Optimization modeling to maximize population access to comprehensive stroke centers
Optimization modeling to maximize population access to comprehensive stroke centers
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DOI：
10.1212/wnl.0000000000001390
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发表时间：
2015-03-24
期刊：
影响因子：
9.9
通讯作者：
Carr, Brendan G.
中科院分区：
文献类型：
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作者：
Mullen, Michael T;Branas, Charles C.;Carr, Brendan G.
目的：综合中风中心（CSC）的位置是至关重要的，以确保快速获得急性中风治疗，我们进行了一个人口水平的虚拟试验，模拟使用优化建模，以选择性地转换初级中风中心（PSC）CSCs.Methods的变化，以获得CSC的转换，每个国家最多20个认证的PSC被选中进行转换，以最大限度地提高人口与60分钟CSC访问地面和空中。访问进行了比较，根据区域和国家一级的紧急医疗服务政策优先路由患者中风centers.Results：在2010年，有811联合委员会PSC和0 CSC在美国的存在。在美国人口中，65.8%的人有60分钟的地面访问PSC。在每个州增加20个最佳位置的CSC后，63.1%的美国人口有60分钟的地面访问时间，86.0%的人有60分钟的地面/空中访问时间。在各州之间，地面CSC访问的中位数为55.7%（四分位数范围为35.7%-71.5%），地面/空中为85.3%（四分位数范围为59.8%-92.1%）。地面访问是较低的中风带状态相比，非中风带状态（32.0%与58.6%，p = 0.02）和较低的国家没有紧急医疗服务路由policies（52.7%与68.3%，p = 0.04）。结论：最佳的系统模拟可以用来开发有效的护理系统，最大限度地提高可访问性。在最佳条件下，大部分美国人口将无法在60分钟内访问CSC。
Objective: The location of comprehensive stroke centers (CSCs) is critical to ensuring rapid access to acute stroke therapies; we conducted a population-level virtual trial simulating change in access to CSCs using optimization modeling to selectively convert primary stroke centers (PSCs) to CSCs.Methods: Up to 20 certified PSCs per state were selected for conversion to maximize the population with 60-minute CSC access by ground and air. Access was compared across states based on region and the presence of state-level emergency medical service policies preferentially routing patients to stroke centers.Results: In 2010, there were 811 Joint Commission PSCs and 0 CSCs in the United States. Of the US population, 65.8% had 60-minute ground access to PSCs. After adding up to 20 optimally located CSCs per state, 63.1% of the US population had 60-minute ground access and 86.0% had 60-minute ground/air access to a CSC. Across states, median CSC access was 55.7% by ground (interquartile range 35.7%-71.5%) and 85.3% by ground/air (interquartile range 59.8%-92.1%). Ground access was lower in Stroke Belt states compared with non-Stroke Belt states (32.0% vs 58.6%, p = 0.02) and lower in states without emergency medical service routing policies (52.7% vs 68.3%, p = 0.04).Conclusion: 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.