Improving Delivery of Acute Stroke Therapy

Abstract

Background and Purpose — 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.