clin Inform 2023; 14(05): 883-891
DOI: 10.1055/s-0043-1772679
CIC 2022

Improving Patient-Reported Outcomes in Stroke Care using Remote Blood Pressure Monitoring and Telehealth

Imama A. Naqvi
1   Division of Stroke and Cerebrovascular Diseases, Department of Neurology, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York, United States
Kevin Strobino
1   Division of Stroke and Cerebrovascular Diseases, Department of Neurology, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York, United States
Hanlin Li
2   NewYork-Presbyterian Hospital, New York, New York, United States
Kevin Schmitt
2   NewYork-Presbyterian Hospital, New York, New York, United States
Yuliya Barratt
2   NewYork-Presbyterian Hospital, New York, New York, United States
Stephen A. Ferrara
3   School of Nursing, Columbia University, New York, New York, United States
Amna Hasni
4   Whiting School of Engineering, Johns Hopkins University, Baltimore, Maryland, United States
Kenrick D. Cato
5   Department of Informatics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States
Mark G. Weiner
6   Department of Population Health Sciences, Weill Cornell Medicine, New York, New York, United States
Mitchell S. V. Elkind
1   Division of Stroke and Cerebrovascular Diseases, Department of Neurology, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York, United States
Ian M. Kronish
7   Division of Cardiology, Department of Internal Medicine, Center for Behavioral Cardiovascular Health, Columbia University Irving Medical Center, New York, New York, United States
Adriana Arcia
8   Hahn School of Nursing and Health Science, University of San Diego, San Diego, California, United States
› Author Affiliations


Background Inequities in health care access leads to suboptimal medication adherence and blood pressure (BP) control. Informatics-based approaches may deliver equitable care and enhance self-management. Patient-reported outcomes (PROs) complement clinical measures to assess the impact of illness on patients' well-being in poststroke care.

Objectives The aim of this study was to determine the feasibility of incorporating PROs into Telehealth After Stroke Care (TASC) and to explore the effect of this team-based remote BP monitoring program on psychological distress and quality of life in an underserved urban setting.

Methods Patients discharged home from a Comprehensive Stroke Center were randomized to TASC or usual care for 3 months. They were provided with a BP monitor and a tablet that wirelessly transmitted data to a cloud-based platform, which were integrated with the electronic health record. Participants who did not complete the tablet surveys were contacted via telephone or e-mail. We collected the Patient-Reported Outcomes Measurement Information System Managing Medications and Treatment (PROMIS-MMT), Patient Activation Measure (PAM), Neuro-QOL (Quality of Life in Neurological Disorders) Cognitive Function, Neuro-QOL Depression, and Patient Health Questionnaire-9 (PHQ-9). T-tests and linear regression were used to evaluate the differences in PRO change between the arms.

Results Of the 50 participants, two-thirds were Hispanic or non-Hispanic Black individuals. Mechanisms of PRO submission for the arms included tablet (62 vs. 47%), phone (24 vs. 37%), tablet with phone coaching (10 vs. 16%), and e-mail (4 vs. 0%). PHQ-9 depressive scores were nominally lower in TASC at 3 months compared with usual care (2.7 ± 3.6 vs. 4.0 ± 4.1; p = 0.06). No significant differences were observed in PROMIS-MMT, PAM, or Neuro-QoL measures.

Conclusion Findings suggest the feasibility of collecting PROs through an interactive web-based platform. The team-based remote BP monitoring demonstrated a favorable impact on patients' well-being. Patients equipped with appropriate resources can engage in poststroke self-care to mitigate inequities in health outcomes.

Protection of Human and Animal Subjects

The study was performed in compliance with the World Medical Association Declaration of Helsinki on Ethical Principles for Medical Research Involving Human Subjects and was reviewed by the TASC Institutional Review Board.

Publication History

Received: 02 March 2023

Accepted: 13 June 2023

Article published online:
08 November 2023

© 2023. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

  • References

  • 1 Ovbiagele B, Goldstein LB, Higashida RT. et al; American Heart Association Advocacy Coordinating Committee and Stroke Council. Forecasting the future of stroke in the United States: a policy statement from the American Heart Association and American Stroke Association. Stroke 2013; 44 (08) 2361-2375
  • 2 O'Donnell MJ, Chin SL, Rangarajan S. et al; INTERSTROKE investigators. Global and regional effects of potentially modifiable risk factors associated with acute stroke in 32 countries (INTERSTROKE): a case-control study. Lancet 2016; 388 (10046): 761-775
  • 3 Kissela B, Schneider A, Kleindorfer D. et al. Stroke in a biracial population: the excess burden of stroke among Blacks. Stroke 2004; 35 (02) 426-431
  • 4 Khan NA, Yun L, Humphries K, Kapral M. Antihypertensive drug use and adherence after stroke: are there sex differences?. Stroke 2010; 41 (07) 1445-1449
  • 5 Cruz-Flores S, Rabinstein A, Biller J. et al; American Heart Association Stroke Council, Council on Cardiovascular Nursing, Council on Epidemiology and Prevention, Council on Quality of Care and Outcomes Research. Racial-ethnic disparities in stroke care: the American experience: a statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 2011; 42 (07) 2091-2116
  • 6 Ireland SE, Arthur HM, Gunn EA, Oczkowski W. Stroke prevention care delivery: predictors of risk factor management outcomes. Int J Nurs Stud 2011; 48 (02) 156-164
  • 7 Shippee ND, Shah ND, May CR, Mair FS, Montori VM. Cumulative complexity: a functional, patient-centered model of patient complexity can improve research and practice. J Clin Epidemiol 2012; 65 (10) 1041-1051
  • 8 Reeves M, Lisabeth L, Williams L. et al. Patient-reported outcome measures (PROMs) for acute stroke: rationale, methods and future directions. Stroke 2018; 49 (06) 1549-1556
  • 9 McAlister FA, Majumdar SR, Padwal RS. et al. Case management for blood pressure and lipid level control after minor stroke: PREVENTION randomized controlled trial. CMAJ 2014; 186 (08) 577-584
  • 10 Naqvi IA, Strobino K, Cheung YK. et al. Telehealth After Stroke Care pilot randomized trial of home blood pressure telemonitoring in an underserved setting. Stroke 2022; 53 (12) 3538-3547
  • 11 Naqvi IA, Cheung YK, Strobino K. et al. TASC (Telehealth After Stroke Care): a study protocol for a randomized controlled feasibility trial of telehealth-enabled multidisciplinary stroke care in an underserved urban setting. Pilot Feasibility Stud 2022; 8 (01) 81
  • 12 Gardener H, Sacco RL, Rundek T, Battistella V, Cheung YK, Elkind MSV. Race and ethnic disparities in stroke incidence in the Northern Manhattan Study. Stroke 2020; 51 (04) 1064-1069
  • 13 Arcia A, Suero-Tejeda N, Bales ME. et al. Sometimes more is more: iterative participatory design of infographics for engagement of community members with varying levels of health literacy. J Am Med Inform Assoc 2016; 23 (01) 174-183
  • 14 Harris PA, Taylor R, Minor BL. et al; REDCap Consortium. The REDCap consortium: building an international community of software platform partners. J Biomed Inform 2019; 95: 103208
  • 15 Kleindorfer DO, Towfighi A, Chaturvedi S. et al. 2021 guideline for the prevention of stroke in patients with stroke and transient ischemic attack: a guideline from the American Heart Association/American Stroke Association. Stroke 2021; 52 (07) e364-e467
  • 16 Health Measures. Accessed August 12, 2022 at:
  • 17 Kwan YH, Weng SD, Loh DHF. et al. Measurement properties of existing patient-reported outcome measures on medication adherence: systematic review. J Med Internet Res 2020; 22 (10) e19179
  • 18 Cella D, Lai JS, Nowinski CJ. et al. Neuro-QOL: brief measures of health-related quality of life for clinical research in neurology. Neurology 2012; 78 (23) 1860-1867
  • 19 HealthMeasures Scoring Service powered by Assessment Center. An application to score PROMIS,. NIH Toolbox, and Neuro-QoL instruments. 2022 Accessed July 31, 2023 at:
  • 20 Hibbard JH, Stockard J, Mahoney ER, Tusler M. Development of the Patient Activation Measure (PAM): conceptualizing and measuring activation in patients and consumers. Health Serv Res 2004; 39 (4, Pt 1): 1005-1026
  • 21 Carlozzi NE, Goodnight S, Kratz AL. et al. Validation of Neuro-QoL and PROMIS mental health patient reported outcome measures in persons with Huntington disease. J Huntingtons Dis 2019; 8 (04) 467-482
  • 22 Kroenke K. Enhancing the clinical utility of depression screening. CMAJ 2012; 184 (03) 281-282
  • 23 Dorr DA, D'Autremont C, Pizzimenti C. et al. Assessing data adequacy for high blood pressure clinical decision support: a quantitative analysis. Appl Clin Inform 2021; 12 (04) 710-720
  • 24 Nakayama M, Inoue R, Miyata S, Shimizu H. Health information exchange between specialists and general practitioners benefits rural patients. Appl Clin Inform 2021; 12 (03) 564-572
  • 25 Strowd RE, Strauss L, Graham R. et al. Rapid implementation of outpatient teleneurology in rural Appalachia: barriers and disparities. Neurol Clin Pract 2021; 11 (03) 232-241
  • 26 Kummer BR, Lerario MP, Navi BB. et al. Clinical information systems integration in New York City's first mobile stroke unit. Appl Clin Inform 2018; 9 (01) 89-98
  • 27 Reeves MJ, Boden-Albala B, Cadilhac DA. Care transition interventions to improve stroke outcomes: evidence gaps in underserved and minority populations. Stroke 2023; 54 (02) 386-395
  • 28 Olive-Gadea M, Cano D, Rodrigo-Gisbert M. et al. Redefining disability: patient-reported outcome measures after minor stroke and transient ischemic attack. Stroke 2023; 54 (01) 144-150
  • 29 Paolucci S. Epidemiology and treatment of post-stroke depression. Neuropsychiatr Dis Treat 2008; 4 (01) 145-154
  • 30 Hénon H, Durieu I, Guerouaou D, Lebert F, Pasquier F, Leys D. Poststroke dementia: incidence and relationship to prestroke cognitive decline. Neurology 2001; 57 (07) 1216-1222
  • 31 Dorr D, D'Autremont C, Richardson JE. et al. Patient-facing clinical decision support for high blood pressure control: patient survey. JMIR Cardio 2023; 7: e39490
  • 32 Hoban MB, Fedor M, Reeder S, Chernick M. The effect of telemonitoring at home on quality of life and self-care behaviors of patients with heart failure. Home Healthc Nurse 2013; 31 (07) 368-377
  • 33 Machado-Vieira R, Baumann J, Wheeler-Castillo C. et al. The timing of antidepressant effects: a comparison of diverse pharmacological and somatic treatments. Pharmaceuticals (Basel) 2010; 3 (01) 19-41
  • 34 Li Y, Cai X, Harrington C. et al. Racial and ethnic differences in the prevalence of depressive symptoms among U.S. nursing home residents. J Aging Soc Policy 2019; 31 (01) 30-48
  • 35 Adams LB, Baxter SLK, Lightfoot AF. et al. Refining Black men's depression measurement using participatory approaches: a concept mapping study. BMC Public Health 2021; 21 (01) 1194