Implementation of a Stroke Protocol for Emergency Evaluation and Disposition (HI-SPEED)

项目摘要 美国每年有近80万人经历急性中风，这仍然是世界上最严重的中风。 成人残疾的原因和第五大死亡原因。尽管全国范围内的中风中心激增， 几乎一半的美国人口居住在距离综合中风中心（CSC）60分钟车程以外的地方， 大多数患者最初在初级中风中心（PSC）进行评估。虽然阿替普酶是一种关键治疗方法， 在大多数美国医院提供，先进的诊断和治疗只能在CSC提供。然而，在这方面， 对于需要转移到CSC的患者，PSC“门中门外”（DIDO）评估过程可以 耗时且效率低下，导致无法接受治疗。在我们先前工作的基础上， 减少PSC DIDO时间，该建议，“实施中风协议，紧急评估和 处置（I-SPEED）”旨在（1）实施一种新的、以证据为基础的多组分DIDO干预， 美国多个地区的八个不同的中风护理系统，（2）对其进行双重评估， 减少中位DIDO时间（主要结局）和残疾（次要结局）的有效性， 忠诚度和执行质量。I-SPEED研究将最终确定有效性， 多组分循证DIDO干预的可推广性，并提供以下信息 为高质量的实施和广泛传播而进行的背景调整。这项研究得益于 我们在中风，急诊和院前医学，系统和 质量工程、卫生服务研究和强大的多中心研究合作。调查结果I- SPEED将对全球范围内的医院和中风护理系统产生重大影响。

Project Abstract Nearly 800,000 people in the United States (US) each year experience acute stroke, which remains the leading cause of adult disability and 5th leading cause of death. Despite the proliferation of stroke centers nationwide, almost half of the US population lives beyond a 60-minute drive of a comprehensive stroke center (CSC) and most patients are initially evaluated at a primary stroke center (PSC). While a key treatment, alteplase can be delivered at most US hospitals, advanced diagnostics and treatments are only available at CSCs. However, the PSC “Door-in-Door-Out” (DIDO) evaluation process for patients who need to be transferred to a CSC can be time consuming and inefficient, contributing to inability to receive treatment. Building upon our prior work to reduce PSC DIDO time, this proposal, “Implementation of a Stroke Protocol for Emergency Evaluation and Disposition (I-SPEED)” seeks to (1) Implement a novel, evidence-based, multi-component DIDO intervention in eight diverse stroke systems of care across multiple regions of the US and (2) Conduct a dual evaluation of its effectiveness in reducing median DIDO time (primary outcome) and disability (secondary outcome) and of the fidelity and quality of implementation. The I-SPEED study will definitively establish the effectiveness and generalizability of a multi-component evidence-based DIDO intervention and provide information about contextual adaptations for high-quality implementation and widespread dissemination. This study benefits from our well-established interdisciplinary expertise in stroke, emergency and prehospital medicine, systems and quality engineering, health services research, and strong multicenter research collaborations. Findings from I- SPEED will have substantial implications for a wide range of hospitals and stroke systems of care worldwide.