{"database":"biostudies-literature","file_versions":[],"scores":null,"additional":{"submitter":["Sauser K"],"funding":["NIA NIH HHS","NIDDK NIH HHS","NINDS NIH HHS"],"pagination":["287-9"],"full_dataset_link":["https://www.ebi.ac.uk/biostudies/studies/S-EPMC3901043"],"repository":["biostudies-literature"],"omics_type":["Unknown"],"volume":["45(1)"],"pubmed_abstract":["<h4>Background and purpose</h4>Patients with acute ischemic stroke benefit from rapid evaluation and treatment, and timely brain imaging is a necessary component. We determined the effect of a targeted behavioral intervention on door-to-imaging time (DIT) among patients with ischemic stroke treated with tissue-type plasminogen activator. Second, we examined the variation in DIT accounted for by patient-level and hospital-level factors.<h4>Methods</h4>The Increasing Stroke Treatment through Interventional behavioral Change Tactics (INSTINCT) trial was a cluster-randomized, controlled trial involving 24 Michigan hospitals. The intervention aimed to increase tissue-type plasminogen activator utilization. Detailed chart abstractions collected data for 557 patients with ischemic stroke. We used a series of hierarchical linear mixed-effects models to evaluate the effect of the intervention on DIT (difference-in-differences analysis) and used patient-level and hospital-level explanatory variables to decompose variation in DIT.<h4>Results</h4>DIT improved over time, without a difference between intervention and control hospitals (intervention: 23.7-19.3 minutes, control: 28.9-19.2 minutes; P=0.56). Adjusted DIT was faster in patients who arrived by ambulance (7.2 minutes; 95% confidence interval, 4.1-10.2), had severe strokes (1.0 minute per +5-point National Institutes of Health Stroke Scale; 95% confidence interval, 0.1-2.0), and presented in the postintervention period (4.9 minutes; 95% confidence interval, 2.3-7.4). After accounting for these factors, 13.8% of variation in DIT was attributable to hospital. Neither hospital stroke volume nor stroke center status was associated with DIT.<h4>Conclusions</h4>Performance on DIT improved similarly in intervention and control hospitals, suggesting that nonintervention factors explain the improvement. Hospital-level factors explain a modest proportion of variation in DIT, but further research is needed to identify the hospital-level factors responsible."],"journal":["Stroke"],"pubmed_title":["Time to brain imaging in acute stroke is improving: secondary analysis of the INSTINCT trial."],"pmcid":["PMC3901043"],"funding_grant_id":["P30 DK092926","R01-NS-050372","K23 AG040278","R01 NS050372","P30DK092926"],"pubmed_authors":["Meurer WJ","Burke JF","Levine DA","Sauser K","Scott PA"],"additional_accession":[]},"is_claimable":false,"name":"Time to brain imaging in acute stroke is improving: secondary analysis of the INSTINCT trial.","description":"<h4>Background and purpose</h4>Patients with acute ischemic stroke benefit from rapid evaluation and treatment, and timely brain imaging is a necessary component. We determined the effect of a targeted behavioral intervention on door-to-imaging time (DIT) among patients with ischemic stroke treated with tissue-type plasminogen activator. Second, we examined the variation in DIT accounted for by patient-level and hospital-level factors.<h4>Methods</h4>The Increasing Stroke Treatment through Interventional behavioral Change Tactics (INSTINCT) trial was a cluster-randomized, controlled trial involving 24 Michigan hospitals. The intervention aimed to increase tissue-type plasminogen activator utilization. Detailed chart abstractions collected data for 557 patients with ischemic stroke. We used a series of hierarchical linear mixed-effects models to evaluate the effect of the intervention on DIT (difference-in-differences analysis) and used patient-level and hospital-level explanatory variables to decompose variation in DIT.<h4>Results</h4>DIT improved over time, without a difference between intervention and control hospitals (intervention: 23.7-19.3 minutes, control: 28.9-19.2 minutes; P=0.56). Adjusted DIT was faster in patients who arrived by ambulance (7.2 minutes; 95% confidence interval, 4.1-10.2), had severe strokes (1.0 minute per +5-point National Institutes of Health Stroke Scale; 95% confidence interval, 0.1-2.0), and presented in the postintervention period (4.9 minutes; 95% confidence interval, 2.3-7.4). After accounting for these factors, 13.8% of variation in DIT was attributable to hospital. Neither hospital stroke volume nor stroke center status was associated with DIT.<h4>Conclusions</h4>Performance on DIT improved similarly in intervention and control hospitals, suggesting that nonintervention factors explain the improvement. Hospital-level factors explain a modest proportion of variation in DIT, but further research is needed to identify the hospital-level factors responsible.","dates":{"release":"2014-01-01T00:00:00Z","publication":"2014 Jan","modification":"2025-04-20T02:48:22.054Z","creation":"2019-03-27T01:20:32Z"},"accession":"S-EPMC3901043","cross_references":{"pubmed":["24232449"],"doi":["10.1161/strokeaha.113.003678","10.1161/STROKEAHA.113.003678"]}}