Impact of Regionalization of Care in Acute Stroke Patients

在美国，中风是第三大致死原因和第一大致残原因。这个 据估计，2008年中风的直接和间接成本约为650亿美元。这是从先前的研究中得知的 这种早期识别和治疗降低了与中风相关的发病率和成本。溶栓 静脉注射组织型纤溶酶原激活剂(IVt-PA)仍然是唯一被证实的治疗急性脑缺血的方法 在症状出现后三小时内出现中风，没有明确的禁忌症。然而，它是 另据了解，在缺血性中风患者中t-PA的使用率仅为2-3%。大规模的研究已经 研究表明，溶栓率较低是由于患者对中风症状缺乏认识，延迟 获得紧急医疗服务(EMS)和院内延误，如缺乏快速出行。因此， 科学上众所周知，要提高t-PA的使用率，需要多学科的方法。 符合条件的急性中风患者。除了提高早期中风识别方面的知识外， 社区，脑攻击联盟(BAG)确定了两个级别的中风护理，即初级和 创建综合性中风中心，以改善中风的急救和其他类型的临床护理。 建立了经过认证的初级中风中心，并有证据表明初级卒中中心的护理质量有所提高 中风中心、县当局和EMS机构制定了政策，绕过最近的紧急情况 并将中风患者送往初级中风中心。尽管多个县都在采用 政策变化对地区患者结局的影响尚未确定 通过科学证据。此外，院前提供者对中风识别的准确性研究 已经表明，在笔划识别方面有相当大的改进空间。为了解决这些问题， 我建议进行一项研究，主要目标是研究区域化患者的比较结果。 和非区域化的卒中系统。次要目标将是评估以下项目的成本效益 系统区域化前后院前卒中识别的区域化护理和准确性。 相关性(请参阅说明)： 研究结果将有助于确定1)静脉注射t-PA使用率的地区差异和 急性缺血性卒中患者的死亡率2)初级卒中中心容量增加的影响 和更长的运输时间在一个地区化的系统中。通过提供证据 我们的研究将提供科学知识来促进 在国家一级具有重大公共卫生重要性的卫生政策变化。

Stroke is the third leading cause of death and leading single cause of disability in the United States. The estimated direct and indirect costs of stroke for 2008 are about $65 billion. It is known from prior research that early recogniton and treatment reduces the morbidity and costs associated with stroke. Thrombolysis with intravenous tissue plasminogen activator (IV t-PA) remains the only proven treatment for acute ischemic stroke who present within three hours of symptom onset with no established contraindication. However, it is also known that the rate of t-PA use in ischemic stroke patients is only 2-3%. Large scale studies have shown that poor rates of thrombolysis are due to lack of patient recognition of stroke symptoms, delay in accessing Emergency Medical Services (EMS) and in-hospital delays like lack of expedited triage.Therefore, it is well known scientifically that a multi-disciplinary approach is necessary to improve the rate of t-PA use in eligible acute stroke patients. In addition to improving knowledge on early stroke recognition in the community, the Brain Attack Coalition (BAG) determined that two levels of stroke care i.e primary and comprehensive stroke centers be created to improve emergency and other types of clinical care for stroke. With establishment of certified primary stroke centers and evidence for improved quality of care at primary stroke centers, county authorities and EMS agencies created policies to bypass the nearest emergency department and transport stroke patients to primary stroke centers. Although multiple counties are adopting the change, the impact of the policy change on regional patient outcomes has not yet been established through scientific evidence. In addition, studies on accuracy of stroke recognition by prehospital providers have shown that there is considerable scope for improvement in stroke recognition. To address these issues, I propose to conduct a study with the primary goal of studying comparative patient outcomes in regionalized and non-regionalized stroke systems. The secondary goals will be to assess the cost-effectiveness of regionalized care and accuracy of prehospital stroke recognition before and after regionalization of systems. RELEVANCE (See instructions): The study results will help to determine 1) regional differences in the rate of intravenous t-PA use and mortality among acute ischemic stroke patients 2) the impact of increasing volume in primary stroke centers and longer transport times within a regionalized system on patient outcomes.By providing evidence for patient outcomes in a regionalized stroke system.our research will provide scientific knowledge to promote health policy changes of great public health importance at a national level.