Rural-Urban Differences in Acute Stroke Management Practices

Leira, Enrique C.; Hess, David C.; Torner, James C.; Adams, Harold P.

doi:10.1001/archneur.65.7.887

Cited by 122 publications

(100 citation statements)

References 39 publications

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“…3 The shortage of stroke specialists and other physicians with experience administering this drug in rural areas is a substantial barrier preventing more widespread tPA use. 33 Telestroke has the potential to lower this barrier by providing longdistance consultation to such areas, in effect increasing the expertise, and therefore quality, of stroke care at rural hospitals.…”

Section: Sensitivity Analysismentioning

confidence: 99%

The cost-effectiveness of telestroke in the treatment of acute ischemic stroke

et al. 2011

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Objective: To conduct a cost-effectiveness analysis of telestroke-a 2-way, audiovisual technology that links stroke specialists to remote emergency department physicians and their stroke patients-compared to usual care (i.e., remote emergency departments without telestroke consultation or stroke experts). Methods:A decision-analytic model was developed for both 90-day and lifetime horizons. Model inputs were taken from published literature where available and supplemented with western states' telestroke experiences. Costs were gathered using a societal perspective and converted to 2008 US dollars. Quality-adjusted life-years (QALYs) gained were combined with costs to generate incremental cost-effectiveness ratios (ICERs). In the lifetime horizon model, both costs and QALYs were discounted at 3% annually. Both one-way sensitivity analyses and Monte Carlo simulations were performed. Results:In the base case analysis, compared to usual care, telestroke results in an ICER of $108,363/QALY in the 90-day horizon and $2,449/QALY in the lifetime horizon. For the 90-day and lifetime horizons, 37.5% and 99.7% of 10,000 Monte Carlo simulations yielded ICERs Ͻ$50,000/QALY, a ratio commonly considered acceptable in the United States.

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Section: Sensitivity Analysismentioning

confidence: 99%

The cost-effectiveness of telestroke in the treatment of acute ischemic stroke

et al. 2011

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“…Urban Japanese diets typically have lower sodium, higher calcium, and higher animal protein than rural Japanese diets, 28 and cities tend to have better access to emergency health services that can help prevent fatal outcomes from stroke. 29 Similar factors may help explain the lower mortality due to heart disease in urban Japan. However, a recent study revealed that the decline in mortality due to coronary heart disease and stroke since the 1970s was notably smaller in men aged 30-49 in Tokyo and Osaka, and has plateaued.…”

Section: Discussionmentioning

confidence: 98%

“…These are likely to be influenced by small-area disparities in the risk factors for these diseases as well as in the availability, accessibility, and utilization of emergency healthcare services. 29 Interventions to improve health equity, thus, require attention to aspects of gender, disease types, and the broader determinants of health. 32 In order to develop policy and program interventions that can effectively address the issues uncovered by the kind of data presented in this study, there needs to be more evidence on the causes of these outcomes which can contribute to theoretical development about causes of health disparities.…”

Section: Discussionmentioning

confidence: 99%

Inequalities in Noncommunicable Disease Mortality in the Ten Largest Japanese Cities

Kano¹,

Hotta

Prasad

2013

J Urban Health

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The burden of noncommunicable diseases and social inequalities in health among urban populations is becoming a common problem around the world. This phenomenon is further compounded by population aging. Japan faces the task of maintaining its high level of population health while dealing with these challenges. This study focused on the ten largest cities in Japan and, using publicly available administrative data, analyzed standardized mortality ratios to examine inequalities in relative mortality levels due to major noncommunicable disease at both city and subcity levels. On average, the ten major cities had excess mortality due to cancer and lower mortality due to heart disease and cerebrovascular disease compared to the country as a whole. Substantial inequalities in relative mortality were observed both between and within cities, especially for heart disease and cerebrovascular disease among men. Inequalities in relative mortality levels within cities appear to be increasing over time even while relative mortality levels are decreasing overall. The widely observed health inequalities signal the need for actions to ensure health equity while addressing the burden of noncommunicable diseases. Increasingly, more countries will have to deal with these challenges of inequity, urbanization, aging, and noncommunicable diseases. Local health governance informed by locally specific data on health determinants and outcomes is essential for developing contextualized interventions to improve health and health equity in major urban areas.

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“…15 The geographic disparity in access to stroke care for a large proportion of the US population can only increase the existing disparity of stroke care between rural and urban areas. 16 Unfortunately, it is clear that the number of PSCs needed to improve the coverage to acceptable levels is quite large.…”

Section: Discussionmentioning

confidence: 99%

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

Leira¹,

Fairchild²,

Segre³

et al. 2012

Stroke

Self Cite

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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.)

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Rural-Urban Differences in Acute Stroke Management Practices

Cited by 122 publications

References 39 publications

The cost-effectiveness of telestroke in the treatment of acute ischemic stroke

The cost-effectiveness of telestroke in the treatment of acute ischemic stroke

Inequalities in Noncommunicable Disease Mortality in the Ten Largest Japanese Cities

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

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