Stroke Disparities Program
中风差异计划
基本信息
- 批准号:7501923
- 负责人:
- 金额:$ 200.19万
- 依托单位:
- 依托单位国家:美国
- 项目类别:
- 财政年份:2007
- 资助国家:美国
- 起止时间:2007-09-30 至 2012-08-31
- 项目状态:已结题
- 来源:
- 关键词:
项目摘要
DESCRIPTION (abstract): Acute stroke is the third leading cause of death and the leading cause of adult disability in the US. A disproportionate amount of morbidity and mortality falls on underserved populations. Reduction of health disparities has become a significant public health challenge and is a major goal of the Healthy People 2010 initiative. The programmatic goal of this proposal is to identify biological and socioeconomic factors contributing to ethnic disparities and to develop innovative approaches to reduce these disparities for ischemic and hemorrhagic stroke. Three research projects are proposed. Project 1, Acute Stroke Program of Interventions addressing Racial and Ethnic disparities (ASPIRE), is an intervention study designed to investigate whether implementation of a multilevel intervention can significantly increase the number of ischemic stroke patients appropriately treated with intravenous tissue plasminogen activator (IV tPA) in a predominantly underserved community. The primary outcome measure will be the percentage of all ischemic stroke patients appropriately treated with IV tPA. Project 2, Preventing Recurrence of Thromboembolic Events through Coordinated Treatment in the District of Columbia (PROTECT DC) is a randomized phase II clinical trial of the PROTECT DC intervention (hospital-based initiation of aggressive secondary prevention combined with navigator case management) vs. standard management in ischemic stroke patients from two underserved hospitals in the District of Columbia. The primary aims are 1) to refine the PROTECT DC design in preparation for a phase INI trial and, 2) to assess the effect of the intervention on 4 medication goals as defined by normalization of objective measures of secondary risk factor control. Project 3, DiffErenCes in the Imaging of Primary Hemorrhage based on Ethnicity or Race (DECIPHER) is a longitudinal, MR imaging, prospective, observational, cohort study designed to evaluate the prevalence and significance by race/ethnicity of chronic cerebral microbleeds in patients with primary intracerebral hemorrhage. Three cores will support the projects: A) Administration B) Participant Recruitment, Retention, Intervention and Outcomes, and C) Biostatistics / Data Management. This application is designed not only to define factors leading to racial/ethnic disparities in stroke treatment and outcomes, but also to demonstrate the efficacy of programs specifically designed to reduce these disparities.
Project 1: Acute Stroke Program of Interventions Addressing Racial and Ethnic Disparities (ASPIRE)
PI: Amie Hsia
DESCRIPTION: Stroke, the third leading cause of death and the leading cause of adult disability in the United States, has a disproportionate impact on underserved populations that is reflected in higher incidence and mortality rates in these groups. Several studies have suggested that blacks are less likely than whites to receive intravenous tissue plasminogen activator (IV tPA), the only FDA-approved acute ischemic stroke therapy. Efforts are needed to elucidate factors contributing to racial/ethnic disparities in access to acute stroke care and to develop programs to overcome these barriers. The specific aims of this intervention project are: A) to identify previously unrecognized sociocultural and environmental barriers to acute stroke treatment in an underserved, urban population; B) to investigate whether implementation of a multilevel intervention designed to address these barriers can significantly increase the number of ischemic stroke patients appropriately treated with intravenous tissue plasminogen activator (IV tPA); and C) to perform program evaluation of the methods used in the intervention to determine which efforts are the most effective. The investigators will assist each of 6 hospitals in the District of Columbia to develop a team of Stroke Champions to implement educational programs and standardized procedures designed to improve acute stroke care. Five Baltimore hospitals will serve as the control group. Essential design features of this project include: 1) a focus on underserved populations to identify community-specific barriers and then tailor existing stroke education materials to increase health literacy and decrease delays in seeking treatment; 2) implementation of interventions to address educational, attitudinal, and structural barriers at the public, paramedic and hospital levels; and 3) assignment of a dedicated research coordinator to each hospital who will also serve as a Stroke Champion. The long term objective of the trial is to identify systematic, reproducible, effective methods for improving the delivery of acute stroke therapies in underserved areas that can be implemented in a broader arena. The only way to definitively affect outcomes for underserved stroke patients is to elucidate the complex issues related to access to treatment, and the District of Columbia is the ideal city in which to perform these investigations.
描述(摘要):急性卒中是美国第三大死亡原因和成人残疾的主要原因。不成比例的发病率和死亡率福尔斯落在得不到充分服务的人口身上。减少健康差距已成为一项重大的公共卫生挑战,也是“健康人2010”倡议的主要目标。该提案的计划目标是确定导致种族差异的生物学和社会经济因素,并开发创新方法以减少缺血性和出血性卒中的这些差异。提出了三个研究项目。项目1,解决种族和民族差异的急性卒中干预计划(ASPIRE),是一项干预研究,旨在调查在服务水平低下的社区中实施多水平干预是否可以显著增加接受静脉组织纤溶酶原激活剂(IV tPA)适当治疗的缺血性卒中患者数量。主要结局指标为所有接受IV tPA适当治疗的缺血性卒中患者的百分比。项目2,哥伦比亚特区通过协调治疗预防血栓栓塞事件复发(CDT DC)是一项在哥伦比亚特区两家服务不足的医院的缺血性卒中患者中进行的CDT DC干预(基于医院的积极二级预防联合导航病例管理)与标准管理的随机II期临床试验。主要目的是:1)为准备INI期试验而完善CRT-DC设计,2)评估干预对次要风险因素控制客观指标标准化所定义的4个药物目标的影响。项目3,基于种族或人种的原发性出血成像差异(DECIPHER)是一项纵向、MR成像、前瞻性、观察性、队列研究,旨在评价原发性脑出血患者中慢性脑微出血的人种/种族患病率和意义。三个核心将支持项目:A)管理B)参与者招募、保留、干预和结局,以及C)生物统计学/数据管理。该应用程序不仅旨在定义导致卒中治疗和结局中种族/民族差异的因素,而且还旨在证明专门设计用于减少这些差异的方案的有效性。
项目1:解决种族和民族差异的急性卒中干预计划(ASPIRE)
PI:Amie Hsia
产品说明:中风是美国第三大死亡原因和成人残疾的主要原因,对服务不足的人群具有不成比例的影响,这反映在这些人群的发病率和死亡率较高。几项研究表明,黑人比白人更不可能接受静脉注射组织纤溶酶原激活剂(IV tPA),这是FDA唯一批准的急性缺血性卒中治疗。需要努力阐明导致急性卒中护理中种族/民族差异的因素,并制定计划以克服这些障碍。该干预项目的具体目标是:A)确定以前未被认识到的在服务不足的城市人群中进行急性中风治疗的社会文化和环境障碍; B)调查实施旨在解决这些障碍的多层次干预是否可以显着增加接受静脉组织纤溶酶原激活剂(IV tPA)适当治疗的缺血性中风患者数量;和C)对干预中使用的方法进行项目评估,以确定哪些努力是最有效的。研究者将协助哥伦比亚特区的6家医院建立卒中冠军团队,以实施旨在改善急性卒中护理的教育计划和标准化程序。五家巴尔的摩医院将作为对照组。该项目的基本设计特征包括:1)关注服务不足的人群,以确定社区特有的障碍,然后定制现有的中风教育材料,以提高健康素养,减少寻求治疗的延误; 2)实施干预措施,以解决公共,护理人员和医院层面的教育,态度和结构性障碍;以及3)为每家医院指派一名专门的研究协调员,他也将担任中风冠军。该试验的长期目标是确定系统的、可重复的、有效的方法,用于改善服务不足地区的急性卒中治疗,这些方法可以在更广泛的竞技场中实施。明确影响服务不足的中风患者结局的唯一方法是阐明与获得治疗相关的复杂问题,而哥伦比亚特区是进行这些调查的理想城市。
项目成果
期刊论文数量(0)
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科研奖励数量(0)
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CHELSEA S KIDWELL其他文献
CHELSEA S KIDWELL的其他文献
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{{ truncateString('CHELSEA S KIDWELL', 18)}}的其他基金
Sub 1: Exercise RCT Targeting African-American Women w Metabolic Syndrome & Hig
子 1:针对患有代谢综合征的非洲裔美国女性的运动随机对照试验
- 批准号:
8795105 - 财政年份:2015
- 资助金额:
$ 200.19万 - 项目类别:
Sub 1: Exercise RCT Targeting African-American Women w Metabolic Syndrome & Hig
子 1:针对患有代谢综合症的非裔美国女性的运动随机对照试验
- 批准号:
8346064 - 财政年份:2012
- 资助金额:
$ 200.19万 - 项目类别:
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