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Skolarus LE, Lin CC, Bi R, Bailey S, Corches CL, Sales AE, Springer MV, Burke JF. Reduction in Racial Differences in Stroke Thrombolytics in Flint, Michigan. Stroke 2024; 55:e24-e26. [PMID: 38152959 PMCID: PMC10872391 DOI: 10.1161/strokeaha.123.044663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2023]
Affiliation(s)
- Lesli E. Skolarus
- Northwestern University, Davee Department of Neurology, Chicago IL
- University of Michigan, Department of Neurology, Ann Arbor, MI
| | - Chun Chieh Lin
- Ohio State University, Department of Neurology, Columbus, OH
| | - Ran Bi
- Ohio State University, Department of Neurology, Columbus, OH
| | | | | | - Anne E. Sales
- Sinclair School of Nursing and Department of Family and Community Medicine, University of Missouri
- VA Ann Arbor Healthcare System, Ann Arbor, MI
| | | | - James F. Burke
- Ohio State University, Department of Neurology, Columbus, OH
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Skolarus LE, Bailey S, Corches CL, Sales AE, Lin CC, Bi R, Springer MV, Oliver A, Robles MC, Brooks T, Tupper M, Jaggi M, Al-Qasmi M, Trevithick BA, Barber K, Majjhoo A, Zimmerman MA, Meurer WJ, Brown DL, Morgenstern LB, Burke JF. Association of the Stroke Ready Community-Based Participatory Research Intervention With Incidence of Acute Stroke Thrombolysis in Flint, Michigan. JAMA Netw Open 2023; 6:e2321558. [PMID: 37399011 PMCID: PMC10318478 DOI: 10.1001/jamanetworkopen.2023.21558] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 05/17/2023] [Indexed: 07/04/2023] Open
Abstract
Importance Acute stroke treatment rates in the US lag behind those in other high-income nations. Objective To assess whether a hospital emergency department (ED) and community intervention was associated with an increased proportion of patients with stroke receiving thrombolysis. Design, Setting, and Participants This nonrandomized controlled trial of the Stroke Ready intervention took place in Flint, Michigan, from October 2017 to March 2020. Participants included adults living in the community. Data analysis was completed from July 2022 to May 2023. Intervention Stroke Ready combined implementation science and community-based participatory research approaches. Acute stroke care was optimized in a safety-net ED, and then a community-wide, theory-based health behavior intervention, including peer-led workshops, mailers, and social media, was conducted. Main Outcomes and Measures The prespecified primary outcome was the proportion of patients hospitalized with ischemic stroke or transient ischemic attack from Flint who received thrombolysis before and after the intervention. The association between thrombolysis and the Stroke Ready combined intervention, including the ED and community components, was estimated using logistic regression models, clustering at the hospital level and adjusting for time and stroke type. In prespecified secondary analyses, the ED and community intervention were explored separately, adjusting for hospital, time, and stroke type. Results In total, 5970 people received in-person stroke preparedness workshops, corresponding to 9.7% of the adult population in Flint. There were 3327 ischemic stroke and TIA visits (1848 women [55.6%]; 1747 Black individuals [52.5%]; mean [SD] age, 67.8 [14.5] years) among patients from Flint seen in the relevant EDs, including 2305 in the preintervention period from July 2010 to September 2017 and 1022 in the postintervention period from October 2017 to March 2020. The proportion of thrombolysis usage increased from 4% in 2010 to 14% in 2020. The combined Stroke Ready intervention was not associated with thrombolysis use (adjusted odds ratio [OR], 1.13; 95% CI, 0.74-1.70; P = .58). The ED component was associated with an increase in thrombolysis use (adjusted OR, 1.63; 95% CI, 1.04-2.56; P = .03), but the community component was not (adjusted OR, 0.99; 95% CI, 0.96-1.01; P = .30). Conclusions and Relevance This nonrandomized controlled trial found that a multilevel ED and community stroke preparedness intervention was not associated with increased thrombolysis treatments. The ED intervention was associated with increased thrombolysis usage, suggesting that implementation strategies in partnership with safety-net hospitals may increase thrombolysis usage. Trial Registration ClinicalTrials.gov Identifier: NCT036455900.
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Affiliation(s)
- Lesli E. Skolarus
- Davee Department of Neurology, Stroke and Vascular Neurology, Northwestern University, Chicago, Illinois
- Department of Neurology, University of Michigan, Ann Arbor
| | | | | | - Anne E. Sales
- Department of Family and Community Medicine, Sinclair School of Nursing, University of Missouri, Columbia
- VA Ann Arbor Healthcare System, Ann Arbor, Michigan
| | - Chun Chieh Lin
- Department of Neurology, University of Michigan, Ann Arbor
- Department of Neurology, Ohio State University, Columbus
| | - Ran Bi
- Department of Neurology, University of Michigan, Ann Arbor
| | | | | | | | - Tia Brooks
- Department of Neurology, University of Michigan, Ann Arbor
| | - Michael Tupper
- Department of Emergency Medicine, University of Michigan, Ann Arbor
- Department of Emergency Medicine, Hurley Medical Center, Flint, Michigan
| | - Michael Jaggi
- Department of Emergency Medicine, University of Michigan, Ann Arbor
- Department of Emergency Medicine, Hurley Medical Center, Flint, Michigan
| | - Mohammed Al-Qasmi
- Department of Emergency Medicine, Hurley Medical Center, Flint, Michigan
| | | | - Kimberly Barber
- Department of Clinical & Academic Research, Genesys Regional Medical Center, Grand Blanc, Michigan
| | - Aniel Majjhoo
- Department of Neurology, McLaren Flint Hospital, Flint, Michigan
| | | | | | - Devin L. Brown
- Department of Neurology, University of Michigan, Ann Arbor
| | - Lewis B. Morgenstern
- Department of Neurology, University of Michigan, Ann Arbor
- Department of Emergency Medicine, University of Michigan, Ann Arbor
- School of Public Health, University of Michigan, Ann Arbor
| | - James F. Burke
- Department of Neurology, University of Michigan, Ann Arbor
- Department of Neurology, Ohio State University, Columbus
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Robles MC, O'Brien A, Islam N, McBride AC, Corches CL, Mansour M, Bailey S, Thrash-Sall E, Skolarus LE. Exploring Social Determinants of Health in Healthy Aging Among Older Adults: A Qualitative Study. Prog Community Health Partnersh 2023. [DOI: 10.1353/cpr.2023.0011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/21/2023]
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Skolarus LE, Springer MV, Bailey S, Rossman N, Corches CL. Partnering With a Home Health Agency to Implement a Brief Stroke Preparedness Intervention: Stroke Ready-Home Health. J Am Heart Assoc 2022; 11:e027462. [PMID: 36172965 PMCID: PMC9673744 DOI: 10.1161/jaha.122.027462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Skolarus LE, Robles MC, Mansour M, Sudore RL, Reynolds EL, Burke JF, Corches CL, Brown DL. Low Engagement of Advance Care Planning Among Patients Who Had a Stroke or Transient Ischemic Attack. J Am Heart Assoc 2022; 11:e024436. [PMID: 35229620 PMCID: PMC9075305 DOI: 10.1161/jaha.121.024436] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Lesli E Skolarus
- Stroke Program University of Michigan Medical School Ann Arbor MI.,Neurology Health Services Research Program University of Michigan Medical School Ann Arbor MI
| | | | - Maria Mansour
- Stroke Program University of Michigan Medical School Ann Arbor MI
| | - Rebecca L Sudore
- Division of Geriatrics Department of Medicine University of California San Francisco CA.,San Francisco Veterans Affairs Health Care System San Francisco CA
| | - Evan L Reynolds
- Neurology Health Services Research Program University of Michigan Medical School Ann Arbor MI
| | - James F Burke
- Stroke Program University of Michigan Medical School Ann Arbor MI.,Neurology Health Services Research Program University of Michigan Medical School Ann Arbor MI.,Ann Arbor Veterans Affairs Health Care System Ann Arbor MI
| | - Casey L Corches
- Stroke Program University of Michigan Medical School Ann Arbor MI
| | - Devin L Brown
- Stroke Program University of Michigan Medical School Ann Arbor MI
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Skolarus LE, Brown DL, Corches CL, Reynolds E, Bailey S, Mansour M, Robles MC, Rice T, Springer MV, Burke JF, Sudore RL. Extending Advance Care Planning to Black Americans in the Community: A Pilot Study of the PREPARE Program. J Pain Symptom Manage 2021; 62:e4-e9. [PMID: 33647422 PMCID: PMC8435356 DOI: 10.1016/j.jpainsymman.2021.02.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 02/18/2021] [Accepted: 02/23/2021] [Indexed: 10/22/2022]
Abstract
CONTEXT Advance care planning (ACP) is underutilized, especially among Black Americans. Yet, no ACP interventions have been tested at the community level. OBJECTIVES Within an established academic and community partnership, we sought to determine whether ACP is a community-identified need and if so, to conduct a pilot study of an evidence-based ACP program, PREPARE (PrepareForYourCare.org). METHODS We conducted open discussions and in-depth interviews to determine the relevance of ACP to the community. We then conducted a pre- to 3-week postpilot study of a virtual peer facilitated brief session to introduce ACP and encourage participants to engage with PREPARE. We conducted thematic content analysis for qualitative data and used paired t-tests to assess within-participant changes in the validated ACP Engagement Survey measured on a 1-5 scale (5 = greatest engagement). RESULT We conducted two discussion groups with community leaders (n = 12) and key informant interviews (n = 6), including leaders in aging, public health, health care and faith. We concluded that ACP is a community priority. In the pilot study, we enrolled 13 Black Americans; 85% were women and the mean age was 59.7 years (SD 15.1). There was a trend toward increased ACP engagement after the peer facilitated PREPARE (mean 3.2 (SD 0.6) pre vs. 3.5 (SD 0.6) post, paired t-test P = 0.06). All participants found the intervention to be acceptable and were satisfied with it. CONCLUSION Community members identified ACP as important for their community. Peer facilitated PREPARE program is a promising community-based strategy to increase engagement in ACP and may promote health equity.
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Affiliation(s)
- Lesli E Skolarus
- Stroke Program, University of Michigan Medical School, Ann Arbor, Michigan; Neurology Health Services Research Program, University of Michigan Medical School, Ann Arbor, Michigan.
| | - Devin L Brown
- Stroke Program, University of Michigan Medical School, Ann Arbor, Michigan
| | - Casey L Corches
- Stroke Program, University of Michigan Medical School, Ann Arbor, Michigan
| | - Evan Reynolds
- Neurology Health Services Research Program, University of Michigan Medical School, Ann Arbor, Michigan
| | | | - Maria Mansour
- Stroke Program, University of Michigan Medical School, Ann Arbor, Michigan
| | | | - Tia Rice
- Stroke Program, University of Michigan Medical School, Ann Arbor, Michigan
| | - Mellanie V Springer
- Stroke Program, University of Michigan Medical School, Ann Arbor, Michigan; Neurology Health Services Research Program, University of Michigan Medical School, Ann Arbor, Michigan
| | - James F Burke
- Stroke Program, University of Michigan Medical School, Ann Arbor, Michigan; Neurology Health Services Research Program, University of Michigan Medical School, Ann Arbor, Michigan; Ann Arbor Veterans Affairs Health Care System, Ann Arbor, Michigan
| | - Rebecca L Sudore
- Division of Geriatrics, Department of Medicine, University of California, San Francisco, California; San Francisco Veterans Affairs Health Care System, San Francisco, California
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Springer MV, Sales AE, Islam N, McBride AC, Landis-Lewis Z, Tupper M, Corches CL, Robles MC, Skolarus LE. A step toward understanding the mechanism of action of audit and feedback: a qualitative study of implementation strategies. Implement Sci 2021; 16:35. [PMID: 33794952 PMCID: PMC8017642 DOI: 10.1186/s13012-021-01102-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 03/19/2021] [Indexed: 01/05/2023] Open
Abstract
Background Audit and feedback (A&F) is a widely used implementation strategy. Understanding mechanisms of action of A&F increases the likelihood that the strategy will lead to implementation of an evidence-based practice. We therefore sought to understand one hospital’s experience selecting and implementing an A&F intervention, to determine the implementation strategies that were used by staff and to specify the mechanism of action of those implementation strategies using causal pathway models, with the ultimate goal of improving acute stroke treatment practices. Methods We selected an A&F strategy in a hospital, initially based on implementation determinants and staff consideration of their performance on acute stroke treatment measures. After 7 months of A&F, we conducted semi-structured interviews of hospital providers and administrative staff to understand how it contributed to implementing guideline-concordant acute stroke treatment (medication named tissue plasminogen activator). We coded the interviews to identify the implementation strategies that staff used following A&F and to assess their mechanisms of action. Results We identified five implementation strategies that staff used following the feedback intervention. These included (1) creating folders containing the acute stroke treatment protocol for the emergency department, (2) educating providers about the protocol for acute stroke, (3) obtaining computed tomography imaging of stroke patients immediately upon emergency department arrival, (4) increasing access to acute stroke medical treatment in the emergency department, and (5) providing additional staff support for implementation of the protocol in the emergency department. We identified enablement, training, and environmental restructuring as mechanisms of action through which the implementation strategies acted to improve guideline-concordant and timely acute stroke treatment. Conclusions A&F of a hospital’s acute stroke treatment practices generated additional implementation strategies that acted through various mechanisms of action. Future studies should focus on how initial implementation strategies can be amplified through internal mechanisms. Supplementary Information The online version contains supplementary material available at 10.1186/s13012-021-01102-6.
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Affiliation(s)
- Mellanie V Springer
- Stroke Program, University of Michigan Medical School, 1500 E. Medical Center Drive, Ann Arbor, MI, 48109, USA.
| | - Anne E Sales
- Department of Veteran Affairs Center for Clinical Management Research, Ann Arbor, MI, USA.,Department of Learning Health Sciences, University of Michigan, Ann Arbor, MI, USA
| | - Nishat Islam
- School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | | | - Zach Landis-Lewis
- Department of Learning Health Sciences, University of Michigan, Ann Arbor, MI, USA
| | - Michael Tupper
- University of Michigan Medical School, Ann Arbor, MI, USA
| | - Casey L Corches
- Stroke Program, University of Michigan Medical School, 1500 E. Medical Center Drive, Ann Arbor, MI, 48109, USA
| | - Maria Cielito Robles
- Stroke Program, University of Michigan Medical School, 1500 E. Medical Center Drive, Ann Arbor, MI, 48109, USA
| | - Lesli E Skolarus
- Stroke Program, University of Michigan Medical School, 1500 E. Medical Center Drive, Ann Arbor, MI, 48109, USA
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Robles MC, Springer MV, Corches CL, Burke JF, Lin CC, Oliver A, Skolarus LE. Stroke Ready Very Brief Intervention Improves Immediate Postintervention Stroke Preparedness. Circ Cardiovasc Qual Outcomes 2020; 13:e006643. [PMID: 33238728 DOI: 10.1161/circoutcomes.120.006643] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Maria Cielito Robles
- Stroke Program, University of Michigan Medical School (M.C.R., M.V.S., C.L.C., J.F.B., C.C.L., L.E.S.)
| | - Mellanie V Springer
- Stroke Program, University of Michigan Medical School (M.C.R., M.V.S., C.L.C., J.F.B., C.C.L., L.E.S.)
| | - Casey L Corches
- Stroke Program, University of Michigan Medical School (M.C.R., M.V.S., C.L.C., J.F.B., C.C.L., L.E.S.)
| | - James F Burke
- Stroke Program, University of Michigan Medical School (M.C.R., M.V.S., C.L.C., J.F.B., C.C.L., L.E.S.)
| | - Chun Chieh Lin
- Stroke Program, University of Michigan Medical School (M.C.R., M.V.S., C.L.C., J.F.B., C.C.L., L.E.S.)
| | | | - Lesli E Skolarus
- Stroke Program, University of Michigan Medical School (M.C.R., M.V.S., C.L.C., J.F.B., C.C.L., L.E.S.)
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Robles MC, Corches CL, Bradford M, Rice TS, Sukul D, Springer MV, Bailey S, Oliver A, Skolarus LE. Understanding and Informing Community Emergency Cardiovascular Disease Preparedness during the COVID-19 Pandemic: Stroke Ready. J Stroke Cerebrovasc Dis 2020; 30:105479. [PMID: 33246207 PMCID: PMC7674014 DOI: 10.1016/j.jstrokecerebrovasdis.2020.105479] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Revised: 11/10/2020] [Accepted: 11/14/2020] [Indexed: 12/22/2022] Open
Abstract
Introduction Acute stroke and acute myocardial infarction (AMI) treatments are time sensitive. Early data revealed a decrease in presentation and an increase in pre-hospital delay for acute stroke and AMI during the coronavirus disease 2019 (COVID-19) pandemic. Thus, we set out to understand community members’ perception of seeking acute stroke and AMI care during the COVID-19 pandemic to inform strategies to increase cardiovascular disease preparedness during the pandemic. Methods Given the urgency of the clinical and public health situation, through a community-based participatory research partnership, we utilized a rapid assessment approach. We developed an interview guide and data collection form guided by the Theory of Planned Behavior (TPB). Semi-structured interviews were recorded and conducted via phone and data was collected on structured collection forms and real time transcription. Direct content analysis was conducted guided by the TPB model and responses for AMI and stroke were compared. Results We performed 15 semi-structured interviews. Eighty percent of participants were Black Americans; median age was 50; 73% were women. Participants reported concerns about coronavirus transmission in the ambulance and at the hospital, hospital capacity and ability to triage, and quality of care. Change in employment and childcare also impacted participants reported control over seeking emergent cardiovascular care. Based on these findings, our community and academic team co-created online materials to address the community-identified barriers, which has reached over 8,600 users and engaged almost 600 users. Conclusions We found that community members’ attitudes and perceived behavioral control to seek emergent cardiovascular care were impacted by the COVID-19 pandemic. Community-informed, health behavior theory-based public health messaging that address these constructs may decrease prehospital delay.
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Affiliation(s)
- Maria Cielito Robles
- University of Michigan, Department of Neurology, Stroke Program, Ann Arbor, MI, USA
| | - Casey L Corches
- University of Michigan, Department of Neurology, Stroke Program, Ann Arbor, MI, USA
| | - Morgan Bradford
- University of Michigan, Department of Neurology, Stroke Program, Ann Arbor, MI, USA
| | - Tia S Rice
- University of Michigan, Department of Neurology, Stroke Program, Ann Arbor, MI, USA
| | - Devraj Sukul
- University of Michigan, Department of Internal Medicine, Division of Cardiovascular Medicine, Ann Arbor, MI, USA
| | - Mellanie V Springer
- University of Michigan, Department of Neurology, Stroke Program, Ann Arbor, MI, USA
| | | | | | - Lesli E Skolarus
- University of Michigan, Department of Neurology, Stroke Program, Ann Arbor, MI, USA.
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Corches CL, McBride AC, Robles MC, Rehman N, Bailey S, Oliver A, Skolarus LE. Development, Adaptation and Scale-up of a Community-wide, Health Behavior Theory-based Stroke Preparedness Intervention. Am J Health Behav 2020; 44:744-755. [PMID: 33081873 DOI: 10.5993/ajhb.44.6.1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Objective: Acute stroke treatments reduce the likelihood of post-stroke disability, but are vastly underutilized. In this paper, we describe the development, adaptation, and scale-up of the Stroke Ready program - a health behavior theory-based stroke preparedness intervention that addresses underlying behavioral factors that contribute to acute stroke treatment underutilization. Methods: Through a community-based participatory research (CBPR) approach, we conducted needs and determinant assessments, which informed creation and pilot testing of Stroke Ready. Based on these results, we then scaled Stroke Ready to the entire community by greatly expanding the delivery system. Results: The scaled Stroke Ready program is a community-wide stroke preparedness education program consisting of peer-led workshops, print materials, and digital, social, and broadcast media campaigns. Whereas the Stroke Ready pilot workshop was delivered to 101 participants, 5945 participants have received the scaled Stroke Ready peer-led workshop to date. Additionally, we have sent mailers to over 44,000 households and reached approximately 35,000 people through our social media campaign. Conclusion: Strategies including an expanded community advisory board, adaptation of the intervention and community-engaged recruitment facilitated the scale-up of Stroke Ready, which may serve as a model to increase acute stroke treatment rates, particularly in majority African-American communities.
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Affiliation(s)
- Casey L. Corches
- Casey L. Corches, Project Manager, Department of Neurology, University of Michigan Medical School, Ann Arbor, MI, United States;,
| | - A. Camille McBride
- A. Camille McBride, Research Assistant, Department of Neurology, University of Michigan Medical School, Ann Arbor, MI, United States
| | - Maria Cielito Robles
- Maria Cielito Robles, Research Area Specialist, Department of Neurology, University of Michigan Medical School, Ann Arbor, MI, United States
| | - Narmeen Rehman
- Narmeen Rehman, Research Assistant, Department of Neurology, University of Michigan Medical School, Ann Arbor, MI, United States
| | - Sarah Bailey
- Sarah Bailey, Bridges Into the Future, Flint, MI, United States
| | - Alina Oliver
- Alina Oliver, Bethlehem Temple Church, Flint, MI, United States
| | - Lesli E. Skolarus
- Lesli E. Skolarus, Associate Professor, Department of Neurology, University of Michigan Medical School, Ann Arbor, MI, United States
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Springer MV, Corches CL, McCracklin B, Scott M, Robles MC, Skolarus LE. Expanding Stroke Preparedness to Vulnerable Populations: A Music Video for the Deaf Community. J Am Heart Assoc 2020; 9:e018352. [PMID: 33032499 PMCID: PMC7763368 DOI: 10.1161/jaha.120.018352] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Background Acute stroke treatments reduce disability after stroke, but eligibility for these treatments depends on rapid hospital arrival after symptom onset. Stroke preparedness interventions teach stroke symptoms and the importance of calling 911, thereby increasing patient eligibility for stroke treatments. Stroke preparedness interventions for the Deaf community are lacking. We sought to adapt a stroke preparedness music video, which was initially created for the hearing, for the Deaf community. Methods and Results We used a community‐engaged approach, partnering with members of the Deaf community, to adapt the video over 4 months. Adaptation involved assessing the comprehensibility and appropriateness of the video and interpreting the song lyrics into American Sign Language. Conclusions We collaborated with the Deaf community to create a stroke preparedness video for the Deaf. Future research will involve refining the video and testing its efficacy to increase stroke symptom recognition and intent to call 911.
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Affiliation(s)
| | - Casey L Corches
- Stroke Program University of Michigan Medical School Ann Arbor MI
| | | | - Melecia Scott
- Flint Canaan Baptist Church Deaf choir/Deaf Ministry Flint MI
| | | | - Lesli E Skolarus
- Stroke Program University of Michigan Medical School Ann Arbor MI
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Skolarus LE, Sales AE, Zimmerman MA, Corches CL, Landis-Lewis Z, Robles MC, McBride AC, Rehman N, Oliver A, Islam N, Springer MV, O'Brien A, Bailey S, Morgenstern LB, Meurer WJ, Burke JF. Stroke Ready: a multi-level program that combines implementation science and community-based participatory research approaches to increase acute stroke treatment: protocol for a stepped wedge trial. Implement Sci 2019; 14:24. [PMID: 30845958 PMCID: PMC6407173 DOI: 10.1186/s13012-019-0869-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Accepted: 02/07/2019] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Post-stroke disability is common, costly, and projected to increase. Acute stroke treatments can substantially reduce post-stroke disability, but few patients take advantage of these cost-effective treatments. Practical, cost-efficient, and sustainable interventions to address underutilized acute stroke treatments are currently lacking. In this context, we present the Stroke Ready project, a stepped wedge design, multi-level intervention that combines implementation science and community-based participatory research approaches to increase acute stroke treatments in the predominately African American community of Flint, Michigan, USA. METHODS Guided by the Tailored Implementation of Chronic Disease (TICD) framework, we begin with optimization of acute stroke care in emergency departments, with particular attention given to our safety-net hospital partners. Then, we move to a community-wide, multi-faceted, stroke preparedness intervention, with workshops led by peer educators, over 2 years. Measures of engagement of the safety-net hospital and the feasibility and sustainability of the implementation strategy as well as community intervention reach, dose delivered, and satisfaction will be collected. The primary outcome is acute stroke treatment rates, which includes both intravenous tissue plasminogen activator, and endovascular treatment. The co-secondary outcomes are intravenous tissue plasminogen activator treatment rates and the proportion of stroke patients who arrive by ambulance. DISCUSSION If successful, Stroke Ready will increase acute stroke treatment rates through emergency department and community level interventions. The stepped wedge design and process evaluation will provide insight into how Stroke Ready works and where it might work best. By exploring the relative effectiveness of the emergency department optimization and the community intervention, we will inform hospitals and communities as they determine how best to use their resources to optimize acute stroke care. TRIAL REGISTRATION ClinicalTrials.gov Trial Identifier NCT03645590 .
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Affiliation(s)
- Lesli E Skolarus
- Stroke Program, University of Michigan Medical School, 1500 E Medical Center Dr, Ann Arbor, MI, 48109, USA. .,School of Public Health, University of Michigan, 1415 Washington Heights, Ann Arbor, MI, 48109, USA.
| | - Anne E Sales
- Department of Learning Health Sciences, University of Michigan, 1111 E. Catherine St, Ann Arbor, MI, 48109, USA.,VA HSR&D Center for Clinical Management Research, VA Ann Arbor Healthcare System, 2215 Fuller Rd, Ann Arbor, MI, 48105, USA
| | - Marc A Zimmerman
- School of Public Health, University of Michigan, 1415 Washington Heights, Ann Arbor, MI, 48109, USA
| | - Casey L Corches
- Stroke Program, University of Michigan Medical School, 1500 E Medical Center Dr, Ann Arbor, MI, 48109, USA
| | - Zach Landis-Lewis
- Department of Learning Health Sciences, University of Michigan, 1111 E. Catherine St, Ann Arbor, MI, 48109, USA
| | - Maria Cielito Robles
- Stroke Program, University of Michigan Medical School, 1500 E Medical Center Dr, Ann Arbor, MI, 48109, USA
| | - A Camille McBride
- Stroke Program, University of Michigan Medical School, 1500 E Medical Center Dr, Ann Arbor, MI, 48109, USA.,School of Public Health, University of Michigan, 1415 Washington Heights, Ann Arbor, MI, 48109, USA
| | - Narmeen Rehman
- Stroke Program, University of Michigan Medical School, 1500 E Medical Center Dr, Ann Arbor, MI, 48109, USA.,School of Public Health, University of Michigan, 1415 Washington Heights, Ann Arbor, MI, 48109, USA
| | - Alina Oliver
- Bethlehem Temple Church, 3401 M L King Ave, Flint, MI, 48505, USA
| | - Nishat Islam
- Stroke Program, University of Michigan Medical School, 1500 E Medical Center Dr, Ann Arbor, MI, 48109, USA.,School of Public Health, University of Michigan, 1415 Washington Heights, Ann Arbor, MI, 48109, USA
| | - Mellanie V Springer
- Stroke Program, University of Michigan Medical School, 1500 E Medical Center Dr, Ann Arbor, MI, 48109, USA
| | - Alison O'Brien
- Stroke Program, University of Michigan Medical School, 1500 E Medical Center Dr, Ann Arbor, MI, 48109, USA.,School of Public Health, University of Michigan, 1415 Washington Heights, Ann Arbor, MI, 48109, USA
| | | | - Lewis B Morgenstern
- Stroke Program, University of Michigan Medical School, 1500 E Medical Center Dr, Ann Arbor, MI, 48109, USA.,School of Public Health, University of Michigan, 1415 Washington Heights, Ann Arbor, MI, 48109, USA
| | - William J Meurer
- Stroke Program, University of Michigan Medical School, 1500 E Medical Center Dr, Ann Arbor, MI, 48109, USA.,Emergency Department, University of Michigan Medical School, 1500 E Medical Center Dr, Ann Arbor, MI, 48109, USA
| | - James F Burke
- Stroke Program, University of Michigan Medical School, 1500 E Medical Center Dr, Ann Arbor, MI, 48109, USA.,Department of Neurology, VA Ann Arbor Healthcare System, Ann Arbor, MI, 48105, USA
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