Regionalization of Acute Stroke Care for Rural Populations: A Systems Modeling Approach

农村人口急性中风护理的区域化：系统建模方法

• 批准号: 10567098
• 负责人: Mehul D. Patel
• 金额: $ 59.12万
• 依托单位: UNIV OF NORTH CAROLINA CHAPEL HILL
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-07-07 至 2028-01-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10567098
• 关键词: Accident and Emergency department; Acute; Address; Adverse effects; Behavioral; Biological; Biological Models; Bypass; Caring; Cause of Death; Characteristics; Clinical; Communities; Complex; Computer Simulation; County; Data Sources; Disparity; Emergency Situation; Emergency medical service; Ensure; Equilibrium; Evaluation; Future; Geographic Locations; Geography; Guidelines; Health Care Costs; Healthcare; Healthcare Systems; Hospitals; Improve Access; Individual; Influentials; Infrastructure; Integrated Health Care Systems; Intervention; Ischemic Stroke; Location; Medical emergency; Mission; Modeling; Morbidity - disease rate; Myocardial Infarction; National Institute on Minority Health and Health Disparities; North Carolina; Patient-Focused Outcomes; Patients; Performance; Population; Population Characteristics; Protocols documentation; Provider; Publishing; Research; Resources; Route; Rural; Rural Community; Rural Population; Science; Sepsis; Signs and Symptoms; Source; Specialized Center; Stroke; Symptoms; System; Testing; Time; Translations; Trauma; Triage; Underserved Population; United States; access disparities; acute care; acute stroke; care coordination; care systems; comparative; compare effectiveness; design; disability; flexibility; functional outcomes; health disparity; improved; in silico; innovation; models and simulation; mortality; mortality disparity; novel; post stroke; prospective; prototype; response; rural area; rural counties; rural disparities; rural healthcare; rural setting; rural underserved; screening; simulation; standard care; stroke incidence; stroke outcome; stroke patient; stroke therapy; underserved rural area; urban area

Project Summary/Abstract Stroke is a leading cause of death and serious long-term disability and particularly devastating to rural communities. In the United States, rural areas have an estimated 30% greater stroke mortality compared to urban areas. Limited access to time-sensitive acute stroke therapies is an important cause of rural disparities in stroke morbidity and mortality. Regional stroke systems of care that coordinate emergency medical services (EMS), emergency departments, inter-facility transfer agencies, and hospitals can improve access to acute stroke care for underserved populations. However, evidence on effective and efficient stroke system designs and strategies is lacking. Prehospital stroke screening by EMS and routing directly to a stroke center specialized in providing advanced care can significantly reduce time to treatment and improve patient outcomes. However, optimal EMS stroke triage and transport strategies that maximize benefit to stroke patients and efficiently use emergency medical resources are largely unknown and depend on regional and local characteristics. Therefore, our overall objective is to develop a decision-analytic systems model that allows stroke system planners to compare potential effects of regionalized EMS triage and transport strategies on rural stroke outcomes and health care resource utilization. Decision-analytic modeling is a rigorous and flexible approach for integrating information sources to conduct in silico testing of system-level strategies under varying contexts. This comparative evidence provides valuable and timely information to decision makers to tailor interventions for real-world implementation and evaluation. Using existing real-world data sources, published evidence, and key stakeholder input, we will build a computer simulation model of regionalized stroke care for 70 rural counties in North Carolina. Our specific aims are to: (1) determine EMS stroke triage and transport strategies that optimize functional outcomes in rural stroke patients; (2) estimate the potential system-wide effects of rural EMS triage and transport on health care resource utilization; and (3) understand the influence of rural population and health care system characteristics on optimizing EMS stroke triage and transport strategies. In response to NOT-MD-20-025, this project aims to understand and address stroke disparities by improving access to timely acute care for underserved rural populations. Upon successful completion, we will have contributed a novel decision support framework to understand and improve regional stroke systems of care across various settings. Our future research will implement refined EMS stroke triage and transport strategies into rural systems and prospectively evaluate long-term patient outcomes and healthcare costs. This line of research has high potential to address significant morbidity and mortality and health disparities caused by acute stroke and other time- and resource-dependent medical emergencies (e.g., myocardial infarction, sepsis, and trauma).

项目摘要/摘要 中风是导致死亡和严重的长期残疾的主要原因，对农村地区造成的破坏尤其严重 社区。在美国，农村地区的中风死亡率估计比 城市地区。获得时间敏感型急性中风治疗的机会有限是农村差距的一个重要原因 中风发病率和死亡率。协调急救医疗服务的区域性中风护理系统 (EMS)、急诊科、设施间转运机构和医院可以改善获得急救的机会 为服务不足的人群提供中风护理。然而，有效和高效的中风系统设计的证据 而且缺乏战略。通过EMS进行院前卒中筛查并直接送往卒中中心 专门提供高级护理可以显著缩短治疗时间并改善患者状况 结果。然而，最优的EMS卒中分流和运输策略最大限度地有利于卒中 患者和有效利用紧急医疗资源在很大程度上是未知的，取决于地区和 地方特色。因此，我们的总体目标是开发一个决策分析系统模型 允许卒中系统规划者比较区域化EMS分流和运输策略的潜在影响 农村卒中结局与卫生资源利用的关系。决策分析建模是一种严格的 综合信息源的灵活方法，以便在电子计算机测试系统级战略 不同的背景。这种比较证据为决策者提供了宝贵和及时的信息，以 为现实世界的实施和评估量身定制干预措施。使用现有的真实世界数据源， 公布的证据，以及关键利益相关者的输入，我们将建立一个区域化的计算机模拟模型 为北卡罗来纳州70个农村县提供中风护理。我们的具体目标是：(1)确定EMS卒中分诊 和运输策略，以优化农村中风患者的功能结果；(2)估计潜在的 农村EMS分类和运输对卫生保健资源利用的全系统影响；以及(3)了解 农村人口和卫生保健系统特征对优化EMS卒中分流和治疗的影响 运输战略。作为对NOT-MD-20-025的响应，本项目旨在了解和解决中风 改善未得到充分服务的农村人口获得及时的急诊护理的机会，从而消除贫富差距。成功后 完成后，我们将贡献一个新的决策支持框架，以了解和改进区域 不同环境中的中风护理系统。我们未来的研究将实现精细化的EMS卒中分流 和运输战略进入农村系统，并前瞻性地评估长期患者结果和 医疗保健成本。这一研究线具有很高的潜力来解决显著的发病率和死亡率 急性中风和其他依赖时间和资源的医疗紧急情况造成的健康差距(例如， 心肌梗死、败血症和创伤)。