Impact of Regionalization of Care in Acute Stroke Patients

中风是美国第三大死亡原因，也是导致残疾的主要单一原因。的 估计2008年中风的直接和间接费用约为650亿美元。根据先前的研究， 早期的预防和治疗可以降低与中风相关的发病率和费用。溶栓 静脉注射组织型纤溶酶原激活剂（IV t-PA）仍然是治疗急性缺血性心脏病的唯一有效方法。 在症状发作后3小时内出现的中风患者，无明确的禁忌症。但据 还已知缺血性卒中患者中t-PA的使用率仅为2- 3%。大规模的研究 溶栓率低是由于患者对卒中症状缺乏认识， 获得紧急医疗服务（EMS）和医院延误，如缺乏快速分诊。因此， 众所周知，科学上需要多学科方法来提高t-PA的使用率， 符合条件的急性卒中患者。除了提高对早期中风识别的认识外， 在社区，脑攻击联盟（BAG）确定，两个级别的中风护理，即初级和 建立综合性中风中心，以改善中风的急诊和其他类型的临床护理。 随着经认证的初级卒中中心的建立和初级卒中中心护理质量改善的证据， 中风中心、县政府和EMS机构制定了政策，以绕过最近的紧急情况 部门和运输中风病人到主要中风中心。尽管多个县正在采用 政策变化对区域患者结局的影响尚未确定 通过科学证据。此外，关于院前提供者识别卒中的准确性的研究 已经表明，在笔画识别方面有相当大的改进空间。为了解决这些问题， 我建议进行一项研究，主要目标是研究区域化患者结局的比较。 和非区域化中风系统。第二个目标将是评估以下方面的成本效益： 区域化护理和系统区域化前后院前卒中识别的准确性。 相关性（参见说明）： 研究结果将有助于确定1）静脉注射t-PA使用率的地区差异， 急性缺血性卒中患者的死亡率2）主要卒中中心患者数量增加的影响 和更长的运输时间内的区域化系统对病人的结果。通过提供证据， 我们的研究将提供科学知识， 在国家一级对公共卫生具有重大意义的卫生政策变化。

Stroke is the third leading cause of death and leading single cause of disability in the United States. The estimated direct and indirect costs of stroke for 2008 are about $65 billion. It is known from prior research that early recogniton and treatment reduces the morbidity and costs associated with stroke. Thrombolysis with intravenous tissue plasminogen activator (IV t-PA) remains the only proven treatment for acute ischemic stroke who present within three hours of symptom onset with no established contraindication. However, it is also known that the rate of t-PA use in ischemic stroke patients is only 2-3%. Large scale studies have shown that poor rates of thrombolysis are due to lack of patient recognition of stroke symptoms, delay in accessing Emergency Medical Services (EMS) and in-hospital delays like lack of expedited triage.Therefore, it is well known scientifically that a multi-disciplinary approach is necessary to improve the rate of t-PA use in eligible acute stroke patients. In addition to improving knowledge on early stroke recognition in the community, the Brain Attack Coalition (BAG) determined that two levels of stroke care i.e primary and comprehensive stroke centers be created to improve emergency and other types of clinical care for stroke. With establishment of certified primary stroke centers and evidence for improved quality of care at primary stroke centers, county authorities and EMS agencies created policies to bypass the nearest emergency department and transport stroke patients to primary stroke centers. Although multiple counties are adopting the change, the impact of the policy change on regional patient outcomes has not yet been established through scientific evidence. In addition, studies on accuracy of stroke recognition by prehospital providers have shown that there is considerable scope for improvement in stroke recognition. To address these issues, I propose to conduct a study with the primary goal of studying comparative patient outcomes in regionalized and non-regionalized stroke systems. The secondary goals will be to assess the cost-effectiveness of regionalized care and accuracy of prehospital stroke recognition before and after regionalization of systems. RELEVANCE (See instructions): The study results will help to determine 1) regional differences in the rate of intravenous t-PA use and mortality among acute ischemic stroke patients 2) the impact of increasing volume in primary stroke centers and longer transport times within a regionalized system on patient outcomes.By providing evidence for patient outcomes in a regionalized stroke system.our research will provide scientific knowledge to promote health policy changes of great public health importance at a national level.