Use of successful medications to break up blood clots rose from 4% to 14% due to new approach
- Suspected stroke victims now bypass emergency room for CT scanner and nurse stroke experts, who support patient care team
- Community educators went to beauty and barber shops, churches and water distribution centers to deliver stroke-awareness talks
- Approach can be duplicated by other communities to improve treatment
Newswise — CHICAGO ---Thrombolysis, the use of medications to dissolve blood clots, is a valuable treatment for acute ischemic stroke that can reduce post-stroke disability. Unfortunately, its utilization remains low, leading to adverse outcomes, particularly among Black individuals who not only experience strokes more frequently but also suffer from greater disability following a stroke compared to white individuals.
To address this issue and enhance outcomes, Northwestern Medicine and the University of Michigan collaborated with community members and healthcare providers in Flint, Michigan, a predominantly Black city with a significant population living below the poverty line. Over a span of five years, this program focused on improving hospital procedures and community education, aiming to enable suspected stroke victims to bypass the emergency room and directly proceed to a CT scanner for swift and critical treatment, thereby promoting equity.
As a result of the concerted efforts of the investigators, the utilization of thrombolysis increased from 4% in 2010 to 14% in 2020. Flint emerged as a leading community in Michigan and nationwide for the implementation of thrombolysis.
Recognizing the potential of their approach, the investigators established strokeready.com, a website that offers resources and guidance for other communities seeking to replicate their successful efforts.
The findings of this study will be published on July 3 in JAMA Network Open.
It is important to note that Flint, with a majority Black population and over 40% of its residents living below the poverty line, bears the highest poverty rate among U.S. cities with at least 65,000 inhabitants.
Dr. Lesli Skolarus, the lead investigator and corresponding author of the study, emphasized that the positive outcomes achieved in Flint were the result of collaborative efforts among researchers, community members, emergency medical services, and emergency departments, all working together to address the specific needs of the community. Dr. Skolarus, a professor of neurology at Northwestern University Feinberg School of Medicine and a neurologist at Northwestern Medicine, conducted this research during her tenure at the University of Michigan.
‘Team huddles’ with the emergency crew
To ensure the effectiveness of thrombolysis, prompt administration following a stroke is crucial. In light of this, Skolarus and her colleagues provided support to their emergency department partners in establishing a dedicated team that held regular meetings to review emergency room procedures. Through "team huddles" and workshops, the team offered valuable feedback to optimize the processes.
Skolarus explained, "The safety-net emergency department enhanced their procedures in various ways. If a stroke was suspected, they directed patients straight from the ambulance to the CT scanner, bypassing the emergency room. They also established a team of skilled nurses specialized in thrombolysis, who either directly administered the treatment or provided support to others. It was an additional resource of expertise."
Their approach incorporated the principles of implementation science, a relatively new field that focuses on studying methods and strategies to facilitate the adoption of evidence-based practices and research by practitioners and policymakers. Community engagement was also an integral part of their approach, involving collaboration with individuals who were most affected by the health challenge.
The Stroke Ready intervention, a nonrandomized, controlled trial, was conducted in Flint from October 2017 to March 2020, with nearly 6,000 community participants involved.
Skolarus noted, "It appears that the majority of the benefits derived from Stroke Ready can be attributed to the interventions implemented in the emergency department."
Educators head to the beauty and barber shops to teach about stroke
The intervention in the emergency room was only part of the comprehensive approach. Skolarus and her team also collaborated with the community to gain insights into the specific challenges faced by residents in terms of accessing healthcare facilities and recognizing stroke symptoms.
Rev. Sarah Bailey played a pivotal role in leading the community education program. Having previously served as a minister at New Jerusalem Full Gospel Baptists, where both her mother and pastor had experienced strokes, Bailey conducted surveys among church members. The findings revealed a concerning lack of knowledge regarding stroke symptoms, despite a high prevalence of stroke cases within the community.
Bailey explained, "We discovered that African-American individuals were experiencing strokes at a younger age. Instead of occurring in their 70s and 80s, strokes were affecting people in their 50s, 60s, and even as young as 40. This is due to the sedentary lifestyle prevalent in Flint, along with factors such as high blood pressure, obesity, and other precursors associated with living in a disadvantaged community. Being in a food desert, the water crisis, and other health conditions contributed to the occurrence of strokes."
To address this knowledge gap and promote awareness, trained local community educators were deployed to various community spaces such as churches, barber shops, beauty shops, health fairs, senior centers, neighborhood meetings, schools, and water distribution sites. Bailey highlighted, "While people waited in line for their water, we took the opportunity to provide a five-minute lecture on stroke symptoms, or even longer if the line was particularly long."
Overall, a total of 5,970 individuals participated in the stroke preparedness workshops, enabling the dissemination of crucial information and empowering the community to recognize the signs of stroke.
"We made sure to explain everything using language that everyone in the community could understand, drawing on familiar individuals," expressed Bailey.
Jeffrey LaValley, the minister and music director of New Jerusalem church, took an active role in this effort. He composed a song and recorded a video with the choir to educate people about the symptoms of stroke. Having personally experienced two strokes, the first occurring when he was 49 years old, LaValley was initially unaware of the signs of stroke and lacked knowledge about adopting healthy habits to prevent it. However, he has since made significant changes. He eliminated his beloved fried pork chops from his diet, opting to cook vegetables in an air fryer instead. Additionally, he engages in daily walks of one to two miles around the church gym.
"Our message extends beyond stroke awareness. We emphasize the importance of monitoring blood pressure and maintaining a healthy diet," Bailey explained. "Encouraging African-American men to overcome their fear of doctors is a significant accomplishment. Many of them uphold a macho bravado that prevents them from admitting any form of weakness."
Through these efforts, the community not only learned about stroke symptoms but also gained valuable insights into overall health maintenance and the significance of proactive healthcare engagement.
The project was funded by the National Institute on Minority Health and Health Disparities grant U01 MD010579, of the National Institutes of Health.
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