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Lewis B. Morgenstern, MD; L. Kay Bartholomew, EdD; James C. Grotta, MD; Lara Staub, MS; Mary King, BS; Wenyaw Chan, PhD

Arch Intern Med. 2003;163:2198-2202.

Background  The ultimate test of an educational intervention is the sustainability of the effect after the intervention ceases.

Methods  The TLL Temple Foundation Stroke Project was a quasi-experimental study aimed at increasing Food and Drug Administration–approved acute stroke therapy in a nonurban community in east Texas. During the intensive community and professional intervention (phase 2), significantly more patients with acute stroke received intravenous tissue plasminogen activator (tPA) compared with the preintervention period (phase 1). In the comparison community, no change was noted. We present the results of tPA treatment in the 6 months after the intervention ended (phase 3).

Results  Two hundred thirty-eight patients had a validated stroke during phase 3. Among patients who experienced an ischemic stroke, 11.2% in the intervention group received intravenous tPA compared with 2.2% in phase 1 (P = .007). In the comparison group, 1.4% received intravenous tPA in phase 3 compared with 0.7% in phase 1 (P>.99). Among eligible candidates for treatment, 69.2% were treated in phase 3 in the intervention community compared with 13.6% in phase 1 (P = .002). In the comparison group, 20.0% were treated in phase 3 compared with 6.7% in phase 1 (P = .45). There was 1 protocol violation among the 9 patients treated in the intervention community in phase 3.

Conclusions  There was a sustained benefit of the intervention in increasing tPA treatments in the intervention community even after cessation of the educational effort. Treatments in the control community remained few through all 3 phases of the study. A carefully planned multilevel intervention can improve community stroke treatments even in a nonurban community.

From the Stroke Program, Department of Neurology, The University of Texas Medical School at Houston (Drs Morgenstern and Grotta and Mss Staub and King); the Stroke Program, University of Michigan Health System, and the Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor (Dr Morgenstern); and the Departments of Health Behavior and Health Education (Dr Bartholomew) and Biometry (Dr Chan), The University of Texas School of Public Health at Houston. The authors have no relevant financial interest in this article.

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