PROJECT TITLE: OPTIMIZATION MODELING AND COMPARATIVE EFFECTIVENESS OF REGIONALIZED STROKE CARE PI: CHARLES CHRISTOS BRANAS, PHD Abstract: In the United States, stroke is the leading cause of serious, long-term disability and the third leading cause of death. Every 40 seconds someone experiences a stroke and every 3-4 minutes someone dies from a stroke. The projected national direct and indirect cost of stroke for 2008 is $65.5 billion. In 2002, a landmark study demonstrated a marked improvement in outcomes for patients treated with medical therapy within 3 hours of symptom onset. Despite this, as of 2004, between 1% and 3% of victims of ischemic stroke were receiving the definitive therapy. Certification of primary stroke centers by the joint commission began in 2003, and treatment at a definitive stroke center has been associated with improved outcomes. The broad objective of this proposal is to use operations research techniques to promote the development of optimized regional stroke systems and to compare the effectiveness of different regionalization schemes to improve population access to stroke center care.
The specific aims of this proposal are 1) to use geographic information systems technology to determine the proportion of the US population that is able to rapidly access existing, definitive stroke center hospital care in all 50 states and the District of Columbia, 2) to use geographic information systems and models describing emergency medical transportation to compare the ability of competing regionalization schemes to rapidly deliver patients to existing stroke center hospitals in all 50 states and the District of Columbia, 3) to create an operations research model that simulates the optimal distribution of stroke center hospitals and air ambulances in order to maximize rapid access to specialized stroke care in all 50 States and the District of Columbia, &4) to use geographic information systems and models describing emergency medical transportation to compare population access to definitive stroke center care using the existing distribution of US stroke center hospitals compared to the optimal distribution of stroke center hospitals in all 50 states and the District of Columbia. We will present our findings at the level of the state in both mathematical and visual format. This study has the capacity to inform the further development of the US stroke system, and in so doing, to optimize the delivery of definitive stroke care to the population.

Public Health Relevance

The proposed study aims to use geographic information systems and optimization modeling to calculate population access to a primary stroke center, to compare the effectiveness of different schemes of regionalizing stroke care, and to develop an optimal solution to the distribution of primary stroke centers in all 50 states and the District of Columbia. We will compare the existing system to the proposed optimized model. Data will be presented at the level of the state in statistical and visual format. This study has the capacity to inform the further development of the US stroke system and to thereby improve stroke related morbidity and mortality.

Agency
National Institute of Health (NIH)
Institute
Agency for Healthcare Research and Quality (AHRQ)
Type
Research Project (R01)
Project #
5R01HS018362-03
Application #
8308960
Study Section
Health Systems Research (HSR)
Program Officer
Hagan, Michael
Project Start
2010-09-30
Project End
2014-07-31
Budget Start
2012-08-01
Budget End
2013-07-31
Support Year
3
Fiscal Year
2012
Total Cost
Indirect Cost
Name
University of Pennsylvania
Department
Biostatistics & Other Math Sci
Type
Schools of Medicine
DUNS #
042250712
City
Philadelphia
State
PA
Country
United States
Zip Code
19104
Mullen, Michael T; Kasner, Scott E; Kallan, Michael J et al. (2013) Joint commission primary stroke centers utilize more rt-PA in the nationwide inpatient sample. J Am Heart Assoc 2:e000071
Mullen, Michael T; Judd, Suzanne; Howard, Virginia J et al. (2013) Disparities in evaluation at certified primary stroke centers: reasons for geographic and racial differences in stroke. Stroke 44:1930-5
Ward, Michael J; Shutter, Lori A; Branas, Charles C et al. (2012) Geographic access to US Neurocritical Care Units registered with the Neurocritical Care Society. Neurocrit Care 16:232-40
Meisel, Zachary F; Pines, Jesse M; Polsky, Daniel et al. (2011) Variations in ambulance use in the United States: the role of health insurance. Acad Emerg Med 18:1036-44