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Association of the Stroke Ready Community-Based Participatory Research Intervention With Incidence of Acute Stroke Thrombolysis in Flint, Michigan

IMPORTANCE: Acute stroke treatment rates in the US lag behind those in other high-income nations. OBJECTIVE: To assess whether a hospital emergency department (ED) and community intervention was associated with an increased proportion of patients with stroke receiving thrombolysis. DESIGN, SETTING,...

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Autores principales: Skolarus, Lesli E., Bailey, Sarah, Corches, Casey L., Sales, Anne E., Lin, Chun Chieh, Bi, Ran, Springer, Mellanie V., Oliver, Alina, Robles, Maria Cielito, Brooks, Tia, Tupper, Michael, Jaggi, Michael, Al-Qasmi, Mohammed, Trevithick, Bruce A., Barber, Kimberly, Majjhoo, Aniel, Zimmerman, Marc A., Meurer, William J., Brown, Devin L., Morgenstern, Lewis B., Burke, James F.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: American Medical Association 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10318478/
https://www.ncbi.nlm.nih.gov/pubmed/37399011
http://dx.doi.org/10.1001/jamanetworkopen.2023.21558
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author Skolarus, Lesli E.
Bailey, Sarah
Corches, Casey L.
Sales, Anne E.
Lin, Chun Chieh
Bi, Ran
Springer, Mellanie V.
Oliver, Alina
Robles, Maria Cielito
Brooks, Tia
Tupper, Michael
Jaggi, Michael
Al-Qasmi, Mohammed
Trevithick, Bruce A.
Barber, Kimberly
Majjhoo, Aniel
Zimmerman, Marc A.
Meurer, William J.
Brown, Devin L.
Morgenstern, Lewis B.
Burke, James F.
author_facet Skolarus, Lesli E.
Bailey, Sarah
Corches, Casey L.
Sales, Anne E.
Lin, Chun Chieh
Bi, Ran
Springer, Mellanie V.
Oliver, Alina
Robles, Maria Cielito
Brooks, Tia
Tupper, Michael
Jaggi, Michael
Al-Qasmi, Mohammed
Trevithick, Bruce A.
Barber, Kimberly
Majjhoo, Aniel
Zimmerman, Marc A.
Meurer, William J.
Brown, Devin L.
Morgenstern, Lewis B.
Burke, James F.
author_sort Skolarus, Lesli E.
collection PubMed
description IMPORTANCE: Acute stroke treatment rates in the US lag behind those in other high-income nations. OBJECTIVE: To assess whether a hospital emergency department (ED) and community intervention was associated with an increased proportion of patients with stroke receiving thrombolysis. DESIGN, SETTING, AND PARTICIPANTS: This nonrandomized controlled trial of the Stroke Ready intervention took place in Flint, Michigan, from October 2017 to March 2020. Participants included adults living in the community. Data analysis was completed from July 2022 to May 2023. INTERVENTION: Stroke Ready combined implementation science and community-based participatory research approaches. Acute stroke care was optimized in a safety-net ED, and then a community-wide, theory-based health behavior intervention, including peer-led workshops, mailers, and social media, was conducted. MAIN OUTCOMES AND MEASURES: The prespecified primary outcome was the proportion of patients hospitalized with ischemic stroke or transient ischemic attack from Flint who received thrombolysis before and after the intervention. The association between thrombolysis and the Stroke Ready combined intervention, including the ED and community components, was estimated using logistic regression models, clustering at the hospital level and adjusting for time and stroke type. In prespecified secondary analyses, the ED and community intervention were explored separately, adjusting for hospital, time, and stroke type. RESULTS: In total, 5970 people received in-person stroke preparedness workshops, corresponding to 9.7% of the adult population in Flint. There were 3327 ischemic stroke and TIA visits (1848 women [55.6%]; 1747 Black individuals [52.5%]; mean [SD] age, 67.8 [14.5] years) among patients from Flint seen in the relevant EDs, including 2305 in the preintervention period from July 2010 to September 2017 and 1022 in the postintervention period from October 2017 to March 2020. The proportion of thrombolysis usage increased from 4% in 2010 to 14% in 2020. The combined Stroke Ready intervention was not associated with thrombolysis use (adjusted odds ratio [OR], 1.13; 95% CI, 0.74-1.70; P = .58). The ED component was associated with an increase in thrombolysis use (adjusted OR, 1.63; 95% CI, 1.04-2.56; P = .03), but the community component was not (adjusted OR, 0.99; 95% CI, 0.96-1.01; P = .30). CONCLUSIONS AND RELEVANCE: This nonrandomized controlled trial found that a multilevel ED and community stroke preparedness intervention was not associated with increased thrombolysis treatments. The ED intervention was associated with increased thrombolysis usage, suggesting that implementation strategies in partnership with safety-net hospitals may increase thrombolysis usage. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT036455900
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spelling pubmed-103184782023-07-05 Association of the Stroke Ready Community-Based Participatory Research Intervention With Incidence of Acute Stroke Thrombolysis in Flint, Michigan Skolarus, Lesli E. Bailey, Sarah Corches, Casey L. Sales, Anne E. Lin, Chun Chieh Bi, Ran Springer, Mellanie V. Oliver, Alina Robles, Maria Cielito Brooks, Tia Tupper, Michael Jaggi, Michael Al-Qasmi, Mohammed Trevithick, Bruce A. Barber, Kimberly Majjhoo, Aniel Zimmerman, Marc A. Meurer, William J. Brown, Devin L. Morgenstern, Lewis B. Burke, James F. JAMA Netw Open Original Investigation IMPORTANCE: Acute stroke treatment rates in the US lag behind those in other high-income nations. OBJECTIVE: To assess whether a hospital emergency department (ED) and community intervention was associated with an increased proportion of patients with stroke receiving thrombolysis. DESIGN, SETTING, AND PARTICIPANTS: This nonrandomized controlled trial of the Stroke Ready intervention took place in Flint, Michigan, from October 2017 to March 2020. Participants included adults living in the community. Data analysis was completed from July 2022 to May 2023. INTERVENTION: Stroke Ready combined implementation science and community-based participatory research approaches. Acute stroke care was optimized in a safety-net ED, and then a community-wide, theory-based health behavior intervention, including peer-led workshops, mailers, and social media, was conducted. MAIN OUTCOMES AND MEASURES: The prespecified primary outcome was the proportion of patients hospitalized with ischemic stroke or transient ischemic attack from Flint who received thrombolysis before and after the intervention. The association between thrombolysis and the Stroke Ready combined intervention, including the ED and community components, was estimated using logistic regression models, clustering at the hospital level and adjusting for time and stroke type. In prespecified secondary analyses, the ED and community intervention were explored separately, adjusting for hospital, time, and stroke type. RESULTS: In total, 5970 people received in-person stroke preparedness workshops, corresponding to 9.7% of the adult population in Flint. There were 3327 ischemic stroke and TIA visits (1848 women [55.6%]; 1747 Black individuals [52.5%]; mean [SD] age, 67.8 [14.5] years) among patients from Flint seen in the relevant EDs, including 2305 in the preintervention period from July 2010 to September 2017 and 1022 in the postintervention period from October 2017 to March 2020. The proportion of thrombolysis usage increased from 4% in 2010 to 14% in 2020. The combined Stroke Ready intervention was not associated with thrombolysis use (adjusted odds ratio [OR], 1.13; 95% CI, 0.74-1.70; P = .58). The ED component was associated with an increase in thrombolysis use (adjusted OR, 1.63; 95% CI, 1.04-2.56; P = .03), but the community component was not (adjusted OR, 0.99; 95% CI, 0.96-1.01; P = .30). CONCLUSIONS AND RELEVANCE: This nonrandomized controlled trial found that a multilevel ED and community stroke preparedness intervention was not associated with increased thrombolysis treatments. The ED intervention was associated with increased thrombolysis usage, suggesting that implementation strategies in partnership with safety-net hospitals may increase thrombolysis usage. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT036455900 American Medical Association 2023-07-03 /pmc/articles/PMC10318478/ /pubmed/37399011 http://dx.doi.org/10.1001/jamanetworkopen.2023.21558 Text en Copyright 2023 Skolarus LE et al. JAMA Network Open. https://creativecommons.org/licenses/by/4.0/This is an open access article distributed under the terms of the CC-BY License.
spellingShingle Original Investigation
Skolarus, Lesli E.
Bailey, Sarah
Corches, Casey L.
Sales, Anne E.
Lin, Chun Chieh
Bi, Ran
Springer, Mellanie V.
Oliver, Alina
Robles, Maria Cielito
Brooks, Tia
Tupper, Michael
Jaggi, Michael
Al-Qasmi, Mohammed
Trevithick, Bruce A.
Barber, Kimberly
Majjhoo, Aniel
Zimmerman, Marc A.
Meurer, William J.
Brown, Devin L.
Morgenstern, Lewis B.
Burke, James F.
Association of the Stroke Ready Community-Based Participatory Research Intervention With Incidence of Acute Stroke Thrombolysis in Flint, Michigan
title Association of the Stroke Ready Community-Based Participatory Research Intervention With Incidence of Acute Stroke Thrombolysis in Flint, Michigan
title_full Association of the Stroke Ready Community-Based Participatory Research Intervention With Incidence of Acute Stroke Thrombolysis in Flint, Michigan
title_fullStr Association of the Stroke Ready Community-Based Participatory Research Intervention With Incidence of Acute Stroke Thrombolysis in Flint, Michigan
title_full_unstemmed Association of the Stroke Ready Community-Based Participatory Research Intervention With Incidence of Acute Stroke Thrombolysis in Flint, Michigan
title_short Association of the Stroke Ready Community-Based Participatory Research Intervention With Incidence of Acute Stroke Thrombolysis in Flint, Michigan
title_sort association of the stroke ready community-based participatory research intervention with incidence of acute stroke thrombolysis in flint, michigan
topic Original Investigation
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10318478/
https://www.ncbi.nlm.nih.gov/pubmed/37399011
http://dx.doi.org/10.1001/jamanetworkopen.2023.21558
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