Morgenstern Lewis B, Staub Lara, Chan Wenyaw, Wein Theodore H, Bartholomew L Kay, King Mary, Felberg Robert A, Burgin W Scott, Groff Janet, Hickenbottom Susan L, Saldin Kamaldeen, Demchuk Andrew M, Kalra Anjali, Dhingra Anupma, Grotta James C
Stroke Program, Department of Neurology, University of Texas Medical School, Houston 77030, USA.
Stroke. 2002 Jan;33(1):160-6. doi: 10.1161/hs0102.101990.
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.
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.
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).
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.
仅有一小部分急性卒中患者接受了获批的急性卒中治疗。我们开展了一项社区及专业行为干预项目，以提高接受获批急性卒中治疗的卒中患者比例。
本研究采用准实验设计。在基线期及教育干预期间，对干预社区和对照社区进行比较。这些社区位于得克萨斯州东部的5个非城市县。多层次干预措施针对医院和社区医生开展，同时改变社区居民的卒中识别技能、结果预期和社会规范。主要目标是将干预社区中接受静脉注射重组组织型纤溶酶原激活剂（rTPA）治疗的患者比例从所有脑血管事件的1%提高到6%。
我们前瞻性评估了1733例患者，并确认了1189例脑血管事件。干预社区中所有脑血管事件患者接受静脉rTPA治疗的比例从1.38%增至5.75%（P=0.01），而对照社区的这一比例从0.49%增至0.55%（P=1.00）。在缺血性卒中患者中，干预社区的治疗比例从2.21%增至8.65%（P=0.02）。对照组无明显变化（0.71%至0.86%，P=1.00）。在符合静脉rTPA治疗条件的患者中，干预社区的治疗比例从14%增至52%（P=0.003），对照社区则无变化（7%至6%，P=1.00）。
积极的多层次卒中教育干预项目可提高急性卒中治疗的可及性。这可能对在全国范围内减少残疾具有重要的公共卫生意义。
