Optimization modeling and comparative effectiveness of regionalized stroke care

描述(申请人提供)：在美国，中风是导致长期严重残疾的首要原因，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成本为655亿美元。2002年，一项具有里程碑意义的研究表明，在症状出现后3小时内接受药物治疗的患者的结果有显著改善。尽管如此，截至2004年，1%至3%的缺血性中风患者正在接受明确的治疗。联合委员会于2003年开始对初级卒中中心进行认证，在权威的卒中中心进行治疗与改善预后有关。这项建议的广泛目标是使用运筹学技术来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，以改善人们获得卒中中心护理的机会。这项提案的具体目标是1)使用地理信息系统技术来确定能够在所有50个州和哥伦比亚特区快速获得现有的、明确的中风中心医院护理的美国人口的比例；2)使用地理信息系统和描述紧急医疗运输的模型来比较相互竞争的地区化方案将患者快速运送到所有50个州和哥伦比亚特区现有的中风中心医院的能力；3)创建一个运营研究模型，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，比较美国现有中风中心医院的分布与所有50个州和哥伦比亚特区的中风中心医院的最佳分布情况下，人群获得明确的中风中心护理的情况。我们将在国家层面上以数学和视觉的形式介绍我们的发现。这项研究有能力为美国中风系统的进一步发展提供信息，并通过这样做，优化向人群提供明确的中风护理。 公共卫生相关性：拟议的研究旨在使用地理信息系统和优化建模来计算人群获得初级卒中中心的机会，比较不同分区卒中护理方案的有效性，并开发出所有50个州和哥伦比亚特区初级卒中中心分布的最佳解决方案。我们将现有的系统与提出的优化模型进行比较。数据将以统计和可视形式在国家一级列报。这项研究有能力为美国中风系统的进一步发展提供信息，从而改善与中风相关的发病率和死亡率。

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.