Abstract 99: Geographic Access to Acute Stroke Care in the United States
Background: Only 5% of ischemic stroke (IS) patients receive IV tPA and less than 1% receive endovascular therapy (ET). Prior work has described access to Primary Stroke Centers (PSC). We describe access of the US population to all facilities that provide IV tPA or ET for IS.
Methods: We used US demographic data and IV tPA and ET rates in the 2011 Medicare Provider and Analysis Review (MEDPAR), a claims-based dataset that contains fee-for-service Medicare-eligible inpatient hospital discharges in the US. ICD-9 codes 433.xx, 434.xx and 436 identified IS cases. ICD-9 code 99.10 defined IV tPA treatment. Among IS cases, hospitals that gave any IV tPA were considered IV capable. ET was defined by ICD-9 code 39.74. Hospitals that performed any ET in IS cases were considered endovascular capable. PSCs were defined as hospitals certified as such by the Joint Commission in 2010. We estimated ambulance response times using arc-GIS’s network analyst and helicopter transport times using validated models. Population access to care was determined by summing the population contained within travelsheds that could reach capable hospitals within 60minutes.
Results: Of 370351 IS primary diagnosis discharges, 14926 (4%) received IV tPA and 1889 (0.5%) had ET. By ground, 81% percent of the US population had access to IV capable hospitals within 60minutes, 66% had access to PSCs and 56% had access to ET capable hospitals. By air, 97% percent had access to IV capable hospitals within 60minutes, 91% had access to PSCs and 85% had access to ET hospitals. The Figure shows 60 (yellow) and 120 minute (green) access to IV rt-PA capable hospitals.
Conclusion: Most of the US population has geographic access to acute stroke care, but treatment rates remain extremely low. Given our definitions of capability, actual access may be less than described. To optimize US stroke care systems and increase the use of acute therapies, pre- and inhospital interventions to overcome barriers in access to acute stroke care are needed.
Author Disclosures: O. Adeoye: None. B.G. Carr: None. K.C. Albright: None. C. Wolff: None. M. Mullen: None. T. Abruzzo: None. A. Ringer: None. P. Khatri: None. C. Branas: None. D. Kleindorfer: None.
- © 2014 by American Heart Association, Inc.