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

Bray, Janet; Denisenko, Sonia; Campbell, Bruce; Stephenson, Michael; Muller, J H; Hocking, Grant; Hand, Peter J.; Bladin, Christopher

doi:10.1111/imj.13494

Cited by 6 publications

(6 citation statements)

References 9 publications

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“…A larger proportion of patients who arrived at the ED within 4.5 hours of symptom onset received thrombolysis within 60 minutes, with more rapid processes of care and fewer adverse events. More than 95% of people living in regional Victoria are now within an hour's drive of a hospital with access to expert stroke care facilitated by the VST program, and some regional hospitals can now deliver stroke thrombolysis for the first time …”

Section: Discussionmentioning

confidence: 99%

Improving acute stroke care in regional hospitals: clinical evaluation of the Victorian Stroke Telemedicine program

Bladin

Kim

Bagot

et al. 2020

Medical Journal of Australia

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Objectives:To evaluate the impact of the Victorian Stroke Telemedicine (VST) program during its first 12 months on the quality of care provided to patients presenting with suspected stroke to hospitals in regional Victoria.Design: Historical controlled cohort study comparing outcomes during a 12-month control period with those for the initial 12 months of full implementation of the VST program at each hospital.Participants: Adult patients with suspected stroke presenting to the emergency departments of the participating hospitals. Main outcome measures:Indicators for key processes of care, including symptom onset-to-arrival, door-to-first medical review, and door-to-CT times; provision and timeliness of provision of thrombolysis to patients with ischaemic stroke.Results: 2887 patients with suspected stroke presented to participating emergency departments during the control period, 3178 during the intervention period; the patient characteristics were similar for both periods. A slightly larger proportion of patients with ischaemic stroke who arrived within 4.5 hours of symptom onset received thrombolysis during the intervention than during the control period (37% v 30%). Door-to-C T scan time (median, 25 min [IQR, 13-49 min] v 34 min [IQR, 18-76 min]) and door-to-needle time for stroke thrombolysis (73 min [IQR, 56-96 min] v 102 min [IQR, 77-128 min]) were shorter during the intervention. The proportions of patients who received thrombolysis and had a symptomatic intracerebral haemorrhage (4% v 16%) or died in hospital (6% v 20%) were smaller during the intervention period.Conclusions: Telemedicine has provided Victorian regional hospitals access to expert care for emergency department patients with suspected acute stroke. Eligible patients with ischaemic stroke are now receiving stroke thrombolysis more quickly and safely.The known: Telemedicine support has improved access to acute stroke therapies in regional hospitals overseas, but has not been provided on a large scale in Australia.The new: The Victorian Stroke Telemedicine (VST) program in 16 hospitals in regional Victoria was associated with improved delivery of acute stroke therapies, including providing thrombolysis more quickly and safely. The implications:The VST program has improved access to stroke specialists in regional Victoria and the quality of care for people with acute stroke. The program is now fully funded by the Victorian government.

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Section: Discussionmentioning

confidence: 99%

Improving acute stroke care in regional hospitals: clinical evaluation of the Victorian Stroke Telemedicine program

Bladin

Kim

Bagot

et al. 2020

Medical Journal of Australia

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“…Our study also has another strength: since the data to generate our model come from the regional government, they are updated regularly. Furthermore, in other studies, the analysis has been performed by ZIP code or municipality 18–21 ; in our study, by using the population nucleus as the level of analysis, we achieve considerably better precision in that we can practically reach the residences of the inhabitants. As recommended by some studies, 15,24 we use travel time calculations based on road networks and the actual speed limit of each road segment, which provide more realistic estimates of travel times and therefore help to more accurately identify neighborhoods that do not have timely access to stroke care.…”

Section: Discussionmentioning

confidence: 79%

“…In recent years, this type of network analysis has been extended to the design of territorial planning strategies in public health. In some of these studies, the proportion of the population with access times of less than 30 min has improved by as much as 21% 18–21 ; however, with our system, it has been possible to expand ultrafast access by 34% through the establishment of this centralized regional network.…”

Section: Discussionmentioning

confidence: 99%

Express improvement of acute stroke care accessibility in large regions using a centralized telestroke network

Barragán-Prieto

Pérez-Sánchez

Moniche

et al. 2022

European Stroke Journal

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Introduction: Acute ischemic stroke therapy has improved in recent decades, decreasing the rates of disability and death among stroke patients. Unfortunately, all health care systems have geographical disparities in infrastructure for stroke patients. A centralized telestroke network might be a low-cost strategy to reduce differences in terms of geographical barriers, equitable access, and quality monitoring across different hospitals. Aims: We aimed to quantify changes in stroke patients’ geographic access to specialized evaluation by neurologists and to intravenous acute stroke reperfusion treatments following the rapid implementation of a centralized telestroke network in the large region of Andalusia (8.5 million inhabitants). Methods: We conducted an observational study using spatial and analytical methods to examine how a centralized telestroke network influences the quality and accessibility of stroke care for a large region. Results: In the pre-implementation period, 5,005,477 (59.72% of the Andalusian population) had access to specialized stroke care in less than 30 min. After the 5-month process of implementing the telestroke network, 7,832,988 (93.5%) inhabitants had an access time of less than 30 min, bridging the gap in acute stroke care in rural hospitals. Conclusions: A centralized telestroke network may be an efficient tool to reduce the differences in stroke care access and quality monitoring across different hospitals, especially in large regions with low population density.

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“…Fourteen articles, published between 2010 to 2021, focused on accessibility to public hospitals [ 98 ] and hospital services, including specialist inpatient care [ 95 , 105 ], outpatient clinics [ 42 , 50 ], maternity care [ 53 , 92 ], intensive care [ 44 , 45 ], emergency care [ 31 , 51 , 64 ], and acute cardiac care [ 36 , 38 ]. Of those articles, two were from the same study investigating intensive care [ 44 , 45 ], and two were from the same study relating to the development of the Cardiac Access-Remoteness Index of Australia (Cardiac ARIA) [ 36 , 38 ].…”

Section: Resultsmentioning

confidence: 99%

The application of spatial measures to analyse health service accessibility in Australia: a systematic review and recommendations for future practice

Wood

Alston

Beks

et al. 2023

BMC Health Serv Res

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Background Australia's inequitable distribution of health services is well documented. Spatial access relates to the geographic limitations affecting the availability and accessibility of healthcare practitioners and services. Issues associated with spatial access are often influenced by Australia's vast landmass, challenging environments, uneven population concentration, and sparsely distributed populations in rural and remote areas. Measuring access contributes to a broader understanding of the performance of health systems, particularly in rural/remote areas. This systematic review synthesises the evidence identifying what spatial measures and geographic classifications are used and how they are applied in the Australian peer-reviewed literature. Methods A systematic search of peer-reviewed literature published between 2002 and 2022 was undertaken using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) methodology. Search terms were derived from three major topics, including: [1] Australian population; [2] spatial analysis of health service accessibility; and [3] objective physical access measures. Results Database searches retrieved 1,381 unique records. Records were screened for eligibility, resulting in 82 articles for inclusion. Most articles analysed access to primary health services (n = 50; 61%), followed by specialist care (n = 17; 21%), hospital services (n = 12; 15%), and health promotion and prevention (n = 3; 4%). The geographic scope of the 82 articles included national (n = 33; 40%), state (n = 27; 33%), metropolitan (n = 18; 22%), and specified regional / rural /remote area (n = 4; 5%). Most articles used distance-based physical access measures, including travel time (n = 30; 37%) and travel distance along a road network (n = 21; 26%), and Euclidean distance (n = 24; 29%). Conclusion This review is the first comprehensive systematic review to synthesise the evidence on how spatial measures have been applied to measure health service accessibility in the Australian context over the past two decades. Objective and transparent access measures that are fit for purpose are imperative to address persistent health inequities and inform equitable resource distribution and evidence-based policymaking.

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

Abstract: A strategic and region-specific approach has resulted in improved access by road transport to reperfusion therapies for stroke patients across Victoria.

Cited by 6 publications

References 9 publications

Improving acute stroke care in regional hospitals: clinical evaluation of the Victorian Stroke Telemedicine program

Improving acute stroke care in regional hospitals: clinical evaluation of the Victorian Stroke Telemedicine program

Express improvement of acute stroke care accessibility in large regions using a centralized telestroke network

The application of spatial measures to analyse health service accessibility in Australia: a systematic review and recommendations for future practice

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