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Original research
Redistributing medical resources for a bypass strategy for large vessel occlusion: a community-based study
  1. Ting-Yu Liu1,
  2. Chun-Han Wang1,
  3. Wen-Chu Chiang2,
  4. Sung-Chun Tang3,
  5. Li-Kai Tsai3,
  6. Chung-Wei Lee4,
  7. Jiann-Shing Jeng3,
  8. Matthew Huei-Ming Ma2,
  9. Ming-Ju Hsieh5,
  10. Yu-Ching Lee1
  1. 1 Department of Industrial Engineering and Engineering Management, National Tsing Hua University, Hsinchu, Taiwan
  2. 2 Departmentof Emergency Medicine, National Taiwan University Hospital Yunlin Branch, Yunlin county, Taiwan
  3. 3 Stroke Center and Department of Neurology, National Taiwan University Hospital, Taipei, Taiwan
  4. 4 Department of Medical Imaging, National Taiwan University Hospital, Taipei, Taiwan
  5. 5 Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan
  1. Correspondence to Dr Ming-Ju Hsieh, Department of Emergency Medicine, National Taiwan University Hospital, Taipei 100, Taiwan; erdrmjhsieh{at}gmail.com and Prof. Yu-Ching Lee, Departmentof Industrial Engineering and Engineering Management, National Tsing Hua University, Hsinchu 300, Taiwan ; yclee{at}ie.nthu.edu.tw

Abstract

Background A bypass strategy for large vessel occlusion (LVO) benefits patients receiving endovascular thrombectomy (EVT), but may delay some patients from receiving IV thrombolysis. However, patient centralization has been shown to improve outcomes.

Objective To understand the current coverage of medical services for patients with stroke, and to identify the best coverage under different medical resource redistribution to help balance medical equality and patient centralization.

Methods This 6-year geographic study of 7679 on-scene patients with suspected stroke with a positive Cincinnati Prehospital Stroke Scale (CPSS) score identified 4037 patients with all three CPSS items who were suspected as having an LVO. Geographic, population, and patient coverage rates for hospitals providing IV thrombolysis and those providing EVT were identified according to hospital service areas, defined as geographic districts with access to a hospital within a ≤15 min off-peak driving time estimated using Google Maps. Moreover, we estimated the effects on resource redistribution when implementing a bypass strategy.

Results Geographic coverage rates for hospitals providing IV thrombolysis and those providing EVT were 64.75% and 56.62%, respectively, and population coverage rates were 97.30% and 92.72%, respectively. The service areas of hospitals providing IV thrombolysis covered 93.77% of patients with suspected stroke, and those of hospitals providing EVT covered 87.89% of patients with suspected LVO. The number of hospitals providing IV thrombolysis and those providing EVT could be reduced to six and two hospitals, respectively, without affecting hospital arrival time when implementing a bypass strategy.

Conclusion Hospitals providing IV thrombolysis and EVT could be reduced without reducing medical equality.

  • stroke
  • bypass strategy
  • emergency medical service
  • intra-arterial thrombectomy
  • resource redistribution
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Footnotes

  • M-JH and Y-CL contributed equally.

  • Contributors All authors made substantial contributions to the design of the analysis, interpretation of data, drafting, critically revising and final approval for the manuscript.

  • Funding The article was supported by the Taiwan Ministry of Science and Technology (MOST 106-2314-B-002-091) and National Taiwan University Hospital (108-09).

  • Competing interests None declared.

  • Ethics approval Institutional review board of the National Taiwan University Hospital.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Patient consent for publication Not required.

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