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.
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