scholarly journals Stroke care networks and the impact on quality of care

2021 ◽  
Author(s):  
Jan Schoenfelder ◽  
Mansour Zarrin ◽  
Remo Griesbaum ◽  
Ansgar Berlis
Keyword(s):  
Network Design ◽  
Rural Areas ◽  
Stroke Care ◽  
Treatment Method ◽  
Stroke Units ◽  
Levels Of Care ◽  
Improvement Potential ◽  
Current Design ◽  
The Impact ◽  
Travel Distances

AbstractLack of rapidly available neurological expertise, especially in rural areas, is one of the key obstacles in stroke care. Stroke care networks attempt to address this challenge by connecting hospitals with specialized stroke centers, stroke units, and hospitals of lower levels of care. While the benefits of stroke care networks are well-documented, travel distances are likely to increase when patients are transferred almost exclusively between members of the same network. This is particularly important for patients who require mechanical thrombectomy, an increasingly employed treatment method that requires equipment and expertise available in specialized stroke centers. This study aims to analyze the performance of the current design of stroke care networks in Bavaria, Germany, and to evaluate the improvement potential when the networks are redesigned to minimize travel distances. To this end, we define three fundamental criteria for assessing network design performance: 1) average travel distances, 2) the populace in the catchment area relative to the number of stroke units, and 3) the ratio of stroke units to lower-care hospitals. We generate several alternative stroke network designs using an analytical approach based on mathematical programming and clustering. Finally, we evaluate the performance of the existing networks in Bavaria via simulation. The results show that the current network design could be significantly improved concerning the average travel distances. Moreover, the existing networks are unnecessarily imbalanced when it comes to their number of stroke units per capita and the ratio of stroke units to lower-care hospitals.

Development of the Madrid Stroke Programme: Milestones and Changes in Stroke Trends and Mortality from 1997 to 2017

2021 ◽  
pp. 1-6
Author(s):  
Silvia Pastor ◽  
Elena de Celis ◽  
Itsaso Losantos García ◽  
María Alonso de Leciñana ◽  
Blanca Fuentes ◽  
...  
Keyword(s):  
Hospital Mortality ◽  
Hospital Admissions ◽  
Temporal Trends ◽  
Intravenous Thrombolysis ◽  
Stroke Care ◽  
Care Organization ◽  
Stroke Units ◽  
Health Region ◽  
Number Of Patients ◽  
The Impact

<b><i>Introduction:</i></b> Stroke is a serious health problem, given it is the second leading cause of death and a major cause of disability in the European Union. Our study aimed to assess the impact of stroke care organization measures (such as the development of stroke units, implementation of a regional stroke code, and treatment with intravenous thrombolysis and mechanical thrombectomy) implemented from 1997 to 2017 on hospital admissions due to stroke and mortality attributed to stroke in the Madrid health region. <b><i>Methods:</i></b> Epidemiological data were obtained from the National Statistics Institute public website. We collected data on the number of patients discharged with a diagnosis of stroke, in-hospital mortality due to stroke and the number of inhabitants in the Madrid health region each year. We calculated rates of discharges and mortality due to stroke and the number of inhabitants per SU bed, and we analysed temporal trends in in-hospital mortality due to stroke using the Daniels test in 2 separate time periods (before and after 2011). Figures representing annual changes in these data from 1997 to 2017 were elaborated, marking stroke care organizational measures in the year they were implemented to visualize their temporal relation with changes in stroke statistics. <b><i>Results:</i></b> Hospital discharges with a diagnosis of stroke have increased from 170.3/100,000 inhabitants in 1997 to 230.23/100,000 inhabitants in 2017. However, the in-hospital mortality rate due to stroke has decreased (from 33.3 to 15.2%). A statistically significant temporal trend towards a decrease in the mortality percentage and rate was found from 1997 to 2011. <b><i>Conclusions:</i></b> Our study illustrates how measures such as the development of stroke units, implementation of a regional stroke code and treatment with intravenous thrombolysis coincide in time with a reduction in in-hospital mortality due to stroke.

scholarly journals Evaluation of Rural Stroke Services

Stroke ◽  
2013 ◽  
Vol 44 (10) ◽  
pp. 2848-2853 ◽  
Author(s):  
Dominique A. Cadilhac ◽  
Tara Purvis ◽  
Monique F. Kilkenny ◽  
Mark Longworth ◽  
Katherine Mohr ◽  
...  
Keyword(s):  
Patient Outcomes ◽  
Rural Areas ◽  
Stroke Care ◽  
Stroke Units ◽  
Care Plans ◽  
Cohort Design ◽  
South Wales ◽  
Health Assessments ◽  
Multivariable Analyses

Background and Purpose— The quality of hospital care for stroke varies, particularly in rural areas. In 2007, funding to improve stroke care became available as part of the Rural Stroke Project (RSP) in New South Wales (Australia). The RSP included the employment of clinical coordinators to establish stroke units or pathways and protocols, and more clinical staff. We aimed to describe the effectiveness of RSP in improving stroke care and patient outcomes. Methods— A historical control cohort design was used. Clinical practice and outcomes at 8 hospitals were compared using 2 medical record reviews of 100 consecutive ischemic or intracerebral hemorrhage patients ≥12 months before RSP and 3 to 6 months after RSP was implemented. Descriptive statistics and multivariable analyses of patient outcomes are presented. Results— Sample: pre-RSP n=750; mean age 74 (SD, 13) years; women 50% and post-RSP n=730; mean age 74 (SD, 13) years; women 46%. Many improvements in stroke care were found after RSP: access to stroke units (pre 0%; post 58%, P <0.001); use of aspirin within 24 hours of ischemic stroke (pre 59%; post 71%, P <0.001); use of care plans (pre 15%; post 63%, P <0.001); and allied health assessments within 48 hours (pre 65%; post 82% P <0.001). After implementation of the RSP, patients directly admitted to an RSP hospital were 89% more likely to be discharged home (adjusted odds ratio, 1.89; 95% confidence interval, 1.34–2.66). Conclusions— Investment in clinical coordinators who implemented organizational change, together with increased clinician resources, effectively improved stroke care in rural hospitals, resulting in more patients being discharged home.

Going the Extra Mile? How Provider Network Design Increases Consumer Travel Distance, Particularly for Rural Consumers

2020 ◽  
Vol 45 (6) ◽  
pp. 1107-1136
Author(s):  
Simon F. Haeder ◽  
David L. Weimer ◽  
Dana B. Mukamel
Keyword(s):  
Network Design ◽  
Rural Areas ◽  
Travel Distance ◽  
Open Networks ◽  
Provider Network ◽  
Network Adequacy ◽  
Cardiac Surgeons ◽  
Almost All ◽  
The Cost ◽  
Travel Distances

Abstract Context: The practical accessibility to medical care facilitated by health insurance plans depends not just on the number of providers within their networks but also on distances consumers must travel to reach the providers. Long travel distances inconvenience almost all consumers and may substantially reduce choice and access to providers for some. Methods: The authors assess mean and median travel distances to cardiac surgeons and pediatricians for participants in (1) plans offered through Covered California, (2) comparable commercial plans, and (3) unrestricted open-network plans. The authors repeat the analysis for higher-quality providers. Findings: The authors find that in all areas, but especially in rural areas, Covered California plan subscribers must travel longer than subscribers in the comparable commercial plan; subscribers to either plan must travel substantially longer than consumers in open networks. Analysis of access to higher-quality providers show somewhat larger travel distances. Differences between ACA and commercial plans are generally substantively small. Conclusions: While network design adds travel distance for all consumers, this may be particularly challenging for transportation-disadvantaged populations. As distance is relevant to both health outcomes and the cost of obtaining care, this analysis provides the basis for more appropriate measures of network adequacy than those currently in use.

scholarly journals Stroke Care in Pakistan

2021 ◽  
pp. 118-121
Author(s):  
Anjum Farooq ◽  
Narayanaswamy Venketasubramanian ◽  
Mohammad Wasay
Keyword(s):  
Acute Stroke ◽  
Plasminogen Activator ◽  
Rural Areas ◽  
Recombinant Tissue Plasminogen Activator ◽  
Stroke Care ◽  
Acute Stroke Care ◽  
Stroke Units ◽  
Stroke Outcomes ◽  
Tissue Plasminogen ◽  
Urban And Rural Areas

Increasing incidence of stroke and lack of infrastructure in both urban and rural areas needs immediate attention in Pakistan. There is a high proportion of young stroke with poor stroke outcomes. Acute stroke care is scarce in Pakistan due to the small number of neurologists (1 neurologist per 1 million population), few stroke units, and limited availability of alteplase (recombinant tissue plasminogen activator) in the country.

scholarly journals Improving Outcomes After Stroke: From Stroke Units to Mobile Stroke Units

Stroke ◽  
2021 ◽  
Author(s):  
Andrei V. Alexandrov ◽  
Yongchai Nilanont
Keyword(s):  
Stroke Care ◽  
Absolute Difference ◽  
Clinical Approach ◽  
Stroke Units ◽  
Stroke Treatment ◽  
Golden Hour ◽  
Systemic Thrombolysis ◽  
Improved Outcomes ◽  
Mobile Stroke Unit ◽  
The Impact

A proactive clinical approach to stroke care improved functional outcomes with implementation of specialized in-hospital stroke units, urgently delivered systemic thrombolysis, mechanical thrombectomy and most recently with mobile stroke units deployed in the field. An 18% absolute difference in outcomes as a shift across all modified Rankin Scale strata at 3 months in the recent Berlin study may not be explained by just 8.8% more patients treated within the golden hour for thrombolytic treatment from symptom onset. These findings parallel the findings in the largest controlled multi-center BEST-MSU trial (Benefits of Stroke Treatment Delivered Using a Mobile Stroke Unit) to date. A shortcoming in blinding of the investigators to the mode of transportation is similar to blinding to the endovascular treatment in PROBE (Prospective Randomized Open, Blinded End-Point) design used in thrombectomy trials. A faster access to stroke experts and brain imaging in the field for all patients suspect of stroke regardless symptom nature, severity, duration or resolution delivered by mobile stroke units is likely the reason for improved outcomes akin the impact observed in the initial multidisciplinary approach to in-hospital stroke units and reperfusion therapies delivery.

Prehospital EMS Triage for Acute Stroke Care

2021 ◽  
Vol 41 (01) ◽  
pp. 005-008
Author(s):  
Ali Reza Noorian
Keyword(s):  
Acute Stroke ◽  
New Technologies ◽  
Systems Of Care ◽  
Prehospital Care ◽  
Stroke Care ◽  
Acute Stroke Care ◽  
Stroke Units ◽  
Levels Of Care ◽  
Stroke Systems Of Care ◽  
Efficient Care

AbstractAcute stroke has had major advances over the last two decades due to the introduction of pharmacologic and endovascular revascularization, which can improve functional outcome. Stroke systems of care have been developed to provide faster, more efficient care for stroke patients. A major part of these care pathways is prehospital care, when patients are triaged to appropriate levels of care. It is essential that prehospital scales are used accurately and effectively by emergency medical services to assist them with the triage process. New technologies including mobile stroke units, telemedicine, and wearable technology have been introduced as options for optimization of this emergent process.

scholarly journals Stroke care during the COVID-19 outbreak in Spain: the experience of Spanish stroke units

2020 ◽  
pp. svn-2020-000678
Author(s):  
María Alonso de Leciñana ◽  
Mar Castellanos ◽  
Óscar Ayo-Martín ◽  
Ana Morales
Keyword(s):  
Incidence Rate ◽  
Disease Incidence ◽  
Intravenous Thrombolysis ◽  
Stroke Care ◽  
Outpatient Clinics ◽  
Activity Data ◽  
Adequate Treatment ◽  
Stroke Units ◽  
The Impact ◽  
Reallocation Of Resources

Background and purposeSpain has been heavily affected by COVID-19. Reallocation of resources for managing the outbreak might have caused a disruption in stroke care. This study analyses the impact on stroke care of reorganising the healthcare system in response to the first COVID-19 outbreak peak in Spain and the strategies adopted by Spanish stroke units to deal with this impact.Materials and methodsWe obtained data from a structured survey sent to the responsible of stroke units across the country. We recorded the number of strokes, stroke code activations, intravenous thrombolysis treatments and mechanical thrombectomies during February and March 2019 and 2020. We also collected information on the impact on workflow metrics and on the availability of specialised neurological care and rehabilitation treatments, the characteristics of stroke care for patients with SARS-CoV-2 infection and the impact on human resources. We compared the activity data between 2019 and 2020 and the information on activity and impact on stroke care between regions classified according to the disease incidence rate.ResultsFifty-seven (75%) of all stroke units in Spain responded to the survey. There was an overall reduction in admissions for all stroke types during the outbreak’s peak and in the number of stroke code activations and intravenous thrombolysis treatments, results that were independent of the COVID-19 incidence rate. Participants reported a delay in workflow metrics and a reduction of admissions to stroke units, outpatient clinics and rehabilitation therapies. Specific pathways and protocols for managing stroke patients with SARS-CoV-2 infection have been established.ConclusionThe COVID-19 outbreak has jeopardised all phases of stroke care. As a consequence, some patients with stroke did not receive adequate treatment.

Emergency department telemedicine consults decrease time to interpret computed tomography of the head in a multi-network cohort

2019 ◽  
pp. 1357633X1987774 ◽  
Author(s):  
Morgan B Swanson ◽  
Aspen C Miller ◽  
Marcia M Ward ◽  
Fred Ullrich ◽  
Kimberly AS Merchant ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Emergency Department ◽  
Rural Areas ◽  
Stroke Care ◽  
Stroke Patients ◽  
Process Outcomes ◽  
Telemedicine Consultation ◽  
Interaction Term ◽  
The Impact ◽  
Improve Access

Introduction Telemedicine can improve access to emergency stroke care in rural areas, but the benefit of telemedicine across different types and models of telemedicine networks is unknown. The objectives of this study were to (a) identify the impact of telemedicine on emergency department (ED) stroke care, (b) identify if telemedicine impact varied by network and (c) describe the variation in process outcomes by telemedicine across EDs. Methods A prospective cohort study identified stroke patients in four telemedicine networks between November 2015 and December 2017. Primary exposure was telemedicine consultation during ED evaluation. Outcomes included: (a) interpretation of computed tomography (CT) of the head within 45 minutes and (b) time to administer tissue plasminogen activator (tPA). An interaction term tested for differences in telemedicine effect on stroke care by network and hospital. Results Of the 932 stroke subjects, 36% received telemedicine consults. For subjects with a last known well time within two hours of ED arrival (27.9%), recommended CT interpretation within 45 minutes was met for 66.8%. Telemedicine was associated with higher odds of timely head CT interpretation (adjusted odds ratio = 3.03; 95% confidence interval (CI) 1.69–5.46). The magnitude of the association between telemedicine and time to interpret a CT of the head differed between telemedicine networks (interaction term p = 0.033). Among eligible patients, telemedicine was associated with faster time to administer tPA (adjusted hazard ratio = 1.81; 95% CI 1.31–2.50). Discussion Telemedicine consultation during the ED encounter decreased the time to interpret at CT of the head among stroke patients, with differing magnitudes of benefit across telemedicine networks. The effect of heterogeneity of telestroke affects across different networks should be explored in future analyses.

A PROPOSED EVALUATION PLAN TO ASSESS THE IMPACT OF A YOUTH DEVELOPMENT PROGRAMME FACILITATED BY THE STATE INFORMATION TECHNOLOGY AGENCY (SITA) IN RURAL SOUTH AFRICA

2017 ◽  
Vol 14 (1) ◽  
pp. 174-181
Author(s):  
Maura Mbunyuza-deHeer Menlah
Keyword(s):  
Information Technology ◽  
Youth Development ◽  
Rural Areas ◽  
Secondary Data ◽  
The State ◽  
State Information ◽  
Evaluation Plan ◽  
Lessons Learnt ◽  
Slow Development ◽  
The Impact

This article reports on a proposed evaluation plan that has been developed to assess the work done by the State Information Technology Agency (SITA). The SITA programme was implemented in response to the South African government’s call to improve the lives of the populations in some rural areas through technology. The programme was meant to address slow development in  rural  areas  that  lack  technological  innovations  and  advances.  In  the proposed evaluation plan a review is made of secondary data, deciding how strategic priorities are to be determined, as well as analysis of the rural context environment. The researcher gives an account of how the evaluation strategies are to be piloted and rolled out thereafter. Lessons learnt are recorded and reported upon. A proposed evaluation plan will be developed, based on the lessons learnt in line with the objectives of the project.

Status, Impact, and Factor Determining Rural Non-farm Economy of India: A Review

2020 ◽  
pp. 68-76
Keyword(s):  
Rural Areas ◽  
Present Status ◽  
Economic Activity ◽  
Rural Livelihoods ◽  
Pivotal Role ◽  
Inclusive Development ◽  
Farm Sector ◽  
Income Inequalities ◽  
Review Study ◽  
The Impact

The rural non-farm sector (RNFS) involves a spectrum of economic activity in rural areas and encompasses all rural productive entities other than farm holdings. It has the potential to play a pivotal role in holistic and inclusive development of India’s rural areas by increasing the employment and wages of rural labour, which can reduce income inequalities. The review was carried out in order to explain the present status of RNFE state wise as well as overall to get a comprehensive view on the topic. The review study also focuses to disaggregate RNFE on the basis of gender, size of landholding and castes. Literature depicting the impact of RNFE on rural livelihoods especially in employment and poverty and factors determining it also been compiled to get an overall idea on the study.

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