Expanding resources of endovascular thrombectomy: An optimization model

Area of Science:

• Healthcare Management
• Public Health
• Emergency Medicine

Background:

• Existing models for selecting endovascular thrombectomy (EVT) capable hospitals overlook prehospital stroke assessment accuracy and secondary transport needs.
• Current medical resource allocation strategies may not optimally position EVT-capable facilities for maximum patient benefit.

Purpose of the Study:

• To propose a novel model for identifying existing intravenous thrombolysis-capable hospitals suitable for upgrading to EVT capability.
• To optimize the selection of EVT hospital locations considering patient flow and treatment times.

Main Methods:

• A mixed integer programming model was developed to sequentially upgrade hospitals based on current resource allocation.
• A centralized plan was drafted to redistribute EVT resources by re-evaluating hospital locations.
• The model was validated using historical data from 7679 suspected stroke patients to maximize EVT treatment within the call-to-definitive-treatment time.

Main Results:

• Under the current model, all suspected stroke patients were directed to EVT-capable hospitals.
• Upgrading one additional hospital increased the percentage of patients receiving timely EVT treatment from 68.82% to 72.97%.
• The model indicated that upgrading three or more hospitals would ensure all suspected stroke patients are sent directly to EVT-capable facilities.

Conclusions:

• The proposed model ensures all eligible acute stroke patients are directed to EVT-capable hospitals within the simulation.
• This approach provides valuable insights for optimizing healthcare capacity redistribution in other regions for stroke care.