Statewide dissemination of a school-based public stroke education intervention

 描述(申请人提供)：在美国，只有7%的缺血性中风事件由于延迟到达医院而接受血栓溶解(t-PA)治疗，最常见的原因是未能识别中风症状并立即拨打911。如果将目前所有接受组织型纤溶酶原激活剂(t-PA)治疗的缺血性中风患者的比例从7%增加到10%，每年为纳税人节省的成本将超过4500万美元。此外，据估计，如果紧急医疗系统的反应时间和医院反应时间得到优化，旨在教育患者在中风发生时立即寻求治疗的干预措施可能会将溶栓率提高到57%。该项目的目标是传播一种新颖的、以证据为基础的中风准备(识别中风症状并立即拨打911的能力)行为干预，以增加中风救护车的使用，并确定背景影响，包括影响采用、实施、忠诚度和维护的障碍和促进者。该计划在纽约州(NYS)卫生部卒中中心指定计划的赞助下传播到47个NYS指定的中风中心，以便在当地的集水区学校实施。我们将使用效力-实施混合类型3设计，该设计将由实施研究综合框架(CFIR)提供信息。中风中心将作为中心，在当地学校传播和实施我们的干预措施。我们的干预措施，我们已经命名为Hip Hop Stroke，是一个新颖的以学校为基础的多媒体项目，面向4到5年级的学生，它使用儿童中介健康沟通的框架，让孩子们对中风识字，然后赋予这些中风识字学生必要的工具，成功地向他们的父母和祖父母传达可操作的中风知识(识别中风症状和拨打911的紧迫性)。最近完成的一项由美国国立卫生研究院资助的研究证实了嘻哈中风的有效性，我们的干预措施已被主要的中风预防指南文章引用。嘻哈中风在纽约中风社区中广为人知，在纽约学校中表现出很高的接受度，最重要的是，帮助中风中心履行其年度监管社区中风教育任务。

 DESCRIPTION (provided by applicant): Only 7% of ischemic stroke events in the US receive thrombolysis (t-PA) therapy due to delayed hospital arrival, most often related to the failure to recognize stroke symptoms and to call 911 immediately. If the current 7% rate of all ischemic stroke patients receiving tissue plasminogen activator (t-PA) is increased to only 10%, the realized annual cost savings to taxpayers would be more than $45m. Moreover, it has been estimated that interventions designed to educate patients to seek immediate treatment when a stroke occurs may increase thrombolysis rates to 57%, if emergency medical system response times and in-hospital response times are optimized. The goals of this project are to disseminate a novel, evidence-based stroke preparedness (ability to recognize stroke symptoms and call 911 immediately) behavioral intervention to increase ambulance use for stroke, and to identify contextual influences, including barriers and facilitators that affect adoption, implementation, fidelity and maintenance. The program is being disseminated under the auspices of the New York State (NYS) Department of Health Stroke Center designation program to 47 NYS designated stroke centers for implementation in their local catchment area schools. We will use a Hybrid Effectiveness-Implementation Type 3 design that will be informed by the Consolidated Framework for Implementation Research (CFIR). Stroke Centers will serve as hubs for disseminating and implementing our intervention in their local schools. Our intervention, which we have named Hip Hop Stroke, is a novel school- based, multimedia program targeting 4th through 5th graders that uses a framework of Child-Mediated Health Communication to make children "stroke literate" and then empower these stroke literate students with the tools required to successfully communicate actionable stroke knowledge (recognition of stroke symptoms and the urgency of calling 911) to their parents and grandparents at home. The effectiveness of Hip Hop Stroke has been established in a recently completed NIH funded study, and our intervention has been cited in major stroke prevention guideline articles. Hip Hop Stroke is well known within the NYS stroke community, has shown high acceptability among NYS schools and, most importantly, helps Stroke Centers fulfill their annual regulatory community stroke education mandates.