Asimos Andrew W, Enright Dianne, Huston Sara L, Mettam Laurie H
Department of Emergency Medicine, Carolinas Medical Center, USA.
N C Med J. 2010 Sep-Oct;71(5):413-20.
In developing a statewide system of stroke care, understanding the relative availability of acute stroke care at designated centers for stroke care is essential. In this article, we compare the change in availability of acute stroke care in North Carolina at Joint Commission Primary Stroke Centers (JCPSCs) between 2006 and 2008 by examining the drive-time proximity of the residential address to the nearest JCPSC among people who died of stroke.
We assigned geographic coordinates to residential addresses of North Carolinians who died of stroke and to addresses of North Carolina JCPSCs. We calculated the distance within a 40-minute drive from each JCPSC and determined whether the residential addresses of patients who died of stroke were in the areas demarcated by the drive time. In a secondary analysis, we included non-ICPSCs that participate in recognized quality-improvement programs for stroke care.
In 2006, 37% of geocodable residences of patients who died of stroke (3,834 of 10,469) were within a 40-minute drive from a JCPSC. By the end of 2008, this percentage increased to 56% (3,482 of 6,204). Inclusion of other hospitals that participate in recognized quality-improvement programs for acute stroke care increased the 40-minute drive-time coverage to 82% (5,095 of 6,204).
As an index of the geographic distribution of the stroke burden, we used deaths due to stroke, rather incident strokes. We included several assumptions in our drive-time calculation.
For many regions of North Carolina in which the stroke burden is high, timely care at JCPSCs for acute stroke is unavailable. To develop a statewide system for acute stroke care in North Carolina, criteria beyond JCPSC certification should be considered for designating hospitals as centers for stroke care.
在建立全州范围的中风护理系统时，了解指定中风护理中心急性中风护理的相对可及性至关重要。在本文中，我们通过检查中风死亡者的居住地址到最近的联合委员会初级中风中心（JCPSC）的驾车时间距离，比较了2006年至2008年北卡罗来纳州JCPSC急性中风护理可及性的变化。
我们为北卡罗来纳州中风死亡者的居住地址以及北卡罗来纳州JCPSC的地址分配了地理坐标。我们计算了每个JCPSC 40分钟驾车范围内的距离，并确定中风死亡患者的居住地址是否在驾车时间划定的区域内。在二次分析中，我们纳入了参与公认的中风护理质量改进项目的非ICPSC。
2006年，中风死亡患者的可地理编码住所中，37%（10469例中的3834例）距离JCPSC在40分钟驾车范围内。到2008年底，这一比例增至56%（6204例中的3482例）。纳入参与公认的急性中风护理质量改进项目的其他医院后，40分钟驾车时间覆盖范围增至82%（6204例中的5095例）。
作为中风负担地理分布的指标，我们使用的是中风死亡数据，而非中风发病率。我们在驾车时间计算中纳入了若干假设。
在北卡罗来纳州许多中风负担较高的地区，无法在JCPSC获得急性中风的及时护理。为在北卡罗来纳州建立全州范围的急性中风护理系统，在指定医院为中风护理中心时，应考虑JCPSC认证以外的标准。
