Optimization modeling and comparative effectiveness of regionalized stroke care

项目名称： 脑卒中区域化护理的优化模型与比较有效性 PI：CHARLES CHRISTOS BRANAS，博士 摘要： 在美国，中风是导致严重、长期残疾的主要原因，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费用为655亿美元。2002年，一项具有里程碑意义的研究 证实了在治疗后3小时内接受药物治疗的患者的结局显著改善， 症状发作。尽管如此，截至2004年，1%至3%的缺血性中风患者接受了 确定性治疗联合委员会对初级中风中心的认证始于2003年， 在一个明确的中风中心已经与改善的结果。其主要目标是 建议采用运筹学技术，促进中风区域优化发展 系统，并比较不同的区域化计划的有效性，以改善人口获得 中风中心护理这项建议的具体目标是：（1）利用地理信息系统技术 确定能够快速访问现有的、确定的卒中中心的美国人口比例 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， 描述紧急医疗运输的模型，以比较竞争区域化的能力 计划迅速将患者送到所有50个州和华盛顿特区的现有中风中心医院。 哥伦比亚，3）创建一个模拟卒中中心最优分布的运筹学模型 医院和空中救护车，以便在所有50个州最大限度地快速获得专门的中风护理， 哥伦比亚特区，以及4）使用地理信息系统和模型描述紧急情况 医疗运输，以比较使用现有的 美国卒中中心医院的分布与所有卒中中心医院的最佳分布相比 50个州和哥伦比亚特区。我们将在国家一级提出我们的调查结果， 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，以优化提供明确的中风护理的人口。

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.