Geographic Modeling to Quantify the Impact of Primary and Comprehensive Stroke Center Destination Policies. Issue 4 (April 2018)

• Record Type: Journal Article
• Authors: Mullen, Michael T.; Pajerowski, William; Messé, Steven R.; Mechem, C. Crawford; Jia, Judy; Abboud, Michael; David, Guy; Carr, Brendan G.; Band, Roger
• Is Part Of: Stroke. Volume 49:Issue 4(2018)
• Publication Date: 2018-04
• Subjects: emergency medical services -- policy -- stroke -- thrombectomy -- tissue-type plasminogen activator; Cerebrovascular disease -- Periodicals; Cerebral circulation -- Periodicals; 616.81
• DOI: 10.1161/STROKEAHA.118.020691
• Languages: English
• ISSNs: 0039-2499

Abstract

Abstract : Background and Purpose—: We evaluated the impact of a primary stroke center (PSC) destination policy in a major metropolitan city and used geographic modeling to evaluate expected changes for a comprehensive stroke center policy. Methods—: We identified suspected stroke emergency medical services encounters from 1/1/2004 to 12/31/2013 in Philadelphia, PA. Transport times were compared before and after initiation of a PSC destination policy on 10/3/2011. Geographic modeling estimated the impact of bypassing the closest hospital for the closest PSC and for the closest comprehensive stroke center. Results—: There were 2 326 943 emergency medical services runs during the study period, of which 15 099 had a provider diagnosis of stroke. Bypassing the closest hospital for a PSC was common before the official policy and increased steadily over time. Geographic modeling suggested that bypassing the closest hospital in favor of the closest PSC adds a median of 3.1 minutes to transport time. Bypassing to the closest comprehensive stroke center would add a median of 8.3 minutes. Conclusions—: Within a large metropolitan area, the time cost of routing patients preferentially to PSCs and comprehensive stroke centers is low. Abstract : Supplemental Digital Content is available in the text.