Trauma Communications Center Coordinated Severity-Based Stroke Triage

创伤通信中心协调的基于严重度的卒中分类 急性中风护理系统应效仿创伤系统，为所有人提供全方位的护理 通过有组织的、协调的努力，在确定的地理区域内为受伤的病人提供服务。就像创伤 系统已被证明有能力挽救生命的最严重的受伤的病人，我们应该有一个中风 该系统能够为最严重的中风患者提供护理。最严重的急性缺血性 中风是由于近端大血管闭塞（LVO）。机械血栓切除术（MT）提供了一个非凡的 改善LVO患者结局的潜力。不幸的是，部分原因是MT只能在 先进的中风中心，只有少数LVO患者接受MT治疗，并且存在种族， 社会经济和农村在获得MT方面的差距。基于创伤系统的成功和我们之前的 合作，公共卫生（ADPH）的亚拉巴马部计划五年全州质量 创伤通讯中心（TCC）协调基于严重度卒中分诊的改进倡议 （SBST）旨在通过协调院前和 机构间紧急中风护理。这提供了一个“自然实验”，允许评估 公共卫生的影响和“如何和为什么”实施创新的急性中风护理模式。我们 目的是（1）比较急诊医疗服务（EMS）遇到的患者比例， 之前接受MT治疗的疑似LVO患者（遵守标准分诊到最近的卒中中心）， 实施TCC协调SBST后;（2）评估TCC协调的广泛公共卫生影响 通过检查干预的范围和有效性（包括种族、族裔、 和人口密度），实施的保真度，以及在各种环境中维持模型的能力; （3）评估利益相关者对干预的可行性、适当性和可接受性的看法， 确定干预措施的采用、实施、维持和推广的障碍和促进因素。这 将指导今后的执行工作。为了实现这些目标，我们将扩大我们的成功模式， 在亚拉巴马的所有EMS地区进行TCC指导的卒中严重程度评估;使用定性方法，包括 访谈和焦点小组，以帮助制定区域和医院特定的院前和院间 为疑似LVO患者制定设施卒中分诊计划;并分阶段推出TCC 协调SBST在亚拉巴马的六个EMS地区，贷款本身的健康过程的分析， 在每个区域进行干预之前和之后的结果。为了实现AIM 3，我们将使用 混合方法采用多种方法，包括调查、访谈和焦点小组。这 项目，如果成功，可以作为一个模型，如何创伤系统的基础设施，已经存在于其他国家， 区域和州可以作为更综合和有效的中风急救系统的基础。

Trauma Communication Center Coordinated Severity-Based Stroke Triage Acute stroke systems of care should emulate trauma systems which deliver the full range of care to all injured patients by means of organized, coordinated efforts in defined geographic areas. Just as trauma systems have proven ability to save lives of the most severely injured patients, we should have a stroke system able to provide care to patients with the most severe strokes. The most severe type of acute ischemic stroke is due to proximal large vessel occlusion (LVO). Mechanical thrombectomy (MT) offers an extraordinary potential to improve the outcome of patients with LVO. Unfortunately, in part because MT is available only at advanced stroke centers, only a minority of patients with LVO are treated with MT, and there are racial, socioeconomic, and rural disparities in access to MT. Based on the success of trauma systems and our prior collaboration, the Alabama Department of Public Health (ADPH) is planning a five-year statewide quality improvement initiative of trauma communications center (TCC) coordinated severity-based stroke triage (SBST) which aims to transform the fragmented acute stroke care system by coordinating prehospital and inter-facility emergency stroke care. This provides a “natural experiment” allowing assessment of both the public health impact and the “how and why” of implementation of an innovative acute stroke care model. We aim to (1) compare the proportion of patients encountered by the emergency medical service (EMS) with suspected LVO who are treated with MT before (adhering to standard triage to the nearest stroke center) and after implementation of TCC coordinated SBST; (2) assess the broad public health impact of TCC coordinated SBST by examining the reach and effectiveness of the intervention (including any differences by race, ethnicity, and population density), the fidelity of implementation, and ability to sustain the model in various settings; and (3) assess stakeholder perceptions of the intervention’s feasibility, appropriateness, and acceptability and identify barriers and facilitators to the intervention’s adoption, implementation, maintenance, and spread. This will guide future implementation efforts. To accomplish these aims, we will expand our successful model of TCC guided stroke severity assessment to all EMS regions in Alabama; use qualitative methods including interviews and focus groups to aid in the development of region and hospital specific prehospital and inter- facility stroke triage plans for patients with suspected LVO; and implement a phased rollout of TCC coordinated SBST across Alabama’s six EMS regions, lending itself to analysis of health processes and outcomes before and after the intervention in each region. To address implementation AIM 3, we will use a mixed methods approach using multiple methods consisting of surveys, interviews and focus groups. This project, if successful, can serve as a model for how the trauma system infrastructure that already exists in other regions and states can serve as the basis for a more integrated and effective system of emergency stroke care.