- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT01864928
Rapid Evaluation for Stroke Outcomes Using Lytics in Vascular Event (RESOLVE) Registry and Implementation Quality Improvement Study (RESOLVE)
Reperfusion in Acute Stroke - Creating the Clinical Decision-Making Tool (RESOLVE)
Despite abundant evident supporting the use of acute reperfusion therapy in the setting of acute ischemic stroke (AIS), adoption of this practice in routine clinical care is poor. We hypothesize that a significant barrier is the difficulty in weighing the benefits and risks of rt-PA treatment in the care of an individual patient, a problem compounded by the time urgency of decision-making and clinical fears that weigh risks of treatment more heavily than benefits.
The goal of this Quality Improvement (QI) study is to leverage an IT solution that we have developed, ePRISM, that executes multivariable risk models with patient-specific data so that a personalized estimate of an individual's outcomes (both risks and benefits) with and without rt-PA, can be generated so support safer, more effective clinical care. Through an earlier project, we will have programmed ePRISM with the best available risk-stratification models and developed a clinically useful format for presenting the data to support clinical decision-making in AIS.
Through QI, we propose to identify the optimal mechanism for integrating the tool within the routine flow of patient care in preparation for more definitive studies, or dissemination strategies, to improve the treatment of patients with AIS.
Study Overview
Status
Conditions
Detailed Description
Specific Aim 1: Implement ePRISM and the RESOLVE Decision Aid (DA) at 2 sites (Saint Luke's Hospital in Kansas City and Saint Luke's North) for Emergency Department (ED) access and decision support.
1. Procedures and Evaluation
- Map process flow and define the optimal points of care for both the informed consent and decision aid.
- Pre-implementation registry or data retrieval of patient/family satisfaction with information during consent process pre-PRISM, as well as time from presentation to treatment.
- Implementation of ePRISM software and the RESOLVE DA.
- Monitor proportion of patients in whom the RESOLVE DA is used.
- Post-implementation registry or data retrieval of patient/family satisfaction and knowledge, as well as time from presentation to treatment.
- Interviews of providers on confidence in making treatment decisions.
- Monitor patient outcomes through 90 day follow up phone call as per the standard of care.
Specific Aim 2: Implement ePRISM and the RESOLVE DA onsite at the the Barnes Jewish Hospital Emergency Department. After optimizing the integration of ePRISM and the RESOLVE DA at Saint Luke's Hospital and Saint Luke's North, we will evaluate strategies for implementation at Barnes Jewish Hospital's Emergency Department Telestroke Program.
Study Type
Enrollment (Actual)
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Sampling Method
Study Population
Description
Inclusion Criteria:
- Acute ischemic stroke
- 18 years of age or older
Exclusion Criteria:
- Active internal bleeding
- History of cerebrovascular accident
- Evidence of intracranial hemorrhage on pretreatment evaluation
- Suspicion of subarachnoid hemorrhage on pretreatment evaluation
- Recent (within 3 months) intracranial or intraspinal surgery, serious head trauma, or previous stroke
- History of intracranial hemorrhage
- Uncontrolled hypertension at time of treatment
- Seizure at the onset of stroke
- Intracranial neoplasm, arteriovenous malformation, or aneurysm
- Known bleeding diathesis
Study Plan
How is the study designed?
Design Details
Cohorts and Interventions
Group / Cohort |
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Stroke population
Adults with ischemic stroke.
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Successful implementation of ePRISM and the RESOLVE DA in 3 ED's and a telestroke program.
Time Frame: 2 years
|
Successful implementation of ePRISM and the RESOLVE DA in 3 ED's and a telestroke program.
Successful implementation is defined as: 1) the activation of ePRISM and generation the RESOLVE DA by ePRISM; 2) the staff and clinician's reported value of the new RESOLVE DA for use during the rt-PA decision making process.
|
2 years
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Patient/family satisfaction.
Time Frame: 2 years
|
Patient/family satisfaction with PRISM for Acute Ischemic Stroke (AIS).
|
2 years
|
Knowledge transfer.
Time Frame: 2 years
|
Knowledge transfer of AIS and rt-PA risks and benefits through survey.
|
2 years
|
Collaborators and Investigators
Sponsor
Collaborators
Investigators
- Study Director: Carole Decker, MSN, PhD, Saint Luke's Hospital of Kansas City
Publications and helpful links
Study record dates
Study Major Dates
Study Start
Primary Completion (ACTUAL)
Study Completion (ACTUAL)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (ESTIMATE)
Study Record Updates
Last Update Posted (ACTUAL)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Keywords
Additional Relevant MeSH Terms
Other Study ID Numbers
- ML28677
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
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