Optimization modeling to maximize population access to comprehensive stroke centers

Mullen, Michael T.; Branas, Charles C.; Kasner, Scott E.; Wolff, Catherine; Williams, J.; Albright, Karen C.; Carr, Brendan G.

doi:10.1212/wnl.0000000000001390

Cited by 52 publications

(36 citation statements)

References 35 publications

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“…4,23 Studies from the USA have documented marked geographic variations in access to care, with lower access in states with a large proportion of rural residents. 19,24 Our findings suggest that the majority of rural Ontarians cannot reach existing EVT centers within 60 minutes of driving time, and that the proportion living within 30 minutes of driving time is exceedingly small at 3.3%. Further, EVT is only indicated in patients with large vessel occlusion, which is estimated to be present in only 20% of patients with stroke.…”

Section: Discussionmentioning

confidence: 79%

Geographic Access to Stroke Care Services in Rural Communities in Ontario, Canada

Kapral

Hall

Gozdyra³

et al. 2020

Can. J. Neurol. Sci.

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ABSTRACT:Background:Optimal stroke care requires access to resources such as neuroimaging, acute revascularization, rehabilitation, and stroke prevention services, which may not be available in rural areas. We aimed to determine geographic access to stroke care for residents of rural communities in the province of Ontario, Canada.Methods:We used the Ontario Road Network File database linked with the 2016 Ontario Acute Stroke Care Resource Inventory to estimate the proportion of people in rural communities, defined as those with a population size <10,000, who were within 30, 60, and 240 minutes of travel time by car from stroke care services, including brain imaging, thrombolysis treatment centers, stroke units, stroke prevention clinics, inpatient rehabilitation facilities, and endovascular treatment centers.Results:Of the 1,496,262 people residing in rural communities, the majority resided within 60 minutes of driving time to a center with computed tomography (85%), thrombolysis (81%), a stroke unit (68%), a stroke prevention clinic (74%), or inpatient rehabilitation (77.0%), but a much lower proportion (32%) were within 60 minutes of driving time to a center capable of providing endovascular thrombectomy (EVT).Conclusions:Most rural Ontario residents have appropriate geographic access to stroke services, with the exception of EVT. This information may be useful for jurisdictions seeking to optimize the regional organization of stroke care services.

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Section: Discussionmentioning

confidence: 79%

Geographic Access to Stroke Care Services in Rural Communities in Ontario, Canada

Kapral

Hall

Gozdyra³

et al. 2020

Can. J. Neurol. Sci.

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“…Access by road to thrombolysis centres in our population is now significantly higher than rates reported in other countries, although they too have reported improvements in access. For example, in the United States (US), it was recently estimated that 87% of the population were within 60 min of a thrombolysis centre by ground transport, an increase from 55% in 2008 and 63% in 2010. However, this recent report also found significant regional variation between US states (33–100%) .…”

Section: Discussionmentioning

confidence: 99%

Strategic framework improves access to stroke reperfusion across the state of Victoria Australia

Bray

Denisenko

Campbell

et al. 2017

Internal Medicine Journal

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“…16 Recent geospatial modeling data suggest that even under optimal configuration, many US residents would be >60 minutes' drive from a CSC, underscoring the need for a distributed, 3-tiered stroke system of care. 17 CSCs must offer endovascular therapy 24 hours per day, 7 days per week. To sustainably provide this 24-hour coverage, 2 to 3 neurointerventionalists are usually needed per service.…”

Section: Equitymentioning

confidence: 99%

Endovascular Clot Retrieval Therapy

Smith

Schwamm

2015

Stroke

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Abstract-Endovascular acute ischemic stroke therapy is now proven by randomized controlled trials to produce large, clinically meaningful benefits. In response, stroke systems of care must change to increase timely and equitable access to this therapy. In this review, we provide a North American perspective on implications for stroke systems, focusing on the United States and Canada, accompanied by initial recommendations for changes. Most urgently, every community must create access to a hospital that can safely and quickly provide intravenous tissue-type plasminogen activator and immediately transfer appropriate patients onward to a more capable center as required. Safe and effective therapy in the community setting will be ensured by certification programs, performance measurement, and data entry into registries.

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Optimization modeling to maximize population access to comprehensive stroke centers

Abstract: Optimal system simulation can be used to develop efficient care systems that maximize accessibility. Under optimal conditions, a large proportion of the US population will be unable to access a CSC within 60 minutes.

Cited by 52 publications

References 35 publications

Geographic Access to Stroke Care Services in Rural Communities in Ontario, Canada

Geographic Access to Stroke Care Services in Rural Communities in Ontario, Canada

Strategic framework improves access to stroke reperfusion across the state of Victoria Australia

Endovascular Clot Retrieval Therapy

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