A standardized, multicomponent intervention does not increase alteplase use significantly in the intention-to-treat population in community hospitals, according to research published in the December 21, 2012, online Lancet Neurology. The intervention appears to provide a significant but modest increase in alteplase use in the target population.
Phillip A. Scott, MD, Associate Professor of Emergency Medicine at the University of Michigan in Ann Arbor, and colleagues studied the barrier assessment–interactive educational intervention in a cluster-randomized controlled trial involving 12 matched pairs of acute-care community hospitals. Within the pairs, the hospitals were randomly assigned to the intervention or control group. During the course of a year, hospitals in the intervention group performed qualitative and quantitative assessments of barriers to alteplase use and developed ways to address their findings. The primary outcome was change in alteplase use in patients with ischemic stroke between the pre- and postintervention periods.