Goldstein L B, Hey L A, Laney R
Departments of Medicine (Neurology), Duke Center for Cerebrovascular Disease, Center for Clinical Health Policy Research, Duke University, Durham, NC 27710
Stroke. 1998 Oct;29(10):2069-72. doi: 10.1161/01.str.29.10.2069.
North Carolina is situated in the "stroke belt" region of the United States, an area of the country with a particularly high incidence of cerebrovascular disease. The North Carolina Stroke Prevention and Treatment Facilities Survey was carried out to determine the availabilities of a variety of stroke prevention and treatment services throughout the state. The purpose of the present study was to determine how widely recombinant tissue-type plasminogen activator (rtPA) has been adopted for the treatment of patients with acute ischemic stroke and to determine the characteristics of the medical facilities in the state offering this therapy.
A single-page survey was mailed to the medical center directors of each inpatient medical facility in North Carolina. Data collected included questions related to the availability of selected basic and advanced diagnostic tests and procedures, stroke prevention and treatment programs and services (community stroke awareness program, acute stroke identification program, acute stroke team, stroke rtPA protocol, stroke care map, neurologist), and facilities (Stroke Acute Care Unit or equivalent).
Responses were obtained from all 125 inpatient medical facilities in North Carolina. rtPA stroke protocols were adopted in 54 facilities located in 46 of the state's 100 counties. Seventy-four percent of the state's population resides in counties with hospitals providing rtPA treatment. Compared with facilities not offering rtPA, those with rtPA protocols more commonly sponsored stroke community awareness programs (41% versus 17%, P=0.003) and more frequently had an organized stroke team (31% versus 8%, P=0. 001), used stroke care maps (56% versus 17%, P<0.001), had rapid stroke identification programs (33% versus 6%, P<0.001), or had a Stroke Acute Care Unit or its equivalent (33% versus 7%, P<0.001). Neurologists were available in 78% of the facilities offering rtPA compared with 38% in facilities without rtPA protocols (P<0.001).
These data show that this new therapy for ischemic stroke is potentially available to a high proportion of the state's citizens based on their county of residence. However, other services that may improve outcomes and reduce stroke-related costs (eg, stroke teams, stroke units, care maps) are not being widely used, even in centers providing treatment with rtPA. The simple methodology used in this study is potentially applicable in other states and permits targeting of selected centers for development of stroke treatment capabilities.
北卡罗来纳州位于美国的“卒中带”地区，该地区脑血管疾病发病率特别高。开展北卡罗来纳州卒中预防与治疗设施调查，以确定全州各种卒中预防与治疗服务的可及性。本研究的目的是确定重组组织型纤溶酶原激活剂（rtPA）在治疗急性缺血性卒中患者中的应用普及程度，并确定该州提供这种治疗的医疗机构的特征。
向北卡罗来纳州各住院医疗机构的医疗中心主任邮寄了一份单页调查问卷。收集的数据包括与选定的基础和高级诊断检查及程序、卒中预防与治疗项目及服务（社区卒中意识项目、急性卒中识别项目、急性卒中团队、卒中rtPA治疗方案、卒中护理流程图、神经科医生）以及设施（卒中急性护理单元或同等设施）的可及性相关的问题。
收到了北卡罗来纳州所有125家住院医疗机构的回复。该州100个县中的46个县的54家医疗机构采用了rtPA卒中治疗方案。该州74%的人口居住在有医院提供rtPA治疗的县。与未提供rtPA治疗的医疗机构相比，采用rtPA治疗方案的医疗机构更常开展卒中社区意识项目（41%对17%，P=0.003），更频繁地拥有组建好的卒中团队（31%对8%，P =0.001），使用卒中护理流程图（56%对17%，P<0.001），设有快速卒中识别项目（33%对6%，P<0.001），或设有卒中急性护理单元或同等设施（33%对7%，P<0.001）。提供rtPA治疗的医疗机构中78%有神经科医生，而未采用rtPA治疗方案的医疗机构中这一比例为38%（P<0.001）。
这些数据表明，基于该州居民所在县，这种缺血性卒中的新疗法可能为很大一部分居民所用。然而，其他可能改善治疗效果并降低卒中相关费用的服务（如卒中团队、卒中单元、护理流程图）并未得到广泛应用，即使在提供rtPA治疗的中心也是如此。本研究中使用的简单方法可能适用于其他州，并有助于确定选定的中心以发展卒中治疗能力。
