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Optimization modeling to maximize population access to comprehensive stroke centers.

Michael T Mullen1, Charles C Branas2, Scott E Kasner2

  • 1From the Department of Neurology, School of Medicine (M.T.M., S.E.K.), and Department of Biostatistics and Epidemiology (C.C.B., B.G.C.), University of Pennsylvania, Philadelphia; School of Medicine (C.W.), Duke University, Durham, NC; Department of Geography and Environmental Engineering (J.C.W.), Johns Hopkins University, Baltimore, MD; Department of Epidemiology, School of Public Health (K.C.A.), Health Services and Outcomes Research Center for Outcome and Effectiveness Research and Education (K.C.A.), and Center of Excellence in Comparative Effectiveness Research for Eliminating Disparities/Minority Health & Health Disparities Research Center (K.C.A.), University of Alabama at Birmingham; and Department of Emergency Medicine (B.G.C.), School of Medicine, Thomas Jefferson University, Philadelphia, PA. michael.mullen@uphs.upenn.edu.

Neurology
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Summary
This summary is machine-generated.

Optimally locating comprehensive stroke centers (CSCs) can improve access to stroke care. However, even with ideal placement, a significant portion of the US population may still lack timely access to CSCs.

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Area of Science:

  • Health Services Research
  • Emergency Medicine
  • Health Systems Engineering

Background:

  • Access to comprehensive stroke centers (CSCs) is vital for timely acute stroke therapy.
  • Primary stroke centers (PSCs) can be converted to CSCs to improve geographic coverage.
  • Optimization modeling can simulate the impact of converting PSCs to CSCs.

Purpose of the Study:

  • To simulate the population-level impact of converting PSCs to CSCs on access to stroke care.
  • To identify optimal locations for new CSCs to maximize patient access within 60 minutes.
  • To evaluate the influence of regional factors and EMS policies on CSC accessibility.

Main Methods:

  • A population-level virtual trial using optimization modeling was conducted.
  • Up to 20 PSCs per state were selected for conversion to CSCs.
  • Access to CSCs by ground and air was analyzed, considering regional variations and EMS routing policies.

Main Results:

  • In 2010, 65.8% of the US population had 60-minute ground access to a PSC.
  • Converting PSCs to CSCs increased 60-minute ground/air access to 86.0% of the population.
  • Ground access was significantly lower in Stroke Belt states and states without preferential EMS routing policies.

Conclusions:

  • System simulation and optimization modeling are effective tools for enhancing healthcare accessibility.
  • Despite optimal CSC placement, a substantial percentage of the US population may remain outside the 60-minute access window.
  • Targeted strategies are needed to address disparities in stroke care access, particularly in underserved regions.