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).

项目摘要/摘要 中风是死亡和严重的长期残疾的主要原因，尤其是毁灭性的农村 社区。在美国，农村地区的中风死亡率比 城市地区。有限的时间敏感急性急性中风疗法是农村差异的重要原因 在中风的发病率和死亡率中。协调紧急医疗服务的区域中风系统 （EMS），急诊部门，实地转移机构和医院可以改善急性的机会 对服务不足的人群的中风护理。但是，有效，高效的中风系统设计的证据 缺乏策略。院前中风筛查通过EMS并直接路由到中风中心 专门提供高级护理可以大大减少治疗时间并改善患者 结果。但是，最佳的EMS中风分类和运输策略，可最大程度地利益中风 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 本地特征。因此，我们的总体目标是开发一个决策分析系统模型 允许中风系统规划人员比较区域化EMS分类和运输策略的潜在影响 关于农村中风成果和医疗资源利用。决策分析建模是一种严格的 灵活的方法是整合信息源以在系统级策略的硅测试中进行操作 不同的上下文。这种比较证据为决策者提供了宝贵，及时的信息 量身定制的干预措施，以实施和评估。使用现有的现实世界数据源， 已发表的证据和主要利益相关者的投入，我们将建立一个计算机模型的区域化模型 北卡罗来纳州70个农村县的中风护理。我们的具体目的是：（1）确定EMS中风分流 和运输策略，以优化农村中风患者的功能结果； （2）估计潜力 农村EMS分类和运输对卫生保健资源利用的影响； （3）理解 农村人口和医疗保健系统特征对优化EMS中风分流和 运输策略。为了响应NOT-MD-20-025，该项目旨在理解和解决中风 通过改善服务不足的农村人口的及时急性护理来改善差异。成功 完成，我们将为理解和改善区域的新型决策支持框架做出贡献 各种环境中的中风系统。我们未来的研究将实施精致的EMS中风分流 并将策略运输到农村系统，并前瞻性评估长期的患者结果和 医疗保健费用。这项研究有很高的潜力来解决重大的发病率和死亡率， 由急性中风和其他时间和资源依赖的医疗紧急情况引起的健康差异（例如 心肌梗塞，败血症和创伤）。