Modeling the Impact of Interhospital Transfer Network Design on Stroke Outcomes in a Large City
| Autor: | Abhinaba Chatterjee, Alexander E Merkler, Saad Mir, Benjamin R Kummer, Babak B. Navi, Iván Díaz, Matthew E. Fink, Gino Gialdini, Michael P Lerario, Hooman Kamel, Neal S. Parikh, Ankur Pandya |
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| Rok vydání: | 2018 |
| Předmět: |
Patient Transfer
medicine.medical_specialty Time Factors 030204 cardiovascular system & hematology Endovascular therapy Article Brain Ischemia 03 medical and health sciences 0302 clinical medicine Modified Rankin Scale Interquartile range Transfer (computing) Humans Medicine Thrombolytic Therapy Large city Stroke Acute stroke Advanced and Specialized Nursing business.industry medicine.disease Hospitals Network planning and design Treatment Outcome Emergency medicine Neurology (clinical) Cardiology and Cardiovascular Medicine business 030217 neurology & neurosurgery |
| Zdroj: | Stroke. 49:370-376 |
| ISSN: | 1524-4628 0039-2499 |
| DOI: | 10.1161/strokeaha.117.018166 |
| Popis: | Background and Purpose— We sought to model the effects of interhospital transfer network design on endovascular therapy eligibility and clinical outcomes of stroke because of large-vessel occlusion for the residents of a large city. Methods— We modeled 3 transfer network designs for New York City. In model A, patients were transferred from spoke hospitals to the closest hub hospitals with endovascular capabilities irrespective of hospital affiliation. In model B, which was considered the base case, patients were transferred to the closest affiliated hub hospitals. In model C, patients were transferred to the closest affiliated hospitals, and transfer times were adjusted to reflect full implementation of streamlined transfer protocols. Using Monte Carlo methods, we simulated the distributions of endovascular therapy eligibility and good functional outcomes (modified Rankin Scale score, 0–2) in these models. Results— In our models, 200 patients (interquartile range [IQR], 168–227) with a stroke amenable to endovascular therapy present to New York City spoke hospitals each year. Transferring patients to the closest hub hospital irrespective of affiliation (model A) resulted in 4 (IQR, 1–9) additional patients being eligible for endovascular therapy and an additional 1 (IQR, 0–2) patient achieving functional independence. Transferring patients only to affiliated hospitals while simulating full implementation of streamlined transfer protocols (model C) resulted in 17 (IQR, 3–41) additional patients being eligible for endovascular therapy and 3 (IQR, 1–8) additional patients achieving functional independence. Conclusions— Optimizing acute stroke transfer networks resulted in clinically small changes in population-level stroke outcomes in a dense, urban area. |
| Databáze: | OpenAIRE |
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