Primary Stroke Centers Should Be Located Using Maximal Coverage Models for Optimal Access

Abstract

Background and Purpose-The current self-initiated approach by which hospitals acquire Primary Stroke Center (PSC) certification provides insufficient coverage for large areas of the United States. An alternative, directed, algorithmic approach to determine near optimal locations of PSCs would be justified if it significantly improves coverage. Methods-Using geographic location-allocation modeling techniques, we developed a universal web-based calculator for selecting near optimal PSC locations designed to maximize the population coverage in any state. We analyzed the current PSC network population coverage in Iowa and compared it with the coverage that would exist if a maximal coverage model had instead been used to place those centers. We then estimated the expected gains in population coverage if additional PSCs follow the current self-initiated model and compared it against the more efficient coverage expected by use of a maximal coverage model to select additional locations. Results-The existing 12 self-initiated PSCs in Iowa cover 37% of the population, assuming a time-distance radius of 30 minutes. The current population coverage would have been 47.5% if those 12 PSCs had been located using a maximal coverage model. With the current self-initiated approach, 54 additional PSCs on average will be needed to improve coverage to 75% of the population. Conversely, only 31 additional PSCs would be needed to achieve the same degree of population coverage if a maximal coverage model is used. Conclusion-Given the substantial gain in population access to adequate acute stroke care, it appears justified to direct the location of additional PSCs or recombinant tissue-type plasminogen activator-capable hospitals through a maximal coverage model algorithmic approach. (Stroke. 2012;43:2417-2422.)

Regional Perspectives on Public Health

“…Locating health facilities often involves multiple objectives, which can be expressed using location modeling. While many examples of modeling along these lines can be found, worth noting is the work of Osleeb and McLafferty (1992) and more recent work by Cocking et al (2012) and Leira et al (2012) in support of public health decision making. A final point is that health services are hierarchically organized and interconnected.…”

Do Primary Stroke Centers Occur Randomly?

“…This dynamic might be one factor driving the uneven distribution of hospitals noted by Leira and colleagues. 10 A significant minority of hospitals in the United States are now certified as PSCs. This has resulted in improved care and outcomes for millions of patients over the past decade.…”

“…These concerns were largely unfounded because most medium and large urban areas now have several certified PSCs that compete for patients. 9,10 Even small urban areas often have one or more PSCs. This is likely a positive development because patients now have many options for acute stroke care in most cities, giving them freedom to choose the care facility that is best for them (to the extent that they have a choice in the matter).…”

“…A study by Leira et al 10 showed that in Iowa, optimal coverage of the population could be achieved if some entity or agency could direct the location of such facilities, instead of having market forces and other groups make such decisions. In that regard, it might be interesting to analyze if and how proximity to one PSC might have influenced the formation of another PSC.…”

How many suffice? A computational framework for sizing sentinel surveillance networks

“…In addition to improving responses to healthcare problems, facilities location algorithms have been used to place preventive healthcare services [4] and also to design healthcare systems in developing countries [5]. In previous work, we have shown how to apply facilities location algorithms to design disease surveillance networks [6] and primary stroke center networks [7]. …”