University of Pennsylvania researchers have created a mathematical model they say could help policy makers plan where to place comprehensive stroke centers to maximize their effectiveness.

The study containing their work was published in Neurology.

“We sought to demonstrate how mathematical modeling can inform the strategic development of the U.S. network of stroke centers by stimulating the conversion of primary stroke centers into comprehensive stroke centers,” said first author Michael Mullen, M.D., assistant professor of neurology at the Perelman School of Medicine at the University of Pennsylvania and director of Penn's Comprehensive Stroke Center.

Mullen and his team obtained population counts and geographic data from the 2010 Neilson-Claritas Census Estimations. Access to hospitals was calculated by ground and air transportation with the hospital that would contribute the maximum population access selected as the first comprehensive stroke center (CSC). Using the team’s proprietary algorithm, CSCs were added in an iterative matter that would offer the greatest ground and air access for the surrounding population to a maximum of 20 CSCs.

As of December 31, 2010, there were 811 designated hospitals to which 66 percent of the U.S. population had 60-minute ground access. The team’s analysis found that averaging across states, the median population with 60-minute ground access to a CSC was 55.7 percent, but there was significant variability across states. Incorporating air ambulance transport into the model showed that median population with 60-minute ground or air access to a CSC was 85.3 percent, but variability across states persisted.

Analysis also found that median ground access in the stroke belt states, including Alabama, Arkansas, Georgia, Louisiana, Mississippi, North Carolina, South Carolina, and Tennessee, was worse, with a median of 32 percent of the population with 60-minute ground access versus 59 percent in non-stroke belt states.

Even with the most optimally located CSCs throughout the country, the team found that roughly one-third (37 percent) of the US population, 114 million people, would be unable to access a CSC by ground transportation within 60 minutes. Allowing for air transportation improved access, researchers report, but in one-quarter of the U.S., less than 60 percent of the population had ground OR air access to a CSC.

“Our results highlight the need for population-based planning for developing systems of care,” Mullen said. “Given finite resources, it is critically important to locate CSCs in a way that maximizes population access.”

The study is available here.

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