Trauma Communications Center Coordinated Severity-Based Stroke Triage

创伤交流中心协调基于严重程度的中风分诊 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 通过在特定地理区域内有组织、协调的努力来治疗受伤患者。就像外伤一样 事实证明，系统能够挽救最严重受伤患者的生命，我们应该中风 系统能够为最严重的中风患者提供护理。最严重的急性缺血类型 中风是由于近端大血管闭塞（LVO）引起的。机械取栓 (MT) 提供了非凡的 改善 LVO 患者预后的潜力。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，并且存在种族、 获得 MT 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经验 通过合作，阿拉巴马州公共卫生部 (ADPH) 正在规划为期五年的全州质量 创伤交流中心 (TCC) 的改进举措协调基于严重程度的中风分类 （SBST）旨在通过协调院前和院内急救来改变分散的急性中风护理系统 机构间紧急中风护理。这提供了一个“自然实验”，允许评估 公共健康影响以及实施创新急性中风护理模式的“方式和原因”。我们 目的 (1) 比较接受紧急医疗服务 (EMS) 的患者比例 之前接受过 MT 治疗的疑似 LVO（遵守前往最近卒中中心的标准分诊）以及 在实施TCC协调的SBST之后； (2) 评估 TCC 协调的广泛公共卫生影响 SBST 通过检查干预措施的范围和有效性（包括种族、族裔、 和人口密度）、实施的保真度以及在各种环境下维持模型的能力； (3) 评估利益相关者对干预措施的可行性、适当性和可接受性的看法 确定干预措施的采用、实施、维护和传播的障碍和促进因素。这个 将指导未来的实施工作。为了实现这些目标，我们将扩展我们的成功模式 TCC 指导阿拉巴马州所有 EMS 地区的中风严重程度评估；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内培训 针对疑似 LVO 患者的机构中风分诊计划；并分阶段推出TCC 协调阿拉巴马州六个 EMS 区域的 SBST，有助于分析卫生流程和 每个地区干预前后的结果。为了解决实现 AIM 3 的问题，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。这个 项目如果成功，可以作为其他地区已经存在的创伤系统基础设施的模型 各地区和州可以作为更综合、更有效的中风急诊护理系统的基础。

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.