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Abstract TP233: Comprehensive Stroke Center Optimization in the United States


 Background:
 Stroke is a time critical disease. Regionalized systems of care are necessary to ensure that patients can be rapidly transported to hospitals with the necessary resources to provide high quality care. The introduction of comprehensive stroke center (CSC) certification presents a unique opportunity to use systems science to guide the development of population-based stroke care for the US. We aim to describe the impact of optimally placed CSCs on access to stroke care nationwide.
 
 
 Methods:
 We defined access as the percentage of people per state who could reach a CSC in 60 minutes or less by ground EMS transport, calculated using road network distances, posted speeds and empirically-derived prehospital care intervals. Hospitals certified as Joint Commission primary stroke centers (PSC) by 12/31/2010 were considered candidate sites. A greedy adding algorithm, in which CSCs were sequentially added to the system while building upon the previously prescribed system, was used to sequentially determine the best locations for up to 20 CSCs per state.
 
 
 Results:
 The average state reached a maximum of 53.3% (IQR 35.0-71.6%) access with a mean marginal increase of 31.0% (IQR 16.2-40.8%) for the 1
 st
 , 8.8% (IQR 5.1-13.1%) for the 2
 nd
 , and 4.2% (IQR 0.0-6.8%) for the 3
 rd
 CSC addition (partial results shown in Figure).
 
 
 Conclusions:
 Operations research techniques can inform the design of efficient stroke care systems by determining optimal locations for CSCs. However, existing candidate sites are clustered and ground transport alone leaves much of the population without access. Collaborative approaches including prehospital helicopter transport and inter-facility transfers need to be developed to ensure access to high quality care for all Americans.
 
 
 
