The INcreasing Stroke Treatment through INterventional

behavioral Change Tactics (INSTINCT) trial is a cluster randomized, controlled trial aimed at increasing appropriate tPA use in ischemic stroke by first determining hospital-specific barriers and then providing targeted, professional educational interventions. Barriers were determined using a partial grounded theory method, whereby qualitative data obtained through focus group discussions is coded into themes using a previously-described taxonomy[9]. Qualitative methods are uniquely Inhibitors,research,lifescience,medical suited to develop understanding of complex situations that are difficult to measure quantitatively[10]. The milieu of clinician attitudes, institutional practices, and hospital resources involved in emergency stroke care in the community is a prime example of such a setting for which qualitative methods may provide important insights. Our primary objective was to describe the qualitatively-derived Inhibitors,research,lifescience,medical barriers to clinician compliance with guidelines recommending the use of tPA in appropriate patients as discovered in the barrier assessment phase of INSTINCT. Methods Inhibitors,research,lifescience,medical Ethics Statement The protocol was approved by the University of Michigan Institutional Review Board (IRBMED) and all relevant site IRBs. Written informed consent was obtained Inhibitors,research,lifescience,medical from

all participants in focus groups and interviews. INSTINCT Trial Overview The INSTINCT trial is evaluating the hypothesis that initial barrier assessment focused on tPA use in stroke followed by targeted, interactive educational interventions will increase appropriate tPA use[11]. These educational initiatives were planned to be specifically

tailored to the needs of each site. A schematic of the INSTINCT trial is depicted in Figure ​Figure1.1. After site selection and randomization, an initial period of barrier assessment was conducted which involved focus groups, interviews, and surveys. The results of the barrier assessments were Florfenicol then used Inhibitors,research,lifescience,medical to tailor site-specific continuing medical education (CME) lectures to the most important barriers that participants reported. Additional interventions to improve stroke care occurred concurrently and included assistance with clinical protocol development, 24-7 telephone access to the University of Michigan acute stroke team, mock stroke codes, and targeted messaging. Examples of targeted messaging include informing participants of their site’s progress and the overall performance of other sites within INSTINCT and IPI-145 ic50 critical incident debriefing, where a physician from the clinical coordinating center contacted local physicians to discuss specific instances of deviations from American Stroke Association guidelines or treatment complications.