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Determining the Need for Thrombectomy-Capable Stroke Centers Based on Travel Time to the Nearest Comprehensive Stroke
Insights
Many Thrombectomy-Capable Stroke Centers (TSCs) are in low-need areas, suggesting a need to re-evaluate their placement. This analysis helps optimize stroke care systems by assessing travel times to Comprehensive Stroke Centers (CSCs).
Area of Science:
- Neurology
- Health Services Research
- Emergency Medicine
Background:
- The Joint Commission established Thrombectomy-Capable Stroke Center (TSC) certification in 2018 for hospitals performing endovascular thrombectomy for large vessel occlusion ischemic strokes.
- This certification targets hospitals not geographically close to Comprehensive Stroke Centers (CSCs).
- The study aimed to assess the need for TSCs based on proximity to CSCs.
Purpose of the Study:
- To determine travel times between existing/potential TSCs and the nearest CSC.
- To evaluate the proportion of TSCs located in areas with significant need for stroke intervention services.
Main Methods:
- Mapped 44 current and applicant TSCs and identified the closest CSC for each.
- Utilized Google Maps to estimate travel times at various hours on Wednesdays.
- Classified TSC service areas based on drive times (>30 or >60 minutes) to the nearest CSC.
Main Results:
- Using a 30-minute threshold and minimum drive times, 68.2% of TSCs were in very low need areas, while 29.5% were in very high need areas.
- With maximum drive times, 31.8% of TSCs fell into high need and 31.8% into very high need categories.
- Even with a 60-minute threshold, 25.0% of TSCs remained in very high need areas.
Conclusions:
- A significant number of TSCs are situated in areas with minimal need, based on a 30-minute travel time to CSCs.
- The developed methodology can assist regional authorities in integrating TSCs into stroke care systems and prehospital destination protocols.
- Findings suggest a potential need for strategic redistribution or reassessment of TSC locations to better serve high-need populations.
Background:
In January 2018 The Joint Commission introduced its Thrombectomy-Capable Stroke Center (TSC) certification program to recognize hospitals capable of performing endovascular thrombectomy for patients with ischemic strokes due to large vessel occlusions, intended for hospitals not in close geographic proximity to Comprehensive Stroke Centers (CSCs). This study was conducted to determine (1) the travel times between current and potential TSCs and the nearest CSC and (2) the proportion of TSCs that were in areas of high need.
Methods:
The locations of current and applicant TSCs (N = 44) were mapped and paired with the closest CSCs. Google Maps estimated travel times for each pair at 8:00 a.m., 12:00 a.m., and 5:00 p.m. on Wednesdays, providing the minimum, maximum, and midpoint for each period. The area served by each TSC was classified based on the number of time periods with drive times > 30 or > 60 minutes to the closest CSC ("very low need" [0 of 3], "low need" [1 of 3], "high need" [2 of 3], or "very high need" [3 of 3]).
Results:
Using minimum drive times and the > 30 minute to the nearest CSC threshold, 68.2% of the 44 TSCs were in very low need areas, and 29.5% were in very high need areas. Using maximum drive times, 31.8% were in high need areas, and 31.8% were in very high need areas. With a 60-minute threshold, 25.0% were still in very high need areas.
Conclusion:
Many TSCs were in very low need areas using a 30-minute threshold. This methodology may help regional authorities determine how a TSC should be included in stroke systems of care prehospital destination protocols.
