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

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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.