Enhancing Stroke Prehospital and Emergency Evaluation and Delivery (E-SPEED)

美国每年有近80万人受到中风的影响， 成人残疾的原因和第五大死亡原因。尽管全国范围内的中风中心激增， 及时获得中风护理和循证治疗的机会仍然很差，而且效率低下， 冗余，错误和基于系统的障碍，导致护理碎片化。中风护理系统， 整合和协调非卒中中心医院、初级卒中中心之间的护理， 综合中风中心已被推荐，因为它将减少20000中风相关的死亡 每年在美国和近400，000世界各地。这一建议意义重大，因为它涉及两个 卒中患者急性评估和治疗知识的重要空白：院前 筛查错误和医院间转移的延迟。加强脑卒中院前急救 评估和交付（E-SPEED）研究将（1）增强现有的LVO筛查工具，评估是否 机器学习方法可改善LVO预测，并评估增强型LVO的影响 筛选工具在院前设置;和（2）使用学习协作和模拟设计， 实施并试点测试一项新的医院间卒中转移协议。我们将系统工程师聚集在一起， 和中风健康服务研究人员在一个新的合作，将产生普遍的知识， 可以广泛应用于全国其他城市地区，并提供初步的数据和示范， 可以在多个国家的大规模比较有效性研究中评估的新方法 地区

Nearly 800,000 people in the United States (US) each year are affected by stroke, which remains the leading cause of adult disability and 5th leading cause of death. Despite the proliferation of stroke centers nationwide, access to timely stroke care and evidence-based therapies is still poor with multiple inefficiencies, redundancies, errors, and system-based barriers that lead to care fragmentation. A stroke system of care that integrates and coordinates care between non-stroke center hospitals, primary stroke centers, and comprehensive stroke centers has been recommended since it would reduce stroke-related deaths by 20,000 annually in the US and nearly 400,000 worldwide. This proposal is significant because it addresses two important gaps in knowledge about the acute evaluation and treatment of stroke patients: prehospital screening errors and delays in inter-hospital transfer. The Enhancing Stroke Prehospital and Emergency Evaluation and Delivery (E-SPEED) study will (1) enhance existing LVO screening tools, assess whether machine learning approaches improve LVO prediction, and evaluate the impact of an Enhanced LVO Screening Tool in the prehospital setting; and (2) use learning collaboratives and simulations to design, implement, and pilot test a new inter-hospital stroke transfer protocol. We bring together systems engineers and stroke health service researchers in a novel collaboration that will produce generalizable knowledge that can be widely applied to other urban regions of the country and provide preliminary data and demonstration of novel approaches that could be evaluated in large-scale comparative effectiveness studies across multiple regions.