Statewide dissemination of a school-based public stroke education intervention

 描述（由申请人提供）：在美国，只有7%的缺血性中风事件因延迟到达医院而接受溶栓（t-PA）治疗，这通常与未能识别中风症状并立即拨打911有关。如果目前接受组织纤溶酶原激活剂（t-PA）治疗的缺血性中风患者的比例从7%增加到10%，纳税人每年节省的费用将超过4500万美元。此外，据估计，如果紧急医疗系统响应时间和院内响应时间得到优化，旨在教育患者在发生卒中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的、基于证据的卒中准备（识别卒中症状并立即拨打911的能力）行为干预，以增加卒中救护车的使用，并确定环境影响，包括影响采用、实施、忠诚和维护的障碍和促进因素。在纽约州（NYS）卫生部卒中中心指定计划的主持下，该计划正在向47个纽约州指定的卒中中心传播，以便在其当地的集水区学校实施。我们将使用一种混合的可靠性-实施类型3设计，该设计将由实施研究综合框架（CFIR）提供信息。中风中心将作为在当地学校传播和实施我们干预措施的中心。我们的干预，我们命名为嘻哈中风，是一个新颖的学校为基础，针对4 - 5年级学生的多媒体程序，使用儿童中介健康沟通框架，使儿童“了解中风”，然后为这些了解中风的学生提供成功沟通可操作中风知识所需的工具（识别中风症状和拨打911的紧急性）向家中的父母和祖父母提供信息。嘻哈中风的有效性已在最近完成的NIH资助的研究中得到证实，我们的干预措施已在主要的中风预防指南文章中引用。嘻哈中风是众所周知的纽约州中风社区，已显示出高接受纽约州的学校，最重要的是，帮助中风中心履行其年度监管社区中风教育的任务。

 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.