Washington, D.C.More than three quarters of adults living in the District of Columbia have at least one risk factor for stroke, but those who are poor do not receive the same level of care as their wealthier counterparts. In an effort to address these disparities in stroke prevention, diagnosis and treatment in D.C., the NIH's National Institute of Neurological Disorders and Stroke (NINDS) has awarded Georgetown University Medical Center a $10 million cooperative research grant. Chelsea Kidwell, MD, associate professor of neurology at Georgetown, is the principal investigator for the grant, which will involve physicians and scientists from twenty other institutions, including GUMCs clinical partner, Georgetown University Hospital, owned by MedStar Health.
We know that the type of stroke care people get in the United States depends at least in part on their race and socioeconomic status, said Kidwell, who directs both the Georgetown Stroke Center and the Washington Hospital Center Stroke Center. What better place to attempt to reduce these disparities than in the nations capital, where so many patients are coming from medically underserved communities"
Kidwell will oversee three research projects addressing key areas of disparities in stroke care in Washington, D.C. hospitals:
- Project ASPIRE (Acute Stroke Program of Interventions Addressing Racial and Ethnic Disparities) will investigate whether a multi-level intervention can significantly increase the number of ischemic stroke patients appropriately treated with intravenous tissue plasminogen activator (tPA) (clot-busting medication) in D.C. hospitals. If administered within a certain time window, tPA is highly effective at dissolving the blood clots that cause strokes and improving clinical outcomes, said Kidwell, but it is typically delivered to less than 3 percent of patients. Kidwell wants to study the barriers to utilizing this treatment in District hospitals. Amie Hsia, assistant professor of neurology at Georgetown, is the principal investigator on this project.
- Project PROTECT DC (Preventing Recurrence of Thromboembolic Events through Coordinated Treatment in the District of Columbia) will examine whether patient navigatorscommunity health workers paired with stroke patientscan help patients adhere to at-home regimens aimed at preventing a second stroke. The patient navigator model has worked well in cancer, but has never been tested in stroke, said Kidwell. If we can help these patients increase compliance with their medications and other preventive behaviors, we can have a significant public health impact in preventing recurrent strokes. Alexander Dromerick, professor of medicine at Georgetown, is the principal investigator on this project.
- Project DECIPHER (Differences in the Imaging of Primary Hemorrhage based on Ethnicity or Race) DECIPHER addresses the finding that African Americans (who make up about 60 percent of D.C.s population) are more likely to have chronic brain microbleeds (small regions of asymptomatic bleeding in the brain), which can be a marker for risk of more serious cerebral hemorrhaging. Some MRI studies have shown that African Americans are more likely to have these tiny microbleeds in their brain, even if they have no symptoms, explained Kidwell. We may learn that these microbleeds could be an important marker of brain hemorrhages and possibly predictors of long-term survival. This research will give us new insight into prevention and treatment of intracerebral hemorrhage in this population.
"We are extremely excited about this multi-level, city-wide, acute and secondary stroke intervention program, said Richard T. Benson, MD, PhD, of the NINDS Office of Minority Health and Research. It is one of the first NINDS-funded studies to address stroke disparities using community-based patient management, state of the art imaging, and the identification of novel risk factors."
The researchers expect to begin enrolling patients into each project by the end of 2007. Study sites include Georgetown University Hospital, Howard University Hospital, George Washington University Hospital, Greater Southeast Community Hospital, Washington Hospital Center, Providence Hospital, Sibley Memorial Hospital, National Rehabilitation Hospital, Suburban Hospital, Franklin Square Hospital, Union Memorial Hospital, , Johns Hopkins Bayview Medical Center, and Good Samaritan Hospital. Other collaboratoring investigators are located at Medstar Research Institute, University of Wisconsin, Johns Hopkins University, UCLA and the University of Michigan.
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