Trauma Communications Center Coordinated Severity-Based Stroke Triage

创伤沟通中心协调基于严重程度的卒中分诊 急性中风的护理系统应该效仿创伤系统，为所有人提供全方位的护理 在确定的地理区域内，通过有组织、协调的努力，帮助受伤的病人。就像创伤一样 系统已被证明有能力挽救最严重受伤患者的生命，我们应该中风 系统能够为中风最严重的患者提供护理。最严重的急性缺血性脑病 中风是由近端大血管闭塞(LVO)引起的。机械血栓切除术(MT)提供了一种非凡的 有可能改善LVO患者的预后。不幸的是，部分原因是MT仅在 先进的卒中中心，只有少数LVO患者接受MT治疗，而且有种族， 在获得MT方面的社会经济和农村差异。基于创伤系统的成功和我们之前的 合作，阿拉巴马州公共卫生部(ADPH)正在计划全州范围内的五年质量 创伤沟通中心(TCC)协调的基于严重程度的卒中分诊的改进倡议 (SBST)，旨在通过协调院前和 设施间的中风急救护理。这提供了一个“自然实验”，允许评估 公共卫生影响以及实施创新的急性中风护理模式的“方式和原因”。我们 目的(1)比较急诊医疗服务(EMS)和急救服务(EMS)患者的就诊比例 之前接受过MT治疗的疑似LVO患者(遵循标准分流到最近的卒中中心)和 实施TCC协调SBST后；(2)评估协调TCC对公众健康的广泛影响 SBST通过检查干预的覆盖范围和有效性(包括种族、民族、 和人口密度)、实施的保真度以及在各种环境中维持该模式的能力； 以及(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，以及 确定干预措施采用、实施、维护和传播的障碍和促进者。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 TCC指导对阿拉巴马州所有EMS地区的中风严重性评估；使用定性方法，包括 访谈和焦点小组，以帮助发展地区和医院特定的院前和院间 为疑似LVO患者提供设施卒中分流计划；并分阶段推出TCC 协调阿拉巴马州六个EMS地区的SBST，有助于分析健康流程和 各地区干预前后的结果。为了解决实现目标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 如果项目成功，可以作为创伤系统基础设施的典范，这些基础设施已经存在于其他 地区和州可以作为更综合和更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.