Stroke Disparities Program

急性中风是美国第三大死亡原因，也是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2010年健康人倡议的一个主要目标。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。

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.