Optimization modeling and comparative effectiveness of regionalized stroke care

项目名称： 卒中区域化护理的优化建模与效果比较 PI：查尔斯·克里斯托斯·布拉纳斯，博士 摘要： 在美国，中风是导致长期严重残疾的首要原因，也是导致严重残疾的第三大原因。 死亡。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，一项里程碑式的研究 结果显示，在3小时内接受药物治疗的患者的结果有显著改善 症状出现。尽管如此，截至2004年，1%至3%的缺血性中风患者接受了 彻底的治疗。联合委员会于2003年开始对初级中风中心进行认证，并进行治疗 在一个明确的中风中心与改善预后相关。这样做的总体目标是 建议运用运筹学技术促进区域中风优化发展 并比较不同区域化方案的有效性，以改善人口获得 中风中心护理中心。这项提议的具体目标是1)使用地理信息系统技术 确定能够快速访问现有的、明确的中风中心的美国人口的比例 在所有50个州和哥伦比亚特区的医院护理，2)使用地理信息系统和 描述紧急医疗运输的模型以比较竞争区域化的能力 快速将患者送往所有50个州和华盛顿特区现有中风中心医院的计划 哥伦比亚，3)创建模拟中风中心最佳分布的运筹学模型 医院和空中救护车，以便最大限度地在所有50个州和 哥伦比亚特区，和4)使用地理信息系统和描述紧急情况的模型 使用现有的医疗运输来比较人群获得确定的中风中心护理的机会 美国卒中中心医院分布与各卒中中心医院最优分布的比较 50个州和哥伦比亚特区。我们将在州的层面上提出我们的发现 数学和视觉格式。这项研究有能力为美国的进一步发展提供信息 中风系统，并在这样做的同时，优化向人群提供明确的中风护理。

PROJECT TITLE: OPTIMIZATION MODELING AND COMPARATIVE EFFECTIVENESS OF REGIONALIZED STROKE CARE PI: CHARLES CHRISTOS BRANAS, PHD Abstract: 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.