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Penn Medicine analysis: One-third of Americans do not have access to stroke center within 1 hour

Time is critical to restore blood flow during stroke

University of Pennsylvania School of Medicine

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IMAGE: Michael Mullen, M.D., is an assistant professor of Neurology at the Perelman School of Medicine at the University of Pennsylvania and director of Penn's Comprehensive Stroke Center. view more

Credit: Penn Medicine

PHILADELPHIA- Stroke is one of the leading causes of death and disability in the United States, but access to rapid EMS care and appropriate stroke care centers with the ability to deliver acute stroke therapies can drastically mitigate the debilitating effects of a stroke. A population-based approach to health planning would prevent disparities in access to specialized stroke care, says new Penn Medicine research. Their evaluation of access to stroke centers in the U.S. found that even under the most optimal conditions, a large proportion of the United States population would be unable to access a comprehensive stroke center within 60 minutes. The study is published in the current issue of Neurology.

In 2003, a system of designation of stroke care centers was initiated by The Joint Commission. The tiered approach designated acute stroke-ready hospitals, primary stroke centers (PSC) and comprehensive stroke centers (CSC) in order of increasing resources and capabilities. While certification of PSCs began in 2003, certification of CSCs did not commence until 2012, and were not yet in place at the time of this research.

"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 PSCs into CSCs," says lead author, Michael Mullen, MD, 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 maximal population access selected as the first 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 PSC-designated hospitals to which 66 percent of the U.S. population had 60 minute ground access. The team's analysis found that after the addition of up to 20 CSCs per state, 63.1% of the U.S. population would have 60 minute ground access to a CSC. And, averaging across states, the median population with 60-minute ground access to a CSC was 55.7%, 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%, but variability across states persisted.

Their 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," says Mullen. "Given finite resources, it is critically important to locate CSCs in a way that maximizes population access."

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The study was supported by the Agency for Healthcare Research & Quality.

Additional Penn authors include Charles C. Branas, PhD; Scott E. Kasner, MD, MS; and Brendan G. Carr, now with the department of Emergency Medicine, Thomas Jefferson University.

Penn Medicine is one of the world's leading academic medical centers, dedicated to the related missions of medical education, biomedical research, and excellence in patient care. Penn Medicine consists of the Raymond and Ruth Perelman School of Medicine at the University of Pennsylvania (founded in 1765 as the nation's first medical school) and the University of Pennsylvania Health System, which together form a $4.9 billion enterprise.

The Perelman School of Medicine has been ranked among the top five medical schools in the United States for the past 17 years, according to U.S. News & World Report's survey of research-oriented medical schools. The School is consistently among the nation's top recipients of funding from the National Institutes of Health, with $409 million awarded in the 2014 fiscal year.

The University of Pennsylvania Health System's patient care facilities include: The Hospital of the University of Pennsylvania -- recognized as one of the nation's top "Honor Roll" hospitals by U.S. News & World Report; Penn Presbyterian Medical Center; Chester County Hospital; Penn Wissahickon Hospice; and Pennsylvania Hospital -- the nation's first hospital, founded in 1751. Additional affiliated inpatient care facilities and services throughout the Philadelphia region include Chestnut Hill Hospital and Good Shepherd Penn Partners, a partnership between Good Shepherd Rehabilitation Network and Penn Medicine.

Penn Medicine is committed to improving lives and health through a variety of community-based programs and activities. In fiscal year 2014, Penn Medicine provided $771 million to benefit our community.

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