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Regionalization of Acute Stroke Care for Rural Populations: A Systems Modeling Approach

Award Number: R01MD018031
ORGANIZATION: NATIONAL CENTER ON MINORITY HEALTH AND HEALTH DISPARITIES
OPDIV: NIH
AWARD CLASS: DISCRETIONARY
AWARD ACTIVITY TYPE: SCIENTIFIC/HEALTH RESEARCH (INCLUDES SURVEYS)

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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).


Issue Date FY	Funding FY	Legal Entity Name	Legal Entity Address	Legal Entity City	Legal Entity State	Legal Entity Zip Code	Legal Entity COUNTY	Legal Entity COUNTRY	Assistance Listing	Award Code	Budget Year	Action Date	Action Type	Action Amount

Issue Date FY: 2025 ( Subtotal = $508,136 )
2025	2025	UNIVERSITY OF NORTH CAROLINA AT CHAPEL HILL	104 AIRPORT DR STE 2200	CHAPEL HILL	NC	27599	ORANGE	USA	Minority Health and Health Disparities Research	000	3	2/18/2025	NON-COMPETING CONTINUATION	$508,136
														Subtotal = $508,136

Issue Date FY: 2024 ( Subtotal = $598,452 )
2024	2024	UNIVERSITY OF NORTH CAROLINA AT CHAPEL HILL	104 AIRPORT DR STE 2200	CHAPEL HILL	NC	27599	ORANGE	USA	Minority Health and Health Disparities Research	001	2	5/28/2024	NON-COMPETING CONTINUATION	$59,845
2024	2024	UNIVERSITY OF NORTH CAROLINA AT CHAPEL HILL	104 AIRPORT DR STE 2200	CHAPEL HILL	NC	27599	ORANGE	USA	Minority Health and Health Disparities Research	000	2	1/24/2024	NON-COMPETING CONTINUATION	$538,607
														Subtotal = $598,452

Issue Date FY: 2023 ( Subtotal = $591,172 )
2023	2023	UNIVERSITY OF NORTH CAROLINA AT CHAPEL HILL	104 AIRPORT DR STE 2200	CHAPEL HILL	NC	27599	ORANGE	USA	Minority Health and Health Disparities Research	000	1	7/7/2023	NEW	$591,172
														Subtotal = $591,172

Grand Total All Awards = $1,697,760

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Regionalization of Acute Stroke Care for Rural Populations: A Systems Modeling Approach

Award Number: R01MD018031

ORGANIZATION: NATIONAL CENTER ON MINORITY HEALTH AND HEALTH DISPARITIES

OPDIV: NIH

AWARD CLASS: DISCRETIONARY

AWARD ACTIVITY TYPE: SCIENTIFIC/HEALTH RESEARCH (INCLUDES SURVEYS)

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