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).

项目概要/摘要 中风是死亡和严重长期残疾的主要原因，对农村地区尤其具有破坏性 社区。在美国，农村地区的中风死亡率估计比其他地区高 30% 城市地区。获得时间敏感的急性中风治疗的机会有限是农村地区差异的一个重要原因 中风发病率和死亡率。协调紧急医疗服务的区域中风护理系统 (EMS)、急诊科、机构间转运机构和医院可以改善获得急症的机会 为服务不足的人群提供中风护理。然而，有效且高效的中风系统设计的证据 并且缺乏策略。通过 EMS 进行院前中风筛查并直接送往中风中心 专门提供高级护理可以显着缩短治疗时间并改善患者状况 结果。然而，最佳的 EMS 中风分诊和转运策略可最大限度地提高中风的益处 患者和有效使用紧急医疗资源在很大程度上是未知的，并且取决于区域和地区 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， 允许中风系统规划者比较区域化 EMS 分诊和转运策略的潜在影响 农村卒中结果和医疗保健资源利用。决策分析模型是一种严格的、 整合信息源的灵活方法，以对系统级策略进行计算机测试 不同的背景。这些比较证据为决策者提供了有价值且及时的信息 为现实世界的实施和评估量身定制干预措施。使用现有的现实世界数据源， 公布的证据和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 中风分诊 优化农村中风患者功能结果的运输策略； (2) 估计潜力 农村急救分诊和运输对医疗保健资源利用的全系统影响； (3) 理解 农村人口和医疗保健系统特征对优化 EMS 卒中分诊的影响 运输策略。为了回应 NOT-MD-20-025，该项目旨在了解和解决中风问题 通过改善服务不足的农村人口获得及时急症护理的机会来缩小差距。成功后 完成后，我们将贡献一个新颖的决策支持框架来理解和改善区域 不同环境下的中风护理系统。我们未来的研究将实施精细的 EMS 中风分诊 和运输策略进入农村系统并前瞻性评估长期患者结果和 医疗费用。该研究领域具有解决重大发病率和死亡率的巨大潜力， 急性中风和其他依赖时间和资源的医疗紧急情况（例如， 心肌梗塞、脓毒症和外伤）。