Improving delivery of acute stroke therapy: The TLL Temple Foundation Stroke Project.
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.
Morgenstern
Lewis B
LB
Stroke Program, Department of Neurology, University of Texas Medical School, Houston 77030, USA. Lewis.Morgenstern@uth.tmc.edu
Staub
Lara
L
Chan
Wenyaw
W
Wein
Theodore H
TH
Bartholomew
L Kay
LK
King
Mary
M
Felberg
Robert A
RA
Burgin
W Scott
WS
Groff
Janet
J
Hickenbottom
Susan L
SL
Saldin
Kamaldeen
K
Demchuk
Andrew M
AM
Kalra
Anjali
A
Dhingra
Anupma
A
Grotta
James C
JC
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
D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator