Project Summary/Abstract
Stroke is a leading cause of death and serious long-term disability and particularly devastating to rural
communities. In the United States, rural areas have an estimated 30% greater stroke mortality compared to
urban areas. Limited access to time-sensitive acute stroke therapies is an important cause of rural disparities
in stroke morbidity and mortality. Regional stroke systems of care that coordinate emergency medical services
(EMS), emergency departments, inter-facility transfer agencies, and hospitals can improve access to acute
stroke care for underserved populations. However, evidence on effective and efficient stroke system designs
and strategies is lacking. Prehospital stroke screening by EMS and routing directly to a stroke center
specialized in providing advanced care can significantly reduce time to treatment and improve patient
outcomes. However, optimal EMS stroke triage and transport strategies that maximize benefit to stroke
patients and efficiently use emergency medical resources are largely unknown and depend on regional and
local characteristics. Therefore, our overall objective is to develop a decision-analytic systems model that
allows stroke system planners to compare potential effects of regionalized EMS triage and transport strategies
on rural stroke outcomes and health care resource utilization. Decision-analytic modeling is a rigorous and
flexible approach for integrating information sources to conduct in silico testing of system-level strategies under
varying contexts. This comparative evidence provides valuable and timely information to decision makers to
tailor interventions for real-world implementation and evaluation. Using existing real-world data sources,
published evidence, and key stakeholder input, we will build a computer simulation model of regionalized
stroke care for 70 rural counties in North Carolina. Our specific aims are to: (1) determine EMS stroke triage
and transport strategies that optimize functional outcomes in rural stroke patients; (2) estimate the potential
system-wide effects of rural EMS triage and transport on health care resource utilization; and (3) understand
the influence of rural population and health care system characteristics on optimizing EMS stroke triage and
transport strategies. In response to NOT-MD-20-025, this project aims to understand and address stroke
disparities by improving access to timely acute care for underserved rural populations. Upon successful
completion, we will have contributed a novel decision support framework to understand and improve regional
stroke systems of care across various settings. Our future research will implement refined EMS stroke triage
and transport strategies into rural systems and prospectively evaluate long-term patient outcomes and
healthcare costs. This line of research has high potential to address significant morbidity and mortality and
health disparities caused by acute stroke and other time- and resource-dependent medical emergencies (e.g.,
myocardial infarction, sepsis, and trauma).
