Stroke Disparities Program

描述（摘要）：急性中风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落在服务不足的人群身上。缩小健康差距已成为一项重大的公共卫生挑战，也是2010年健康人倡议的一项主要目标。本提案的规划目标是确定导致种族差异的生物学和社会经济因素，并开发创新方法来减少缺血性和出血性中风的这些差异。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，旨在调查在一个主要服务不足的社区实施多层次干预是否能显著增加适当接受静脉注射组织纤溶酶原激活剂（IV tPA）治疗的缺血性卒中患者的数量。主要结局指标将是所有适当接受静脉注射tPA治疗的缺血性脑卒中患者的百分比。项目2，通过哥伦比亚特区的协调治疗预防血栓栓塞事件的复发（PROTECT DC）是一项随机II期临床试验，对哥伦比亚特区两家服务不足的医院的缺血性卒中患者进行PROTECT DC干预（以医院为基础的积极二级预防结合导航病例管理）和标准管理。主要目的是：1)完善PROTECT DC设计，为i期试验做准备；2)评估干预对4个用药目标的影响，这些目标是通过二级危险因素控制的客观测量标准化来定义的。项目3，基于种族或种族的原发性出血影像学差异（DECIPHER）是一项纵向、磁共振成像、前瞻性、观察性、队列研究，旨在评估原发性脑出血患者慢性脑微出血的患病率和意义。三个核心将支持项目：A)管理；B)参与者招募、保留、干预和结果；C)生物统计/数据管理。该应用程序不仅旨在定义导致中风治疗和结果中种族/民族差异的因素，而且还展示了专门设计用于减少这些差异的程序的有效性。

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.