Availability of Diagnostic and Treatment Services for Acute Stroke in Frontier Counties in Montana and Northern Wyoming

Okon, Nicholas J; Rodriguez, Daniel; Dietrich, Dennis W.; Oser, Carrie S.; Blades, Lynda L.; Burnett, Anne M; Russell, Joseph A.; Allen, Martha J.; Chasson, Linda; Helgerson, Steven D.; Gohdes, Dorothy; Harwell, Todd S.

doi:10.1111/j.1748-0361.2006.00038.x

Cited by 17 publications

(18 citation statements)

References 17 publications

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“…However, in rural areas and small communities these recommendations are often not implemented both in Europe 45 and the United States. 27 Of 58 hospitals in Montana and Wyoming, 79% were located in frontier counties. 27 Only 30% of the frontier hospitals met 6 to 10 of the Brain Attack Coalition criteria, compared to 67% of hospitals in the nonfrontier counties.…”

Section: Subacute Carementioning

confidence: 99%

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Stroke in Rural Areas and Small Communities

Joubert

Prentice

Moulin

et al. 2008

Stroke

120

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Abstract-The management of stroke in rural and regional areas is variable in both the developed and developing world.Informed by best-practice guidelines and recommendations for systems of stroke care, adaptable models of care that are appropriate for local needs should be devised for rural and regional settings. This review addresses the issue of the provision of appropriate services in rural and regional settings, with particular attention to the barriers involved, according to the classification of Low Human Development Country (LHDC), Medium Human Development Country (MHDC) and High Human Development Country (HHDC). We discuss the need and feasibility of developing implementing stroke care in rural settings according to best-practice recommendations, within models of care adapted to local conditions.

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Section: Subacute Carementioning

confidence: 99%

“…27 Of 58 hospitals in Montana and Wyoming, 79% were located in frontier counties. 27 Only 30% of the frontier hospitals met 6 to 10 of the Brain Attack Coalition criteria, compared to 67% of hospitals in the nonfrontier counties. Of 21 rural hospitals in Idaho, 29 none had a designated stroke team.…”

Section: Subacute Carementioning

confidence: 99%

Stroke in Rural Areas and Small Communities

Joubert

Prentice

Moulin

et al. 2008

Stroke

120

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“…Similar findings have been reported in Montana and northern Wyoming. 11 The implications of these findings for stroke outcomes in the Northwest region are sobering. Following the stroke continuum of care model, without use of EMS prehospital stroke screening tools and advance notification of ED arrival, medical staff and equipment cannot be prepared for timely evaluation and treatment of patients; without the availability of written stroke protocols in the ED and hospital, personnel may not provide timely and appropriate care to patients with stroke; and ultimately without timely and appropriate acute care, patients with stroke are not eligible for appropriate interventions.…”

Section: Discussionmentioning

confidence: 99%

“…In 2004, acute stroke care capacity was lower in frontier hospitals compared with nonfrontier hospitals in Montana and northern Wyoming. 11 Closer proximity to optimal stroke care (through designated stroke centers) has been shown to be associated with lower mortality. 8 Given the known disparities that exist in rural and frontier areas, the Northwest Regional Stroke Network (NWRSN) wanted to assess the specific needs in our region to ultimately provide targeted and strategic interventions.…”

mentioning

confidence: 99%

Striking Rural-Urban Disparities Observed in Acute Stroke Care Capacity and Services in the Pacific Northwest

Shultis

Graff

Chamie

et al. 2010

Stroke

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Background and Purpose-The age-adjusted stroke death rate in adults aged Ն45 years is significantly higher in the Northwest region than in the rest of the United States. Alaska, Idaho, Montana, Oregon, and Washington have substantial rural and frontier areas with unique characteristics and complexities that pose challenges to timely acute stroke care and ultimately affect the patient. Methods-A regional needs assessment was conducted to assess acute stroke care capacity and services in the Northwest region. Hospitals with an emergency department were surveyed with a standardized online tool based on the Brain Attack Coalition recommendations and developed by stroke neurologists, emergency medical services leaders, state public health professionals, and American Stroke Association members. Results-Approximately 76% of hospitals completed the questionnaire. Striking rural-urban differences were seen with rural hospitals having a much lower capacity to adequately care for patients with stroke. Two thirds lacked the necessary personnel, one third lacked necessary neuroimaging equipment, and one fourth were functioning without written emergency department and tissue plasminogen activator stroke protocols. Conclusions-This survey represents the first comprehensive regional assessment of stroke care capacity and services both in the Northwest region and the whole United States. The findings have confirmed the need to focus on strengthening stroke personnel, increasing access to care, and promoting written protocols, especially in rural settings. Additionally, promoting stroke center certification, increasing the number of stroke registries throughout the region, encouraging use of inpatient stroke care protocols in rural hospitals, and conducting ongoing stroke care capacity and services surveys is highly recommended. (Stroke. 2010;41:2278-2282.)

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“…In rural Australia, for example, over 90% of hospitals have 24-hour access to CT scanning, but residents have to travel, on average, about 100km. A study carried out in Montana and Northern Wyoming by Okon et al (2006) revealed that only 39% of hospitals had 24-hour CT capabilities. A study in China by Liu et al (2007) showed the use of CT in rural areas to be "low" compared to urban areas, but exact data are not available.…”

mentioning

confidence: 99%