Only 1 to 3 percent of stroke patients in community settings are receiving tPA therapy seven years after FDA approval. Data from academic stroke teams, stroke patient arrival times and thrombolytic use in myocardial infarction suggest substantially higher treatment rates are possible.The development and implementation of educational interventions to motivate physicians and other healthcare providers, along with health care organizations, to learn the principles of acute stroke care has been declared a high-priority objective of the NINDS. Limited prior work found a combination of community and professional education increased thrombolytic use in stroke from a pre-intervention rate of 2.2% to a post-intervention rate of 11.3%, with the data suggesting the professional education component was the critical element in increasing use. The INcreasing Stroke Treatment through Interactive behavioral Change Tactics, The INSTINCT trial, is a multi-center, randomized, controlled study designed to evaluate a standardized, system-based, barrier assessment and interactive educational intervention (BA-IEI) in increasing appropriate tPA use in stroke. The intervention targets emergency departments, is based on adult education and behavior change theory and is designed for replication in community health initiatives. It incorporates local stroke champion development, hospital-specific barrier evaluation, mixed CME targeting identified barriers, performance feedback, protocol development, and academic detailing. The primary endpoint will be the increase in appropriate use of tPA in stroke with evaluations of change in emergency physician knowledge on tPA use. The Primary Specific Aims of this Study are: 1. To test whether a barrier assessment - interactive educational intervention, realistic in scope and effort, is effective in increasing appropriate thrombolytic use in stroke. 2. To assess whether a BA-IEI enhances emergency physician knowledge, beliefs and attitudes regarding the use of tPA in acute stroke.

Agency
National Institute of Health (NIH)
Institute
National Institute of Neurological Disorders and Stroke (NINDS)
Type
Research Project (R01)
Project #
1R01NS050372-01A1
Application #
6985244
Study Section
Health Services Organization and Delivery Study Section (HSOD)
Program Officer
Radziszewska, Barbara S
Project Start
2005-08-01
Project End
2010-04-30
Budget Start
2005-08-01
Budget End
2006-04-30
Support Year
1
Fiscal Year
2005
Total Cost
$661,559
Indirect Cost
Name
University of Michigan Ann Arbor
Department
Emergency Medicine
Type
Schools of Medicine
DUNS #
073133571
City
Ann Arbor
State
MI
Country
United States
Zip Code
48109
Adelman, Eric E; Scott, Phillip A; Skolarus, Lesli E et al. (2016) Protocol Deviations before and after Treatment with Intravenous Tissue Plasminogen Activator in Community Hospitals. J Stroke Cerebrovasc Dis 25:67-73
Sauser, Kori; Burke, James F; Levine, Deborah A et al. (2014) Time to brain imaging in acute stroke is improving: secondary analysis of the INSTINCT trial. Stroke 45:287-9
Weston, Victoria C; Meurer, William J; Frederiksen, Shirley M et al. (2014) Prevention of emergency physician migratory contamination in a cluster randomized trial to increase tissue plasminogen activator use in stroke (the INSTINCT trial). Am J Emerg Med 32:1460-3
Scott, Phillip A; Meurer, William J; Frederiksen, Shirley M et al. (2013) A multilevel intervention to increase community hospital use of alteplase for acute stroke (INSTINCT): a cluster-randomised controlled trial. Lancet Neurol 12:139-48
Xu, Zhenzhen; Kalbfleisch, John D (2013) Repeated randomization and matching in multi-arm trials. Biometrics 69:949-59
Meurer, William J; Kwok, Heemun; Skolarus, Lesli E et al. (2013) Does preexisting antiplatelet treatment influence postthrombolysis intracranial hemorrhage in community-treated ischemic stroke patients? An observational study. Acad Emerg Med 20:146-54
Burke, James F; Sussman, Jeremy B; Morgenstern, Lewis B et al. (2013) Time to stroke magnetic resonance imaging. J Stroke Cerebrovasc Dis 22:784-91
Meurer, William J; Sozener, Cemal B; Xu, Zhenzhen et al. (2013) The impact of emergency physician turnover on planning for prospective clinical trials. West J Emerg Med 14:16-22
Majersik, Jennifer J; Meurer, William J; Frederiksen, Shirley A et al. (2012) Observational study of telephone consults by stroke experts supporting community tissue plasminogen activator delivery. Acad Emerg Med 19:E1027-34
Skolarus, Lesli E; Scott, Phillip A; Burke, James F et al. (2012) Antihypertensive treatment prolongs tissue plasminogen activator door-to-treatment time: secondary analysis of the INSTINCT trial. Stroke 43:3392-4

Showing the most recent 10 out of 21 publications