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).

项目总结/文摘