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Implementation Science
Published in: Implementation Science 1/2019

Open Access 01-12-2019 | Stroke | Study protocol

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

Authors: Lesli E. Skolarus, Anne E. Sales, Marc A. Zimmerman, Casey L. Corches, Zach Landis-Lewis, Maria Cielito Robles, A. Camille McBride, Narmeen Rehman, Alina Oliver, Nishat Islam, Mellanie V. Springer, Alison O’Brien, Sarah Bailey, Lewis B. Morgenstern, William J. Meurer, James F. Burke

Published in: Implementation Science | Issue 1/2019

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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.

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Appendix
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Metadata
Title
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
Authors
Lesli E. Skolarus
Anne E. Sales
Marc A. Zimmerman
Casey L. Corches
Zach Landis-Lewis
Maria Cielito Robles
A. Camille McBride
Narmeen Rehman
Alina Oliver
Nishat Islam
Mellanie V. Springer
Alison O’Brien
Sarah Bailey
Lewis B. Morgenstern
William J. Meurer
James F. Burke
Publication date
01-12-2019
Publisher
BioMed Central
Keyword
Stroke
Published in
Implementation Science / Issue 1/2019
Electronic ISSN: 1748-5908
DOI
https://doi.org/10.1186/s13012-019-0869-3

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