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
基本信息
- 批准号:10567098
- 负责人:
- 金额:$ 59.12万
- 依托单位:
- 依托单位国家:美国
- 项目类别:
- 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:
- 关键词:Accident and Emergency departmentAcuteAddressAdverse effectsBehavioralBiologicalBiological ModelsBypassCaringCause of DeathCharacteristicsClinicalCommunitiesComplexComputer SimulationCountyData SourcesDisparityEmergency SituationEmergency medical serviceEnsureEquilibriumEvaluationFutureGeographic LocationsGeographyGuidelinesHealth Care CostsHealthcareHealthcare SystemsHospitalsImprove AccessIndividualInfluentialsInfrastructureIntegrated Health Care SystemsInterventionIschemic StrokeLocationMedical emergencyMissionModelingMorbidity - disease rateMyocardial InfarctionNational Institute on Minority Health and Health DisparitiesNorth CarolinaPatient-Focused OutcomesPatientsPerformancePopulationPopulation CharacteristicsProtocols documentationProviderPublishingResearchResourcesRouteRuralRural CommunityRural PopulationScienceSepsisSigns and SymptomsSourceSpecialized CenterStrokeSymptomsSystemTestingTimeTranslationsTraumaTriageUnderserved PopulationUnited Statesaccess disparitiesacute careacute strokecare coordinationcare systemscomparativecompare effectivenessdesigndisabilityflexibilityfunctional outcomeshealth disparityimprovedin silicoinnovationmodels and simulationmortalitymortality disparitynovelpost strokeprospectiveprototyperesponserural arearural countiesrural disparitiesrural healthcarerural settingrural underservedscreeningsimulationstandard carestroke incidencestroke outcomestroke patientstroke therapyunderserved rural areaurban area
项目摘要
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)。
项目成果
期刊论文数量(0)
专著数量(0)
科研奖励数量(0)
会议论文数量(0)
专利数量(0)
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Mehul D. Patel其他文献
CARDIOVASCULAR OUTCOMES WITH β-BLOCKER COMBINATION TREATMENT IN PATIENTS WITH HYPERTENSION: A LARGE, RETROSPECTIVE COHORT STUDY
高血压患者联合 β 受体阻滞剂治疗的心血管结局:一项大型回顾性队列研究
- DOI:
10.1016/s0735-1097(18)32293-9 - 发表时间:
2018 - 期刊:
- 影响因子:24
- 作者:
B. Egan;J. Basile;H. Punzi;S. Ali;Qian Li;Mehul D. Patel;J. Neutel - 通讯作者:
J. Neutel
ADDITIVITY OF NEBIVOLOL/VALSARTAN SINGLE-PILL COMBINATIONS VERSUS OTHER APPROVED SINGLE-PILL COMBINATIONS FOR HYPERTENSION
- DOI:
10.1016/s0735-1097(17)35081-7 - 发表时间:
2017-03-21 - 期刊:
- 影响因子:
- 作者:
Jack Ishak;Michael Rael;Henry Punzi;Alan Gradman;Lynn M. Anderson;Mehul D. Patel;Sanjida Ali;William Ferguson;Joel Neutel - 通讯作者:
Joel Neutel
Do We Need a New Nomenclature for Atypical Antipsychotics? A Survey of Health Care Professionals and Patients.
我们是否需要非典型抗精神病药物的新命名法?
- DOI:
- 发表时间:
2023 - 期刊:
- 影响因子:0
- 作者:
G. Mattingly;Tina Matthews;Mehul D. Patel;Kenneth Kramer;S. Stahl - 通讯作者:
S. Stahl
Cariprazine for the treatment of bipolar mania with mixed features: A post hoc pooled analysis of 3 trials.
卡利拉嗪治疗具有混合特征的双相躁狂:3 项试验的事后汇总分析。
- DOI:
- 发表时间:
2019 - 期刊:
- 影响因子:6.6
- 作者:
R. McIntyre;P. Masand;W. Earley;Mehul D. Patel - 通讯作者:
Mehul D. Patel
Modernizing Informed Consent During Emergency Care.
实现紧急护理期间知情同意的现代化。
- DOI:
- 发表时间:
2020 - 期刊:
- 影响因子:6.2
- 作者:
Mehul D. Patel;Brooke L Namboodri;T. Platts - 通讯作者:
T. Platts
Mehul D. Patel的其他文献
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{{ truncateString('Mehul D. Patel', 18)}}的其他基金
Regional Trauma Systems of Care to Address Rural Disparities in Injury Mortality
解决农村伤害死亡率差异的区域创伤护理系统
- 批准号:
10790406 - 财政年份:2023
- 资助金额:
$ 59.12万 - 项目类别:
Understanding and Addressing Disparities in Triage and Disposition Decisions in the Emergency Department
了解并解决急诊科分诊和处置决策中的差异
- 批准号:
10510091 - 财政年份:2022
- 资助金额:
$ 59.12万 - 项目类别:
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