Department of Medicine (Neurology), Duke Stroke Center, Center for Clinical Health Policy Research, Duke University, and the Durham Department of Veterans Affairs Medical Center, Durham, NC 27710, USA.
Stroke. 2010 Apr;41(4):778-83. doi: 10.1161/STROKEAHA.109.572750. Epub 2010 Feb 18.
Statewide assessments of stroke prevention and treatment services were performed in North Carolina in 1998 and 2003. The 2003 survey found certain technologies, but not stroke-related programs, were more widely available. The survey was repeated in 2008 to determine whether there was an interval change in accessibility.
A 2-page questionnaire was sent to each North Carolina hospital. Results were compared with the 1998 and 2003 surveys.
Complete responses were obtained from each of the state's emergent stroke care hospitals. The proportions providing CT angiography and diffusion-weighted MRI increased between each period (each P<0.05); the use of care maps and intravenous tissue plasminogen activator protocols increased between 2003 and 2008 but not between 1998 and 2003. There were no changes in availability of MRI, MR angiography, catheter angiography, carotid ultrasound, transcranial Doppler, transthoracic echocardiography, or in the proportions of hospitals having a stroke unit, having a neurologist or neurointerventionalist readily available, or providing stroke-related public education (each P>0.05). The proportions of hospitals having a group of "basic" stroke capabilities did not change (18%, 21%, and 20%, respectively, P>0.05). In 2008, 41% of North Carolina's population resided in a county with at least 1 Primary Stroke Center and an additional 40% in a county using telemedicine or having a transfer plan for patients with acute stroke.
The availability of certain diagnostic tests, but not specialty staff or stroke units, increased in North Carolina hospitals between 1998 and 2008. Although there was no change in stroke-related hospital-based organizational features between 1998 and 2003, there were improvements between 2003 and 2008, possibly reflecting programs aimed at developing stroke care systems.
1998 年和 2003 年，北卡罗来纳州对卒中预防和治疗服务进行了全州评估。2003 年的调查发现，某些技术（但不是与卒中相关的项目）的应用更为广泛。2008 年再次进行了调查，以确定在可及性方面是否存在间隔变化。
向北卡罗来纳州的每家医院发送了一份 2 页的调查问卷。将结果与 1998 年和 2003 年的调查进行了比较。
该州所有急症卒中护理医院都收到了完整的回复。提供 CT 血管造影和弥散加权 MRI 的比例在每个时期都有所增加（每次 P<0.05）；使用护理图和静脉组织型纤溶酶原激活物方案的比例在 2003 年至 2008 年间增加，但在 1998 年至 2003 年间没有增加。MRI、磁共振血管造影、导管血管造影、颈动脉超声、经颅多普勒、经胸超声心动图的可用性或具有卒中单元的医院、随时有神经科医生或神经介入医生的医院、或提供与卒中相关的公众教育的医院的比例均无变化（每次 P>0.05）。具有一组“基本”卒中能力的医院比例没有变化（分别为 18%、21%和 20%，P>0.05）。2008 年，北卡罗来纳州 41%的人口居住在至少有 1 家初级卒中中心的县，另有 40%的人口居住在使用远程医疗或为急性卒中患者制定转院计划的县。
1998 年至 2008 年间，北卡罗来纳州医院某些诊断测试的应用有所增加，但专科人员或卒中单元并未增加。1998 年至 2003 年期间，与卒中相关的医院组织特征没有变化，但 2003 年至 2008 年期间有所改善，这可能反映了旨在发展卒中护理系统的计划。
