A Community-Engaged Stroke Preparedness Intervention in Chicago

Shyam Prabhakaran, Christopher T Richards, Soyang Kwon, Erin Wymore, Sarah Song, Amy Eisenstein, Jen Brown, Namratha R Kandula, Maryann Mason, Heather Beckstrom, Knitasha V Washington, Neelum T Aggarwal, Shyam Prabhakaran, Christopher T Richards, Soyang Kwon, Erin Wymore, Sarah Song, Amy Eisenstein, Jen Brown, Namratha R Kandula, Maryann Mason, Heather Beckstrom, Knitasha V Washington, Neelum T Aggarwal

Abstract

Background We evaluated a community-engaged stroke preparedness intervention that aimed to increase early hospital arrival and emergency medical services (EMS) utilization among patients with stroke in the South Side of Chicago, Illinois. Methods and Results We compared change in early hospital arrival (<3 hours from symptom onset) and EMS utilization before and after our intervention among patients with confirmed ischemic stroke at an intervention hospital on the South Side of Chicago with concurrent data from 6 hospitals in nonintervention communities on the North Side of Chicago and 17 hospitals in St Louis, Missouri. We assessed EMS utilization for suspected stroke secondarily, using geospatial information systems analysis of Chicago ambulance transports before and after our intervention. Among 21 497 patients with confirmed ischemic stroke across all sites, early arrival rates at the intervention hospital increased by 0.5% per month (95% CI, -0.2% to 1.2%) after intervention compared with the preintervention period but were not different from North Side Chicago hospitals (difference of -0.3% per month [95% CI, -0.12% to 0.06%]) or St Louis hospitals (difference of 0.7% per month [95% CI, -0.1% to 1.4%]). EMS utilization at the intervention hospital decreased by 0.8% per month (95% CI, -1.7% to 0.2%) but was not different from North Side Chicago hospitals (difference of 0.004% per month [95% CI, -1.1% to 1.1%]) or St Louis hospitals (difference of -0.7% per month [95% CI, -1.7% to 0.3%]). EMS utilization for suspected stroke increased in the areas surrounding the intervention hospital (odds ratio [OR], 1.4; 95% CI, 1.2-1.6) and in the South Side (OR, 1.2; 95% CI, 1.1-1.3), but not in the North Side (OR, 1.0; 95% CI, 0.9-1.1). Conclusions Following a community stroke preparedness intervention, early hospital arrival and EMS utilization for confirmed ischemic stroke did not increase. However, ambulance transports for suspected stroke increased in the intervention community compared with other regions. Registration URL: https://www.clini​caltr​ials.gov; Unique identifier: NCT02301299.

Keywords: acute stroke; education campaigns; emergency medical services.

Conflict of interest statement

The authors all received support from PCORI during the conduct of the study.

Figures

Figure 1. Pacts received by Chicago zip‐code.
Figure 1. Pacts received by Chicago zip‐code.
CEERIAS indicates Community Engagement for Early Recognition and Immediate Action in Stroke.
Figure 2. Geographic information system analysis of…
Figure 2. Geographic information system analysis of effect of intervention on secondary outcomes in Chicago before and after intervention; statistical hot and cold spots are defined as areas where there is
A, Overall EMS utilization; B, EMS utilization for suspected stroke (purple circles indicate geocoded regions where cold spots became hot spots after the intervention). CEERIAS indicates Community Engagement for Early Recognition and Immediate Action in Stroke.

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Source: PubMed

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