scholarly journals Analisis Perbandingan Biaya Langsung (Direct Cost) dan Biaya Tidak Langsung (Indirect Cost) pada Pasien Stroke Di Rumah Sakit

2017 ◽  
Vol 2 (2) ◽  
Author(s):  
Destanul Aulia, SKM, MBA-HM, MEc, PhD ◽  
Sri Fajar Ayu ◽  
Nefonafratilova Nefonafratilova
Keyword(s):  
Ischemic Stroke ◽  
Indirect Cost ◽  
Direct Cost ◽  
Average Cost ◽  
Hemorrhagic Stroke ◽  
Indirect Costs ◽  
Total Direct Cost ◽  
Stroke Patients ◽  
Stroke Treatment ◽  
The Public

Abstrak Stroke dibagi dalam dua kategori, yaitu stroke iskemik dan hemoragik. Setiap tahunnya terdapat 15 juta orang di seluruh dun­ia yang mengalami stroke. Pengobatan stroke memerlukan biaya yang tinggi. Beban akibat penyakit jantung dan stroke dari tahun 2012 hingga 2030 mencapai Rp. 1,7 triliun. Penelitian ini bertujuan untuk menganalisis perbandingan biaya langsung dan tidak langsung yang dikelarkan oleh pasien stroke di RSUD Kota X tahun 2017. Hasil penelitian menunjukkan bahwa jum­lah pasien stroke iskemik lebih banyak dibandingkan pasien stroke hemoragik. Secara rata-rata, lama hari rawat untuk pasien stroke hemoragik lebih lama dibandingkan stroke iskemik. Namun demikian, total biaya pasien stroke jenis iskemik lebih be­sar dibandingkan total biaya pasien stroke hemoragik. Biaya rata-rata yang dikeluarkan pasien stroke hemoragik lebih besar Rp 3.763.750 dibandingkan biaya rata-rata pasien stroke iskemik. Total biaya langsung pasien stroke yaitu Rp. 527.895.000 (54,7%) dan total biaya tidak langsung yaitu Rp. 437.295.000 (45,3%). Disarankan agar masyarakat lebih teratur dalam me­mantau kesehatan, pergerakan tekanan darah dan kemungkinan gejala stroke.Abstract Stroke is divided into two categories, ischemic and hemorrhagic. Each year there are 15 million people around the world who suffer a stroke. Stroke treatment requires a high cost. The burden of heart disease and stroke from 2012 to 2030 reaches Rp. 1,7 trillion. This study aimed to analyze the comparison of direct and indirect costs of stroke patient in X hospital in 2017. The results showed that the number of ischemic stroke patients more than hemorrhagic stroke patients. The average cost of hemorrhagic stroke patients is greater at Rp 3,763,750 than the average cost of ischemic stroke patients. The total direct cost of stroke patients is Rp. 527,895,000 (54.7%) and the total indirect cost of Rp. 437,295,000 (45.3%). It is recommended that the public more actively to monitor health, blood pressure movements, and symptoms of stroke. 

The full cost of tonsillectomy at Children’s hospital 1 in 2019

2021 ◽  
Vol 04 (03) ◽  
pp. 95-106
Author(s):  
Dinh Pham ◽  
◽  
Quynh Nguyen
Keyword(s):  
Indirect Cost ◽  
Direct Cost ◽  
Average Cost ◽  
Indirect Costs ◽  
Maintenance Cost ◽  
Full Cost ◽  
Children's Hospital ◽  
Study Results ◽  
Children’S Hospital ◽  
Plasma Peak

Objective: Determine full cost of tonsillectomy at Children’s Hospital 1 in 2019. Methods: Coss–sectional descriptive study 304 tonsillectomy children at Children’s Hospital 1 in 2019. Results: The study results showed that the cost of tonsillectomy (excluding consultation fees and pre-operation tests) depend on surgery devices. The average cost of cautery tonsillectomy was 1,740, 869 VND (68% direct cost, 32% indirect cost), of the coblator tonsillectomy was 3,610,031 VND 84.58% direct cost, 15.46% indirect cost), and of the plasma peak tonsillectomy one was 3,600,124 VND (84.54% direct cost, 15.46% indirect cost). In 3 surgery methods, the percentage’s cost of drugs, medical disposible items, and operation team were the largest share in direct costs; in indirect costs, the percentage of human management was the highest proportion, followed by the percentage of facility maintenance cost, and the percentage of other regular expenses cost was very low. Conclusion: The average cost of cautery tonsillectomy was 1,740, 869 VND, of the coblator tonsillectomy was 3,610,031 VND, and of the plasma peak tonsillectomy one was 3,600,124 VND.This cost is higher than the current hospital fee the patient or the health insurance paid. This implies a mismatch between input costs and hospital rates. Key words: Tonsillectomy cost, Children’s Hospital 1, cautery, Coblator, Plasma Peak Blade.

scholarly journals Impact of COVID-19 on Acute Stroke Presentation in a Designated COVID-19 Hospital

2021 ◽  
Vol 12 ◽  
Author(s):  
Qing Tan ◽  
Qing-Jun Liu ◽  
Wen-Hui Fan ◽  
Xiao-Yan Du ◽  
Lin Wu ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Stroke ◽  
Hemorrhagic Stroke ◽  
Surgical Operation ◽  
Stroke Patients ◽  
Stroke Treatment ◽  
Patient Arrival ◽  
The Mean ◽  
Set Up ◽  
Mean Time

Objectives: Thousands of designated COVID-19 hospitals have been set up in China to fight the ongoing COVID-19 pandemic. Anecdotal reports indicate a falling rate of acute stroke diagnoses in these hospitals during the COVID-19 period. We conducted an exploratory single-center analysis to estimate the change in acute stroke presentation at the designated COVID-19 hospitals.Methods: This retrospective observational study included all patients admitted to Yongchuan Hospital Affiliated to Chongqing Medical University with acute stroke between January 24 and March 10, 2020. Patient demographics, characteristics of the stroke, treatment details, and clinical outcomes were compared with those of patients admitted in the corresponding period in the year before (2019, “the pre-COVID-19 period”). Subgroup analysis was performed in the ischemic and hemorrhagic stroke groups.Results: A total of 110 patients presented with acute stroke symptoms during the COVID-19 pandemic, compared with 173 patients in the pre-COVID-19 period. A higher proportion of stroke patients presented to the hospital via emergency medical services during the pandemic (48.2 vs. 31.8%, p = 0.006). There was a lower proportion of ischemic stroke patients (50.9 vs. 65.3%, p = 0.016) than in the preceding year. There were significantly fewer patients with 90-day modified Rankin Scale score ≥3 in the COVID-19 period compared with the pre-COVID-19 period (17.3 vs. 30.6%, p = 0.012). Among patients with ischemic stroke, the mean time from patient arrival to vessel puncture for emergency endovascular therapy in the COVID-19 period was shorter than that in the pre-COVID-19 period (109.18 ± 71.39 vs. 270.50 ± 161.51 min, p = 0.002). Among patients with hemorrhagic stroke, the rate of emergency surgical operation in the COVID-19 period was higher than that in the pre-COVID-19 period (48.1 vs. 30.0%, p = 0.047). The mean time from patient arrival to emergency surgical operation (15.31 ± 22.89 vs. 51.72 ± 40.47 min, p = 0.002) was shorter in the COVID-19 period than in the pre-COVID-19 period.Conclusions: Although fewer acute stroke patients sought medical care in this designated COVID-19 hospital during the COVID-19 pandemic, this type of hospital was more efficient for timely treatment of acute stroke. Recognizing how acute strokes presented in designated COVID-19 hospitals will contribute to appropriate adjustments in strategy for dealing with acute stroke during COVID-19 and future pandemics.

Abstract 176: Long Term Mortality in Acute Ischemic Stroke Patients with Nonvalvular Atrial Fibrillation According to Location and Burden of Cerebral Microbleeds

Stroke ◽  
2014 ◽  
Vol 45 (suppl_1) ◽  
Author(s):  
Tae-Jin Song ◽  
Jinkwon Kim ◽  
Dongbeom Song ◽  
Yong-Jae Kim ◽  
Hyo Suk Nam ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Hemorrhagic Stroke ◽  
Independent Predictor ◽  
Stroke Patients ◽  
Risk Of Death ◽  
Long Term Mortality

Background: Cerebral microbleeds (CMBs) were predictive of mortality in elderly and considered as a putative marker for risk of intracranial hemorrhage. Stroke patients with non valvular atrial fibrillation (NVAF) require anticoagulation, which increases the risk of hemorrhages. We investigated association of CMBs with the long term mortality in acute ischemic stroke patients with NVAF. Methods: During 6 years , consecutive ischemic stroke patients who had NVAF and who had undergone brain MRI with a gradient-recalled echo sequence were enrolled. Long-term mortality and causes of death were identified using data from Korean National Statistical Office. Survival analysis was performed whether the presence, number and location of CMBs were related with all causes, cardiovascular, and cerebrovascular mortality during follow-up. Results: Total 506 patients were enrolled during the study period and were followed up for median 2.5 years. CMBs were found in 30.8% of patients (156/506). Oral anticoagulation with warfarin was prescribed at discharge in 477 (82.7%) patients. During follow up, 177 (35%) patients died and cerebrovascular death was noted in 93 patients (81 ischemic stroke and 12 hemorrhagic stroke). After adjusting age, sex and significant variables in univariate analysis (p<0.1), multiple CMBs (≥5) were the independent predictor for all-cause, cardiovascular and ischemic stroke mortalities. The strictly lobar CMBs were associated with hemorrhagic stroke mortality in multivariate Cox regression analysis (HR 4.776, p=0.032) (Figure 1). Conclusions: Multiple CMBs were the independent predictor for the long term mortality in stroke patients with NVAF. Among them, patients with strictly lobar CMBs had a high risk of death due to hemorrhagic stroke. Our findings suggest that detection of CMBs in stroke patients with NVAF are of clinical relevance for predicting long term outcome and that particular concern is necessary in those with strictly lobar CMBs for their increased risk of death due to hemorrhagic stroke. Figure 1.

scholarly journals Comparison of Tryglicerides Levels and Total Cholesterol in Ischemic Stroke and Haemorrhagic Stroke Patients

2020 ◽  
Vol 1 (2) ◽  
pp. 49
Author(s):  
Hijriyah Putri Tarmizi Hasibuan ◽  
Isra Thristy
Keyword(s):  
Ischemic Stroke ◽  
Total Cholesterol ◽  
Large Scale ◽  
Hemorrhagic Stroke ◽  
Total Cholesterol Level ◽  
Haemorrhagic Stroke ◽  
Total Sample ◽  
Stroke Patients ◽  
Average Value ◽  
Significant Difference

Background: Stroke is the second largest cause of death in the world. Stroke is classified based on its etiology as ischemic stroke and hemorrhagic stroke. Most large-scale studies on the risk of total cholesterol and triglyceride levels in stroke are not distinguished between ischemic and hemorrhagic strokes. Purposes: The purpose of this study was to determine the comparison of triglyceride and total cholesterol levels in ischemic stroke patients with hemorrhagic stroke. Method: Descriptive analytic study using medical records of patients at Medan Haji General Hospital in 2018-2019. The number of ischemic stroke patients is 28 patients and hemorrhagic stroke 28 patients with a total sample of 56 patients. Results: In ischemic stroke patients, the average value of triglyceride levels was 144.75 mg/dL and the average value of total cholesterol was 250.93 mg/dL. In hemorrhagic stroke patients, the average value of triglyceride levels is 126.93 mg/dL and the average total cholesterol level is 174.25 mg/dL. Conclusion: From this study we found a significant difference in total cholesterol between ischemic and hemorrhagic strokes. No significant difference was found in triglycerides between ischemic and hemorrhagic strokes.

scholarly journals Admission blood glucose and in-hospital clinical outcome among patients with acute stroke in Inner Mongolia, China

2009 ◽  
Vol 32 (2) ◽  
pp. 151 ◽  
Author(s):  
Ning Wang ◽  
Dawei Qiao ◽  
Weijun Tong ◽  
Fengshan Zhang ◽  
Zhong Ju ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Blood Glucose ◽  
Acute Stroke ◽  
Inner Mongolia ◽  
Odds Ratio ◽  
Logistic Model ◽  
Hemorrhagic Stroke ◽  
Blood Glucose Concentration ◽  
Hospital Death ◽  
Stroke Patients

Purpose: There is still controversy about the association between admission blood glucose concentration and outcome of acute stroke. We studied the association between admission blood glucose and in-hospital death / dependency among acute stroke patients in Inner Mongolia, China. Methods: 2,178 acute ischemic and 1,760 hemorrhagic stroke patients in six hospitals were included in the study. Blood glucose and other study variables were collected within the first 24-hr of hospital admission. Clinical outcomes were evaluated by neurologists during hospitalization. The associations between admission blood glucose and the risk of in-hospital death/dependency were analyzed using a multiple logistic model. Results: There were associations between admission blood glucose and in-hospital death/dependency among patients with acute ischemic or hemorrhagic stroke. Compared with patients with blood glucose < 6.1mmol/L, multivariate-adjusted odds ratio (95% confidence interval) of death/dependency were 0.53 (0.23, 1.27), 2.22 (1.21, 4.11), 1.92 (1.12, 3.33) and 1.91 (1.00, 3.64) for ischemic stroke patients, and 0.93 (0.44, 1.96), 1.42 (0.65, 3.10), 1.98 (1.10, 3.55) and 2.93 (1.40, 6.11) for hemorrhagic stroke patients, with blood glucose 6.1-6.9, 7.0-7.7, 7.8-11.0 and ?11.1mmol/L, respectively. Conclusion: Increased admission blood glucose was associated with death/dependency among patients with acute hemorrhagic and ischemic stroke.

scholarly journals Comparison of Ischemic and Hemorrhagic Stroke in the Medical Ward of Dessie Referral Hospital, Northeast Ethiopia: A Retrospective Study

2021 ◽  
Vol 2021 ◽  
pp. 1-9
Author(s):  
Hussen Abdu ◽  
Fentaw Tadese ◽  
Girma Seyoum
Keyword(s):  
Ischemic Stroke ◽  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Hemorrhagic Stroke ◽  
Medical Ward ◽  
Body Parts ◽  
Middle Cerebral Artery Territory ◽  
Common Site ◽  
Stroke Patients ◽  
Stroke Subtypes

Background. Distinguishing the category of stroke plays a vital role in planning patient care. Simple clinical findings help distinguish the type of stroke. However, there is a need for diagnostic imaging. In Ethiopia, stroke is the most common neurological condition in patients admitted to hospitals. Yet, there are limited data on comparisons of stroke subtypes. Thus, this study was designed to determine the prevalence of stroke and to compare ischemic and hemorrhagic strokes. Methods. A retrospective cross-sectional study design was employed. Medical records containing complete information and confirmed diagnosis using imaging techniques were included. The data were entered into SPSS version 24.0 for analysis. Results with a P value of <0.05 were considered statistically significant. Results. From a total of 312 stroke patients, 204 (65.4%) patients were admitted due to ischemic stroke. More females, 59 (18.9%), were admitted for hemorrhagic stroke than males. In both ischemic, 175 (56.1%) and hemorrhagic, 91 (29.2%) stroke cases, most of the patients were 45 years and above. Middle cerebral artery territory was the most common site of arterial territory infarctions in ischemic stroke, 158 (50.7%). Middle cerebral artery territory also was the most common site of hematoma in hemorrhagic stroke, 91 (29.2%). Infarctions in more than one lobe of the cerebrum (16.4%) and intracerebral hemorrhage in multiple areas of the cerebrum (7.4%) were observed in ischemic as well as hemorrhagic stroke cases. Most of the ischemic, 124 (39.8%), and hemorrhagic, 39 (12.5%), stroke patients presented loss of sensation and weakness of body parts. Hypertension was observed in 124 (39.8%) ischemic and 73 (23.4%) hemorrhagic stroke patients. The mortality rate of ischemic stroke, 47 (15.3%), was two times higher than hemorrhagic stroke, 20 (6.5%). Hypertension was the most common predictor of death in both ischemic and hemorrhagic stroke cases. Conclusions. Ischemic stroke is a common type of stroke in the medical ward of the study hospital. More females were affected by hemorrhagic stroke than males. Middle cerebral artery territory was the most affected area of the brain in both ischemic and hemorrhagic strokes. Most ischemic and hemorrhagic stroke patients were admitted due to loss of sensation and weakness of body parts. Hypertension was the most common risk factor of stroke as well as a predictor of stroke-related deaths. Identification of the stroke subtypes may be important in the management of stroke. Thus, health professionals, government officials, community leaders, and the population at large could be involved in creating awareness about antecedent risk factors and clinical presentations of stroke subtypes.

Animal production studies in Jamaica. IV. The costs of developing and maintaining pangola grass pastures

1964 ◽  
Vol 62 (2) ◽  
pp. 179-186 ◽  
Author(s):  
B. L. Nestel
Keyword(s):  
Indirect Cost ◽  
Direct Cost ◽  
Inverse Relationship ◽  
Indirect Costs ◽  
Animal Production ◽  
Direct And Indirect Costs ◽  
Production Studies ◽  
Total Range ◽  
The Cost

The cost of developing and maintaining pangola grass pastures has been examined under a range of conditions. The direct cost of improving pastures to the stage where they were established as 5–10 acre, fenced, watered units of pangola grass was about £30 per acre. Under favourable conditions this cost could be reduced to £20, but with difficult land or poor techniques the cost could rise to £40 or more per acre. In addition to the direct cost of establishment there was an indirect cost due to land being out of use or stock numbers having to be reduced. This indirect cost appeared to be highest on lands where planting costs were least. It was suggested that there might be an inverse relationship between direct and indirect costs which tended to narrow the total range of establishment costs.

Barriers to Providing Prehospital Care to Ischemic Stroke Patients: Predictors and Impact on Care

2018 ◽  
Vol 33 (5) ◽  
pp. 501-507 ◽  
Author(s):  
Timmy Li ◽  
Jeremy T. Cushman ◽  
Manish N. Shah ◽  
Adam G. Kelly ◽  
David Q. Rich ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Barriers To Care ◽  
Prehospital Care ◽  
Heart Association ◽  
Living Alone ◽  
Stroke Patients ◽  
Publication Type ◽  
Stroke Treatment ◽  
Significant Difference ◽  
The Impact

AbstractIntroductionIschemic stroke treatment is time-sensitive, and barriers to providing prehospital care encountered by Emergency Medical Services (EMS) providers have been under-studied.Hypothesis/ProblemThis study described barriers to providing prehospital care, identified predictors of these barriers, and assessed the impact of these barriers on EMS on-scene time and administration of tissue plasminogen activator (tPA) in the emergency department (ED).MethodsA retrospective cohort study was performed using the Get With The Guidelines-Stroke (GWTG-S; American Heart Association [AHA]; Dallas, Texas USA) registry at two hospitals to identify ischemic stroke patients arriving by EMS. Variables were abstracted from prehospital and hospital medical records and merged with registry data. Barriers to care were grouped into themes. Logistic regression was used to identify predictors of barriers to care, and bi-variate tests were used to assess differences in EMS on-scene time and the proportion of patients receiving tPA between patients with and without barriers.ResultsBarriers to providing prehospital care were documented for 15.5% of patients: 29.6% related to access, 26.7% communication, 23.0% extrication and transportation, 20.0% refusal, and 14.1% assessment/management. Non-white and non-black race (OR: 3.69; 95% CI, 1.63-8.36) and living alone (OR: 1.53; 95% CI, 1.05-2.23) were associated with greater odds of barriers to providing care. The EMS on-scene time was ≥15 minutes for 70.4% of patients who had a barrier to care, compared with 49.0% of patients who did not (P<.001). There was no significant difference in the proportion of patients who were administered tPA between those with and without barriers to care (14.1% vs 19.2%; P=.159).ConclusionsBarriers to providing prehospital care were documented for a sizable proportion of ischemic stroke patients, with the majority related to patient access and communication, and occurred more frequently among non-white and non-black patients and those living alone. Although EMS on-scene time was longer for patients with barriers to care, the proportion of patients receiving tPA in the ED did not differ.LiT, CushmanJT, ShahMN, KellyAG, RichDQ, JonesCMC. Barriers to providing prehospital care to ischemic stroke patients: predictors and impact on care. Prehosp Disaster Med.2018;33(5):501–507.

Abstract P201: Octogenarian and Nonagenarian Outcomes Among Acute Ischemic Stroke Patients

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
RAJAN R GADHIA ◽  
Farhaan S Vahidy ◽  
Tariq Nisar ◽  
Destiny Hooper ◽  
David Chiu ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Stroke ◽  
Acute Ischemic Stroke ◽  
Combined Treatment ◽  
Stroke Patients ◽  
Stroke Treatment ◽  
Intravenous Tissue Plasminogen Activator ◽  
Significant Difference ◽  
Acute Stroke Treatment ◽  
Iv Tpa

Objective: Most acute stroke treatment trials exclude patients above the age of 80. Given the clear benefit of revascularization with intravenous tissue plasminogen activator (IV tPA) and mechanical thrombectomy (MT), we sought to assess functional outcomes in patients treated above the age of 80. Methods: We conducted a review of all patients admitted to Houston Methodist Hospital between January 2019 and August 2020 with an acute ischemic stroke (AIS) presentation[MOU1] for whom premorbid, discharge, and 90 day modified Rankin Scale scores were available. Patients were categorized by acute stroke treatment (IV tPA, MT, both or none[MOU2] ). mRS values were assessed during admission prior to discharge and at 90 days post stroke event. A delta mRS (Discharge vs. 90-day [MOU3] ) was defined and grouped as no change, improved, or worsened to assess overall functional disability in regards to the index stroke presentation. Results: A total of 865 patients with AIS presentation were included, of whom 651 (75.3%) were <80 years and 214 (24.7%) were > 80 years of age at presentation. A total of 208 patients received IV tPA, 176 underwent revascularization with MT only, 71 had both treatments, and 552 had no acute intervention. In patients >80 yrs who had no acute stroke intervention. mRS improvement was noted in 71.4% compared to 54.1% observed in those patients <80 years. Among patients who received IV tPA, 81.5% of > 80 years improved vs. 61.6% in the younger cohort. A similar trend was noted in the MT and combined treatment groups (76.2% vs. 71.2% and 78.6% vs. 79.3%, respectively). Conclusion: Based on our cohort of acute stroke patients, there was no significant difference in outcomes (as measured by delta mRS) for octogenarians and nonagenarians when compared to younger patients. There was a trend towards improvement in the elderly patients. Chronological age by itself may be an insufficient predictor of functional outcome among stroke patients and age cutoffs for enrollment of patients in acute stroke trials may need additional considerations.

Abstract T P267: Development of an EMS Interfacility Ground Transport Protocol for Patients During/After IV tPA Administration for Acute Ischemic Stroke

Stroke ◽  
2014 ◽  
Vol 45 (suppl_1) ◽  
Author(s):  
Kerrin Connelly ◽  
Rishi Gupta ◽  
Raul Nogueira ◽  
Arthur Yancey ◽  
Alexander Isakov ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Stroke ◽  
Acute Ischemic Stroke ◽  
Transport Protocol ◽  
Stroke Patients ◽  
Stroke Registry ◽  
The Public ◽  
State Office ◽  
Stroke Center ◽  
Iv Tpa

Purpose: To standardize the care of acute stroke patients who receive IV tPA being transported by ground EMS from a treating hospital to a stroke center. Background: National consensus guidelines exist for the hospital management of patients receiving IV tPA for acute ischemic stroke. Such patients require close monitoring and management to minimize risk of clinical deterioration. Although patients are often emergently transported from local hospitals to a stroke center, there are no treatment specific national guidelines for managing such patients enroute. As a result, there is a need to develop and implement a standardized approach to guide EMS personnel, particularly in states like Georgia where the public health burden of stroke is high. Methods: In 2012, the “Georgia EMS Interfacility Ground Transport Protocol for Patients during/after IV tPA Administration for Acute Ischemic Stroke” was developed in conjunction with the Georgia Coverdell Acute Stroke Registry, the Georgia State Office of EMS, a representative group of Georgia hospitals and EMS providers. Stakeholders were brought together with the goal of creating a unified statewide protocol. The intent was to create a streamlined protocol which could be readily implemented by pre-hospital care providers. Results: Stakeholders discussed challenges and opportunities to change the process of pre-hospital care. Challenges included recognition of the broad diversity of EMS providers representing over 250 agencies in the state. Opportunities included establishing the framework for greater collaboration across organizations and providers. The final protocol was endorsed by both the Georgia Coverdell Acute Stroke Registry and the State Office of EMS, and distributed to all EMS regions in Georgia. EMS agencies are currently implementing the protocol. Conclusion: Engaging a diverse group of statewide stakeholders to develop a new treatment protocol enhances success in implementation and serves to further the public health mission of improving care of acute stroke patients.

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