Optimization modeling and comparative effectiveness of regionalized stroke care

描述（由申请人提供）：在美国，中风是导致严重、长期残疾的主要原因，也是导致死亡的第三大原因。每40秒就有人中风，每3-4分钟就有人死于中风。预计2008年全国中风的直接和间接费用为655亿美元。2002年，一项具有里程碑意义的研究表明，在症状出现3小时内接受药物治疗的患者的预后有显著改善。尽管如此，截至2004年，1%至3%的缺血性中风患者接受了最终治疗。联合委员会于2003年开始对初级卒中中心进行认证，在权威卒中中心进行治疗与改善预后有关。本提案的总体目标是利用运筹学技术促进优化的区域卒中系统的发展，并比较不同区域化方案的有效性，以改善卒中中心护理的人口获取。该提案的具体目标是：1)利用地理信息系统技术确定能够快速获得所有50个州和哥伦比亚特区现有的、明确的中风中心医院护理的美国人口比例；2)利用地理信息系统和描述紧急医疗运输的模型来比较竞争性区域化方案的能力，以便将患者快速送到所有50个州和哥伦比亚特区的现有中风中心医院；3)创建一个运筹学模型，模拟中风中心医院和空中救护车的最佳分布，以便在所有50个州和哥伦比亚特区最大限度地快速获得专门的中风护理；& 4)使用地理信息系统和描述紧急医疗运输的模型，比较使用美国中风中心医院现有分布的人口获得最终中风中心护理的机会，与所有50个州和哥伦比亚特区中风中心医院的最佳分布进行比较。我们将以数学和视觉两种形式在国家层面展示我们的发现。这项研究有能力为美国中风系统的进一步发展提供信息，并在此过程中优化向人群提供明确的中风护理。

DESCRIPTION (provided by applicant): In the United States, stroke is the leading cause of serious, long-term disability and the third leading cause of death. Every 40 seconds someone experiences a stroke and every 3-4 minutes someone dies from a stroke. The projected national direct and indirect cost of stroke for 2008 is $65.5 billion. In 2002, a landmark study demonstrated a marked improvement in outcomes for patients treated with medical therapy within 3 hours of symptom onset. Despite this, as of 2004, between 1% and 3% of victims of ischemic stroke were receiving the definitive therapy. Certification of primary stroke centers by the joint commission began in 2003, and treatment at a definitive stroke center has been associated with improved outcomes. The broad objective of this proposal is to use operations research techniques to promote the development of optimized regional stroke systems and to compare the effectiveness of different regionalization schemes to improve population access to stroke center care. The specific aims of this proposal are 1) to use geographic information systems technology to determine the proportion of the US population that is able to rapidly access existing, definitive stroke center hospital care in all 50 states and the District of Columbia, 2) to use geographic information systems and models describing emergency medical transportation to compare the ability of competing regionalization schemes to rapidly deliver patients to existing stroke center hospitals in all 50 states and the District of Columbia, 3) to create an operations research model that simulates the optimal distribution of stroke center hospitals and air ambulances in order to maximize rapid access to specialized stroke care in all 50 States and the District of Columbia, & 4) to use geographic information systems and models describing emergency medical transportation to compare population access to definitive stroke center care using the existing distribution of US stroke center hospitals compared to the optimal distribution of stroke center hospitals in all 50 states and the District of Columbia. We will present our findings at the level of the state in both mathematical and visual format. This study has the capacity to inform the further development of the US stroke system, and in so doing, to optimize the delivery of definitive stroke care to the population. PUBLIC HEALTH RELEVANCE: The proposed study aims to use geographic information systems and optimization modeling to calculate population access to a primary stroke center, to compare the effectiveness of different schemes of regionalizing stroke care, and to develop an optimal solution to the distribution of primary stroke centers in all 50 states and the District of Columbia. We will compare the existing system to the proposed optimized model. Data will be presented at the level of the state in statistical and visual format. This study has the capacity to inform the further development of the US stroke system and to thereby improve stroke related morbidity and mortality.