Results Summary

What was the research about?

People having a stroke who go to the emergency room, or ER, early have a better chance of recovery and survival. But some racial and ethnic groups, such as African Americans and Latinos, are more likely to suffer from strokes and less likely to receive prompt care. Many people don’t know they should get to the ER as soon as possible. People may not be sure they are having a stroke. They also may not call 911 for an ambulance, a quick way to get to the ER.

In this study, the research team created a community education program in the South Side of Chicago, where most residents are African American. The program trained people from the community to talk with others about stroke and the importance of getting to the ER early.

To see how well the program worked, the research team compared stroke registry data from before and after the program. Stroke registries track hospital care provided to patients who’ve had a stroke. The team also compared data from the hospital on the South Side of Chicago to hospitals in two communities that didn’t have the program. One community, on the North Side of Chicago, had six hospitals. The other community, in St. Louis, had 14 hospitals.

What were the results?

In the community with the program, among people who’d had a stroke,

  • The number of people who got to the ER early or used an ambulance didn’t differ before and after the program.
  • When looking at specific groups of people, more younger people, men, and African Americans got to the ER early after the program than before the program.

When comparing the community with the program to communities that didn’t have the program, the study found no difference in how often people with stroke got to the ER early or used an ambulance.

The number of people who used an ambulance when they thought they were having a stroke increased after the program started.

Who was in the study?

The program went from December 2015 to November 2016. Of the people in the community where the program took place, 72 percent were African American, 26 percent were Hispanic, 11 percent were white, and 1 percent were Asian. In their analysis, the research team looked at stroke registry data from 21,497 patients. Of these, 29 percent were African American, 63 percent were white, and 5 percent were other races; 3 percent were Hispanic. Also, 52 percent were women, and 35 percent were age 65 or younger.

What did the research team do?

In the program, the research team trained 242 people from local churches, schools, and businesses to be community educators. The educators taught people in the community about

  • Benefits of getting early treatment for stroke
  • Symptoms of stroke
  • Who has strokes
  • Cost of an ambulance

The educators also gave out flyers and pamphlets about strokes to people in the community and at community events.

The research team looked at stroke registry data for the hospitals. The team also looked at ambulance records from the Chicago Fire Department. The team used these records to see how many people with suspected strokes used an ambulance in the community with the program.

What were the limits of the study?

Community educators talked to community members in person only. Results may have differed if educators had reached out to community members in other ways, such as with social media or phone apps.

Future studies could look at a similar program that uses other ways, such as social media and phone apps, to send out health messages.

How can people use the results?

Health educators and communities can use the results when considering ways to help community members get timely care for strokes.

Final Research Report

View this project's final research report.

Peer-Review Summary

Peer review of PCORI-funded research helps make sure the report presents complete, balanced, and useful information about the research. It also assesses how the project addressed PCORI’s Methodology Standards. During peer review, experts read a draft report of the research and provide comments about the report. These experts may include a scientist focused on the research topic, a specialist in research methods, a patient or caregiver, and a healthcare professional. These reviewers cannot have conflicts of interest with the study.

The peer reviewers point out where the draft report may need revision. For example, they may suggest ways to improve descriptions of the conduct of the study or to clarify the connection between results and conclusions. Sometimes, awardees revise their draft reports twice or more to address all of the reviewers’ comments. 

Peer reviewers commented, and the researchers made changes or provided responses. The comments and responses included the following:

  • Reviewers questioned when the researchers dropped one of the two intervention hospitals from the study because of unreliable data. The researchers explained that the second hospital was not removed from analyses until aim 3. They indicated that they had already collected focus group data from patients in that hospital’s catchment area, as well as having trained half of the stroke promoters.
  • Reviewers had questions about how dropping one of the two intervention hospitals from the study affected the statistical analysis. They worried that the study may have been underpowered with around 20 patients per month seen in the intervention hospital. The researchers said because they used interrupted time series for analysis, the primary unit of analysis was time, or months, not hospitals or patients. Therefore, the statistical power of the work depended on time units rather than the number of hospitals or patients in the study. To improve the power of the study, the researchers chose an extended study period, five years.
  • Reviewers asked for greater detail on the locations of comparison hospitals and the populations they serve. It was not clear how hospitals on Chicago’s North Side and in St. Louis, Missouri were similar or different from the Chicago South Side hospitals, especially with regards to their patient populations. The researchers added information to the report about the number of comparison hospitals in both locations and their characteristics, especially comparing stroke patients between the target hospital and comparison hospitals. They also added maps showing the locations of the hospitals in both cities and explaining the geography of Chicago.

Conflict of Interest Disclosures

Project Information

Shyam Prabhakaran, MD, MS
Northwestern University at Chicago
$1,429,850
10.25302/04.2020.AD.131007237
Community Engagement for Early Recognition and Immediate Action in Stroke (CEERIAS)

Key Dates

July 2014
May 2019
2014
2019

Study Registration Information

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Last updated: January 25, 2023