Rapid Evaluation for Stroke Outcomes Using Lytics in Vascular Event (RESOLVE) Registry and Implementation Quality Improvement Study (RESOLVE)
|ClinicalTrials.gov Identifier: NCT01864928|
Recruitment Status : Completed
First Posted : May 30, 2013
Last Update Posted : June 21, 2017
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.
|Condition or disease|
|Acute Ischemic Stroke|
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 :||Observational [Patient Registry]|
|Actual Enrollment :||192 participants|
|Target Follow-Up Duration:||90 Days|
|Official Title:||Reperfusion in Acute Stroke - Creating the Clinical Decision-Making Tool (RESOLVE)|
|Study Start Date :||July 2013|
|Actual Primary Completion Date :||December 31, 2016|
|Actual Study Completion Date :||December 31, 2016|
Adults with ischemic stroke.
- 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.
- Patient/family satisfaction. [ Time Frame: 2 years ]Patient/family satisfaction with PRISM for Acute Ischemic Stroke (AIS).
- Knowledge transfer. [ Time Frame: 2 years ]Knowledge transfer of AIS and rt-PA risks and benefits through survey.
Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT01864928
|Principal Investigator:||John A Spertus, MD, MPH||Saint Luke's Hospital of Kansas City|
|Study Director:||Carole Decker, MSN, PhD||Saint Luke's Hospital of Kansas City|