Acute Stroke Program of Interventions: Racial & Ethnic Disparities(ASPIRE)

中风是美国第三大死亡原因和成人残疾的主要原因， 对得不到充分服务的人口造成不成比例的影响，反映在较高的发病率和死亡率上 在这些群体中。一些研究表明，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），是FDA唯一批准的急性缺血性卒中治疗方法。 需要努力阐明导致急性卒中治疗中种族/民族差异的因素 并制定计划来克服这些障碍。该干预项目的具体目标是：A） 确定以前未被认识到的社会文化和环境障碍， B）调查是否实施多层次干预 旨在解决这些障碍的药物可以显著增加缺血性卒中患者的数量， 用静脉内组织纤溶酶原激活剂（IV tPA）适当治疗;和C）执行程序 评估干预中使用的方法，以确定哪些努力最有效。的 研究人员将协助哥伦比亚特区的6家医院建立一个卒中治疗小组， 倡导实施教育计划和标准化程序，以改善急性 中风护理五家巴尔的摩医院将作为对照组。本项目的基本设计特点 包括：1）重点关注得不到充分服务人口，以查明社区特有的障碍， 中风教育材料，以提高健康素养和减少延误寻求治疗; 2） 实施干预措施，解决公众在教育、态度和结构方面的障碍， 3）为每家医院指派一名专职研究协调员， 也将成为一名世界冠军。试验的长期目标是确定系统性， 在服务不足地区改善急性卒中治疗的可重复、有效的方法 可以在更广阔的竞技场中实现。唯一能决定性地影响服务不足者的结果的方法 中风患者是阐明有关获得治疗的复杂问题，和哥伦比亚特区 是进行这些调查的理想城市。

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.