From the Division of Social Epidemiology, Global Institute for Public Health (B.B.-A.), Department of Neurology, Langone Medical Center (B.B.-A.), and Department of Epidemiology, College of Dentistry (B.B.-A.), New York University, New York; Departments of Kinesiology and Medicine, University of Wisconsin, Madison (D.F.E.); Department of Neurology and Georgetown Stroke Center, Georgetown University Medical Center, Washington, DC (S.S.C., A.W.H., C.S.K.); Department of Biostatistics (J.J.W.), and Departments of Epidemiology and Neurology Emergency Medicine and Neurosurgery (L.B.M.), University of Michigan, Ann Arbor; Medstar Health Research Institute, Hyattsville, MD (S.F.); Johns Hopkins Urban Health Institute, Baltimore, MD (M.C.G.); Stroke Center, Medstar Washington Hospital Center, DC (A.W.H.); and Departments of Neurology and Medical Imaging, University of Arizona College of Medicine, Tucson (C.S.K.).
Stroke. 2014 Jul;45(7):2047-52. doi: 10.1161/STROKEAHA.113.003502. Epub 2014 May 15.
Acute stroke education has focused on stroke symptom recognition. Lack of education about stroke preparedness and appropriate actions may prevent people from seeking immediate care. Few interventions have rigorously evaluated preparedness strategies in multiethnic community settings.
The Acute Stroke Program of Interventions Addressing Racial and Ethnic Disparities (ASPIRE) project is a multilevel program using a community-engaged approach to stroke preparedness targeted to underserved black communities in the District of Columbia. This intervention aimed to decrease acute stroke presentation times and increase intravenous tissue-type plasminogen activator utilization for acute ischemic stroke.
Phase 1 included (1) enhancement of focus of emergency medical services on acute stroke; (2) hospital collaborations to implement and enrich acute stroke protocols and transition District of Columbia hospitals toward primary stroke center certification; and (3) preintervention acute stroke patient data collection in all 7 acute care District of Columbia hospitals. A community advisory committee, focus groups, and surveys identified perceptions of barriers to emergency stroke care. Phase 2 included a pilot intervention and subsequent citywide intervention rollout. A total of 531 community interventions were conducted, reaching >10,256 participants; 3289 intervention evaluations were performed, and 19,000 preparedness bracelets and 14,000 stroke warning magnets were distributed. Phase 3 included an evaluation of emergency medical services and hospital processes for acute stroke care and a year-long postintervention acute stroke data collection period to assess changes in intravenous tissue-type plasminogen utilization.
We report the methods, feasibility, and preintervention data collection efforts of the ASPIRE intervention.
http://www.clinicaltrials.gov. Unique identifier: NCT00724555.
急性脑卒中教育一直侧重于脑卒中症状识别。缺乏关于脑卒中预备和适当行动的教育可能会导致人们无法及时寻求治疗。少数干预措施已经在多民族社区环境中严格评估了预备策略。
急性脑卒中项目中的干预措施（ASPIRE）项目是一个多层次的项目，采用社区参与的方法，针对哥伦比亚特区服务不足的黑人群体进行脑卒中预备。该干预措施旨在减少急性脑卒中的就诊时间，并增加急性缺血性脑卒中患者使用静脉组织型纤溶酶原激活剂的比例。
第一阶段包括（1）增强急诊医疗服务对急性脑卒中的关注；（2）医院合作实施和丰富急性脑卒中治疗方案，并将哥伦比亚特区的医院向初级脑卒中中心认证推进；（3）在所有 7 家急性护理哥伦比亚特区医院收集急性脑卒中患者的预干预数据。社区咨询委员会、焦点小组和调查确定了对紧急脑卒中护理的障碍看法。第二阶段包括一个试点干预措施和随后的全市范围的干预措施推出。共进行了 531 次社区干预措施，覆盖超过 10256 名参与者；完成了 3289 次干预评估，并分发了 19000 个预备手镯和 14000 个脑卒中警告磁铁。第三阶段包括评估急诊医疗服务和医院急性脑卒中治疗流程，以及为期一年的干预后急性脑卒中数据收集期，以评估静脉组织型纤溶酶原激活剂使用的变化。
我们报告了 ASPIRE 干预措施的方法、可行性和预干预数据收集工作。
