{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,27]],"date-time":"2026-10-27T00:08:02Z","timestamp":1793059682856,"version":"4.5.0"},"reference-count":29,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"5","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Stroke"],"published-print":{"date-parts":[[2019,5]]},"abstract":"<jats:sec>\n            <jats:title>Background and Purpose\u2014<\/jats:title>\n            <jats:p>Recognition of stroke symptoms and hospital prenotification by emergency medical services (EMS) facilitate rapid stroke treatment; however, one-third of patients with stroke are unrecognized by EMS. To promote stroke recognition and quality measure compliant prehospital stroke care, we deployed a 30-minute online EMS educational module coupled with a performance feedback system in a single Michigan county.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods\u2014<\/jats:title>\n            <jats:p>During a 24-month study period, a registry of consecutive EMS-transported suspected or unrecognized stroke cases was utilized to perform an interrupted time series analysis of the impact of the EMS education and feedback intervention. For each agency, we compared EMS stroke recognition and quality measure compliance rates, as well as emergency department performance and hospital outcomes during 12 preintervention months with performance in the remaining study months.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results\u2014<\/jats:title>\n            <jats:p>\n              A total of 1805 EMS-transported cases met inclusion criteria; 1235 (68.4%) of these had ischemic or hemorrhagic strokes or transient ischemic attacks. There were no trends toward improvement in any outcome before the intervention. After the intervention, the EMS stroke recognition rate increased from 63.8% to 69.5% (\n              <jats:italic>P<\/jats:italic>\n              =0.037). Prenotification increased from 60.9% to 77.3% (\n              <jats:italic>P<\/jats:italic>\n              &lt;0.001). Among patients with ischemic stroke\/transient ischemic attack, there was a trend toward higher rates of tPA (tissue-type plasminogen activator) delivery (13.9%\u201317.7%;\n              <jats:italic>P<\/jats:italic>\n              =0.096) and a significant increase in tPA delivery within 45 minutes (5.7%\u20138.9%;\n              <jats:italic>P<\/jats:italic>\n              =0.042) after intervention. However, improvements in EMS recognition were limited to the first 3 months following intervention.\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions\u2014<\/jats:title>\n            <jats:p>A brief educational intervention was associated with improved EMS stroke recognition, hospital prenotification, and faster tPA delivery. Gains were primarily observed immediately following education and were not sustained through provision of performance feedback to paramedics.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/strokeaha.118.023885","type":"journal-article","created":{"date-parts":[[2019,3,28]],"date-time":"2019-03-28T09:03:04Z","timestamp":1553763784000},"page":"1193-1200","update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":43,"title":["Brief Educational Intervention Improves Emergency Medical Services Stroke Recognition"],"prefix":"10.1161","volume":"50","author":[{"given":"J. Adam","family":"Oostema","sequence":"first","affiliation":[{"name":"From the Department of Emergency Medicine, Spectrum Health and Michigan State University College of Human Medicine, Grand Rapids (J.A.O.)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Todd","family":"Chassee","sequence":"additional","affiliation":[{"name":"Kent County Emergency Medical Services, Grand Rapids, MI (T.C.)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"William","family":"Baer","sequence":"additional","affiliation":[{"name":"Department of Research and Innovation, Mercy Health St. Mary\u2019s Hospital, Grand Rapids, MI (W.B.)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Allison","family":"Edberg","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Metro Health Hospital, Wyoming, MI (A.E.)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mathew J.","family":"Reeves","sequence":"additional","affiliation":[{"name":"Department of Epidemiology and Biostatistics, Michigan State University College of Human Medicine, East Lansing, MI (M.J.R.)."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_4_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(14)60584-5"},{"key":"e_1_3_4_3_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2016.13647"},{"key":"e_1_3_4_4_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIR.0000000000000485"},{"key":"e_1_3_4_5_2","doi-asserted-by":"publisher","DOI":"10.1161\/STR.0000000000000158"},{"key":"e_1_3_4_6_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCOUTCOMES.113.000089"},{"key":"e_1_3_4_7_2","doi-asserted-by":"publisher","DOI":"10.1161\/JAHA.112.002345"},{"key":"e_1_3_4_8_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jstrokecerebrovasdis.2016.02.011"},{"key":"e_1_3_4_9_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jstrokecerebrovasdis.2014.06.030"},{"key":"e_1_3_4_10_2","doi-asserted-by":"publisher","DOI":"10.1080\/10903120802099526"},{"key":"e_1_3_4_11_2","doi-asserted-by":"publisher","DOI":"10.3389\/fneur.2017.00466"},{"key":"e_1_3_4_12_2","doi-asserted-by":"publisher","DOI":"10.1080\/10903127.2016.1182602"},{"key":"e_1_3_4_13_2","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.115.008650"},{"key":"e_1_3_4_14_2","doi-asserted-by":"publisher","DOI":"10.1080\/10903127.2018.1447620"},{"key":"e_1_3_4_15_2","doi-asserted-by":"publisher","DOI":"10.3109\/10903120903572335"},{"key":"e_1_3_4_16_2","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.114.005679"},{"key":"e_1_3_4_17_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0196-0644(99)70299-4"},{"key":"e_1_3_4_18_2","doi-asserted-by":"publisher","DOI":"10.1186\/1751-0473-3-17"},{"key":"e_1_3_4_19_2","doi-asserted-by":"publisher","DOI":"10.2202\/1557-4679.1195"},{"key":"e_1_3_4_20_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamaneurol.2013.293"},{"key":"e_1_3_4_21_2","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.110.605857"},{"key":"e_1_3_4_22_2","doi-asserted-by":"publisher","DOI":"10.1080\/10903127.2017.1294222"},{"key":"e_1_3_4_23_2","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.117.017386"},{"key":"e_1_3_4_24_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamaneurol.2014.1528"},{"key":"e_1_3_4_25_2","doi-asserted-by":"publisher","DOI":"10.1186\/1748-5908-7-17"},{"key":"e_1_3_4_26_2","doi-asserted-by":"publisher","DOI":"10.1080\/10903127.2017.1413466"},{"key":"e_1_3_4_27_2","doi-asserted-by":"publisher","DOI":"10.1017\/S0266462303000576"},{"key":"e_1_3_4_28_2","doi-asserted-by":"crossref","first-page":"47","DOI":"10.1136\/qhc.12.1.47","article-title":"Research designs for studies evaluating the effectiveness of change and improvement strategies.","volume":"12","author":"Eccles M","year":"2003","unstructured":"Eccles, M, Grimshaw, J, Campbell, M, Ramsay, C. Research designs for studies evaluating the effectiveness of change and improvement strategies. Qual Saf Health Care. 2003;12:47\u201352.","journal-title":"Qual Saf Health Care"},{"key":"e_1_3_4_29_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jstrokecerebrovasdis.2016.04.021"},{"key":"e_1_3_4_30_2","doi-asserted-by":"publisher","DOI":"10.1080\/10903127.2017.1405131"}],"updated-by":[{"DOI":"10.1161\/str.0000000000000208","type":"correction","label":"Correction","source":"publisher","updated":{"date-parts":[[2019,9,23]],"date-time":"2019-09-23T00:00:00Z","timestamp":1569196800000}}],"container-title":["Stroke"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ahajournals.org\/doi\/full\/10.1161\/STROKEAHA.118.023885","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,5,13]],"date-time":"2024-05-13T14:51:08Z","timestamp":1715611868000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ahajournals.org\/doi\/10.1161\/STROKEAHA.118.023885"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,5]]},"references-count":29,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2019,5]]}},"alternative-id":["10.1161\/STROKEAHA.118.023885"],"URL":"https:\/\/doi.org\/10.1161\/strokeaha.118.023885","relation":{"correction":[{"id-type":"doi","id":"10.1161\/STR.0000000000000208","asserted-by":"object"}]},"ISSN":["0039-2499","1524-4628"],"issn-type":[{"value":"0039-2499","type":"print"},{"value":"1524-4628","type":"electronic"}],"subject":[],"published":{"date-parts":[[2019,5]]},"assertion":[{"value":"2018-10-15","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2019-02-07","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2019-03-28","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}