title: Improving delivery of acute stroke therapy: The TLL Temple Foundation Stroke Project.
abstract: OBJECTIVE
  Only a small minority of acute stroke patients receive approved acute stroke therapy. We performed a community and professional behavioral intervention project to increase the proportion of stroke patients treated with approved acute stroke therapy.
  
  
  METHODS
  This study used a quasi-experimental design. Intervention and comparison communities were compared at baseline and during educational intervention. The communities were based in 5 nonurban East Texas counties. The multilevel intervention worked with hospitals and community physicians while changing the stroke identification skills, outcome expectations, and social norms of community residents. The primary goal was to increase the proportion of patients treated with intravenous recombinant tissue plasminogen activator (rTPA) from 1% to 6% of all cerebrovascular events in the intervention community.
  
  
  RESULTS
  We prospectively evaluated 1733 patients and validated 1189 cerebrovascular events. Intravenous rTPA treatment increased from 1.38% to 5.75% among all cerebrovascular event patients in the intervention community (P=0.01) compared with a change from 0.49% to 0.55% in the comparison community (P=1.00). Among the ischemic stroke patients, an increase from 2.21% to 8.65% was noted in the intervention community (P=0.02). The comparison group did not appreciably change (0.71% to 0.86%, P=1.00). Of eligible intravenous rTPA candidates, treatment increased in the intervention community from 14% to 52% (P=0.003) and was unchanged in the comparison community (7% to 6%, P=1.00).
  
  
  CONCLUSIONS
  An aggressive, multilevel stroke educational intervention program can increase delivery of acute stroke therapy. This may have important public health implications for reducing disability on a national level.
authors.affiliation: Stroke Program, Department of Neurology, University of Texas Medical School, Houston 77030, USA. Lewis.Morgenstern@uth.tmc.edu
authors.forename: Lewis B
authors.initials: LB
authors.lastname: Morgenstern
authors.forename: Lara
authors.initials: L
authors.lastname: Staub
authors.forename: Wenyaw
authors.initials: W
authors.lastname: Chan
authors.forename: Theodore H
authors.initials: TH
authors.lastname: Wein
authors.forename: L Kay
authors.initials: LK
authors.lastname: Bartholomew
authors.forename: Mary
authors.initials: M
authors.lastname: King
authors.forename: Robert A
authors.initials: RA
authors.lastname: Felberg
authors.forename: W Scott
authors.initials: WS
authors.lastname: Burgin
authors.forename: Janet
authors.initials: J
authors.lastname: Groff
authors.forename: Susan L
authors.initials: SL
authors.lastname: Hickenbottom
authors.forename: Kamaldeen
authors.initials: K
authors.lastname: Saldin
authors.forename: Andrew M
authors.initials: AM
authors.lastname: Demchuk
authors.forename: Anjali
authors.initials: A
authors.lastname: Kalra
authors.forename: Anupma
authors.initials: A
authors.lastname: Dhingra
authors.forename: James C
authors.initials: JC
authors.lastname: Grotta
mesh_terms: D000208:Acute Disease; D000368:Aged; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006801:Humans; D008297:Male; D010043:Outcome and Process Assessment, Health Care; D010353:Patient Education as Topic; D011446:Prospective Studies; D011785:Quality Assurance, Health Care; D020521:Stroke / Q000175:diagnosis / Q000188:drug therapy*; D013781:Texas; D013997:Time Factors; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use
chemical_list: D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator