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

与城市安全网医院合作，在急诊科提供中风预防服务

• 批准号: 10038411
• 负责人: Mellanie V Springer
• 金额: $ 24.34万
• 依托单位: UNIVERSITY OF MICHIGAN AT ANN ARBOR
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-07-15 至 2025-07-14
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10038411
• 关键词: 911 call; Accident and Emergency department; Address; African American; Alteplase; Attitude; Behavior Therapy; Behavioral; Child; Chronic Disease; Church; Cities; Clinic; Clinical Trials Design; Collaborations; Communities; Development Plans; Education; Educational Intervention; Educational workshop; Eligibility Determination; Emergency Department patient; Emergency Nursing; Emergency department visit; Feedback; Freedom; Funding; Future; Goals; Health system; Hospitals; Hour; Imaging technology; Individual; Intervention; Interview; Intravenous; Measures; Medical; Medical center; Mentors; Mentorship; Methods; Michigan; Neurology; Participant; Patients; Perfusion; Phase; Population; Provider; Race; Randomized; Randomized Clinical Trials; Randomized Controlled Trials; Readiness; Research; Research Personnel; Resources; Societies; Stroke; Structure; Testing; Time; Translating; United States National Institutes of Health; Universities; X-Ray Computed Tomography; acute stroke; base; career; career development; clinical practice; community based participatory research; community partnership; comparison intervention; disability; educational atmosphere; efficacy testing; experience; health equity; healthy lifestyle; high risk; implementation science; improved; innovation; member; multiple chronic conditions; novel; post intervention; post stroke; practical application; prevent; primary outcome; racial difference; racial disparity; randomized controlled design; response; safety net; scale up; secondary outcome; skills; stroke education; stroke incidence; stroke intervention; stroke risk; stroke symptom; stroke therapy; success; successful intervention; therapy design; vascular risk factor

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.

摘要 急性中风的治疗具有时效性。组织型纤溶酶原激活剂在施用后3至4.5小时， 中风症状消失的时间。成像技术，如计算机断层扫描灌注 可以延长治疗时间然而，快速到达医院对于卒中的合格性仍然至关重要 可以减少后续残疾的治疗。非裔美国人比白人更有可能推迟 中风症状出现后到达医院。先前的干预措施教育了非洲裔美国人群体或 向整个社区宣传中风和拨打911的重要性。一对一的中风教育干预 数量很少。这个项目的目的是教育非洲裔美国人个别时，他们提出的 城市安全网医院急诊科（艾德）。这种方法使我们能够访问一个难以访问的 接触中风高危人群，提供一对一的中风干预， 非裔美国人推迟到医院的原因。通过与每个参与者直接接触，我们希望 改善人们对拨打911的态度，这有助于尽早到达医院，并提高中风治疗的资格 这可以最终减轻中风对人群的负担。我们的具体目标是（一）调整一组- 以一对一的形式向到艾德就诊的患者提供基于卒中的教育干预， 通过对患者和提供者的定性访谈，（ii）测试中风干预是否有所改善 呼叫911的行为意图，如通过对中风和非中风视频插图的响应所测量的。本研究 这符合我的职业目标，即开发、测试和实施行为干预， 中风发病率和治疗方面的种族差异。为此，我的计划是（i）获得实际技能 应用以社区为基础的参与性研究，这是一种与社区合作的研究方法。 社区开发行为干预措施，（ii）建立随机临床试验设计的技能，严格 行为干预的有效性测试涉及参与者的随机化，（iii）建立 实施科学方法，这样我就可以将我开发的干预措施转化为临床实践。 密歇根大学的指导和资源将使我能够完成这些职业生涯 发展目标在密歇根大学，我是一群成功的健康公平中风患者之一。 有获得R级NIH资助的记录并做出重大贡献的研究人员 减轻中风对社会的负担。该大学促进跨部门的研究合作， 使我能够得到神经科内外的知名研究人员的指导。 课程由各自领域的专家授课，提供丰富的学习环境。其他资源包括 提供研讨会和讲习班以促进向独立调查员过渡的组织。的 建议的项目和职业发展计划将加快我的研究独立性。未来R 01研究 将涉及扩大和实施拟议的干预措施。