A Community Based Participatory Trial to Increase Stroke Treatment
Lesli Elizabeth Skolarus, PI; University of Michigan Medical School Neurology Department; Daniel James Kruger
Post-stroke disability represents a significant public health problem. Currently, there are over 7 million stroke survivors in the US, most of whom have persistent disability. Despite the fact that acute stroke treatments dramatically reduce post-stroke disability and are cost saving, they are markedly underutilized. There is no region in the US where acute stroke treatments are more underutilized than in Flint, Michigan. Flint is an urban, underserved city with nearly 100,000 residents of whom about 60% are African American. One of the main reasons for acute stroke treatment underutilization is pre-hospital delay-patients arrive to the hospital too late to receive the treatment. For the past 6 years, the Community Health Partnership-composed of academic partners from the University of Michigan and community partners, Bridges into the Future-has worked to increase acute stroke treatment rates in Flint by decreasing pre-hospital delay. The Community Health Partnership completed several community needs assessments, and from those designed and tested a peer-led, health behavior theory-based intervention in African American churches. The intervention focused on increasing stroke preparedness (i.e., increasing community member’s recognition of stroke warning signs and the importance of calling 911 immediately for stroke).
This community intervention, Stroke Ready, successfully increased stroke preparedness. The current application represents the larger scale adaption and testing of the Stroke Ready intervention to increase the Flint community’s acute stroke treatment rates. Stroke Ready, now expanded to a multi-level intervention, aims to increase acute stroke treatment through both community stroke preparedness and Emergency Department readiness. The Stroke Ready community intervention will adapt and expand the Stroke Ready pilot intervention consisting of interactive workshops and a stroke music video to newly include community-wide education activities such as social media and mass print media. We will also collaborate with a Flint safety-net hospital, where the majority of stroke patients are African American that is in great need of improved acute stroke care, to optimize treatment pathways. The primary outcome of the project will be change in acute stroke treatments, which will directly benefit the entire community by reducing post-stroke disability. Sustainability will be achieved in Flint by training of peer-leaders, wide dissemination of Stroke Ready materials, ease of administering the intervention, hospital improvements and continued commitment and engagement of the Community Advisory Board. The products of this application include a strategy to improve acute stroke treatments in safety-net hospitals and the easy to deliver Stroke Ready community intervention to allow for sustainability and dissemination.
If acute stroke treatments are given soon after the start of a stroke, they can reduce the chance that stroke survivors are left with disability. Yet few stroke patients, particularly African Americans, receive these treatments. In this project, community and academic researchers will work together to increase the number of patients who receive acute stroke treatments in the predominately African American community of Flint, Michigan.
Funding Source: National Institute on Minority Health and Health Disparities
Funding Period: 09/26/2016-05/31/2022
National Institute on Minority Health and Health Disparities
Daniel James Kruger
09/26/2016 - 05/31/2022