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 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.  

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