Partnering with an Urban Safety Net Hospital to Deliver Stroke Preparedness in the Emergency Department

摘要 急性中风的治疗是时间敏感的。组织纤溶酶原激活剂在3至4.5小时内注射 从中风症状中解放出来的时间。计算机断层扫描灌注等成像技术 可能会延长治疗窗口。然而，快速到达医院对于中风的资格仍然至关重要。 可以减少后续残疾的治疗。非洲裔美国人比白人更有可能推迟 中风症状出现后到达医院。先前的干预教育了非裔美国人团体或 整个社区都在谈论中风和拨打911的重要性。一对一卒中教育干预 在数量上很少。该项目旨在教育非洲裔美国人，当他们向 一家城市安全网医院的急诊科。这种方法使我们能够访问难以访问的 覆盖中风高危人群，提供针对特定人群的一对一中风干预 非洲裔美国人延迟到达医院的原因。通过与每个参与者直接接触，我们希望 改善对拨打911的态度，这有助于提前到达医院，并符合中风治疗的条件 这最终可以减轻中风对人群的负担。我们的具体目标是(I)使一群人适应- 以一对一的形式向出现在急诊室的患者提供基于中风的教育干预， 通过对患者和提供者的定性访谈，(Ii)测试中风干预是否有所改善 拨打911的行为意图，通过对中风和非中风视频片段的反应来衡量。这项研究 符合我的职业目标，即开发、测试和实施行为干预，以减少 中风发病率和治疗的种族差异。为此，我的计划是(I)在实践中获得技能 基于社区的参与性研究的应用，这是一种研究方法，涉及与 社区制定行为干预措施，(Ii)建立随机临床试验设计的技能，作为严格的 行为干预措施的有效性测试涉及参与者的随机化，(3)在以下方面建立专门知识 实施科学方法，这样我就可以将我开发的干预措施转化为临床实践。 在密歇根大学的指导和资源将使我能够完成这些事业 发展目标。在密歇根大学，我是一群有成就的健康公平中风患者之一 有获得美国国立卫生研究院R级资助并做出重大贡献的研究人员 为减轻中风给社会带来的负担。该大学促进部门间的研究合作， 使我能够得到神经科内外知名研究人员的指导。 课程由各自领域的专家教授，提供了丰富的学习环境。其他资源包括 提供研讨会和讲习班以促进向独立调查员过渡的组织。这个 提出的项目和职业发展计划将加快我的研究独立性。未来的R01研究 将涉及扩大和实施拟议的干预措施。

Abstract Acute stroke treatments are time-sensitive. Tissue plasminogen activator is administered 3 to 4.5 hours from the time of freedom from stroke symptoms. Imaging technologies such as computed tomography perfusion might extend the treatment window. However, rapid hospital arrival remains critical to eligibility for stroke treatment that can reduce subsequent disability. African Americans are more likely than Whites to delay in hospital arrival after stroke symptom onset. Prior interventions have educated African American groups or the entire community about stroke and the importance of calling 911. One-on-one stroke education interventions are few in number. This project aims to educate African Americans individually when they present to the emergency department (ED) of an urban safety net hospital. This approach allows us to access a hard-to reach population at high risk for stroke to deliver a one-on-one stroke intervention that addresses specific reasons African Americans delay in hospital arrival. By directly engaging with each participant, we expect to improve attitudes towards calling 911, which promotes early hospital arrival, and eligibility for stroke treatments which can ultimately reduce the burden of stroke on the population. Our specific aims are (i) to adapt a group- based stroke education intervention to be delivered in a one-on-one format to patients presenting to the ED, through qualitative interviews of patients and providers, (ii) to test whether the stroke intervention improves behavioral intent to call 911, as measured by response to stroke and non-stroke video vignettes. This research is in line with my career goal of developing, testing, and implementing behavioral interventions that will reduce racial disparities in stroke incidence and treatment. To this end, my plan is to (i) obtain skills in the practical application of community based participatory research, a research approach which involves partnering with the community to develop behavioral interventions, (ii) build skills in randomized clinical trial design, as rigorous efficacy testing of behavioral interventions involves randomization of participants, (iii) building expertise in implementation science methods, so that I can translate the interventions that I develop into clinical practice. The mentorship and resources at the University of Michigan will enable me to accomplish these career development goals. At the University of Michigan, I am among a group of accomplished health equity stroke researchers who have a track record of obtaining R-level NIH funding and are making significant contributions to reducing the burden of stroke on society. The university facilitates interdepartmental research collaborations, enabling me to be mentored by established researchers within and outside of the department of neurology. Courses are taught by experts in their field, providing a rich learning environment. Additional resources include organizations that offer seminars and workshops to facilitate the transition to an independent investigator. The proposed project and career development plan will expedite my research independence. Future R01 studies will involve scaling up and implementation of the proposed intervention.