Use of Geospatial Modeling to Evaluate the Impact of Telestroke on Access to Stroke Thrombolysis in Ontario.

BACKGROUND

The treatment of acute ischemic stroke in Ontario is coordinated through a network of stroke centers, supplemented by emergency telemedicine consultations to nonstroke centers through the Ontario Telemedicine Network's province-wide Telestroke program. Using geoinformatics, we sought to evaluate the overall impact of Telestroke on access to stroke thrombolysis in Ontario.

METHODS

Ontario population data (census) were used to overlay polygons created by Service Area Analysis using ArcGIS 10.1. Service areas were divided into predefined driving times toward the nearest stroke center. Centers were compared after they were categorized as being able to administer stroke thrombolysis either independently or through the Telestroke program.

RESULTS

Of the 12,857,821 people living in Ontario in 2011, 99.83% had timely access to stroke thrombolysis, leaving 21,829 people, exclusively within Northern Ontario, without access. Of the population, 71.86% was within a 30-minute drive of a regional or district stroke center, increasing to 91.28% when the Telestroke program was included, for an additional 2,501,121 people. Of the population, 1.85% had access to stroke thrombolysis only through the extended time window (between 3 and 4.5 hours), increasing to 3.86% with Telestroke, for an additional 258,618 people.

CONCLUSION

The vast majority of people in Ontario have access to stroke thrombolysis. The provincial Telestroke program improves timeliness of access for those living in Southern Ontario, although some remote rural and Northern communities remain without access. Geoinformatics may likewise prove useful in coordinating provincial access to endovascular thrombectomy.