MedicalResearch.com Interview with:
Kimon Bekelis, MD Chief Resident
Department of Neurosurgery
Dartmouth-Hitchcock School of Medicine
MedicalResearch.com: What is the background for this study?
Response: Physicians often must decide whether to treat acute stroke patients locally, or refer them to a more distant Primary Stroke Center (PSC). There is little evidence on how much the increased risk of prolonged travel time offsets benefits of specialized Primary Stroke Center care.
MedicalResearch.com: What are the main findings?
Response: In this prospective cohort study of 865,184 Medicare beneficiaries with acute stroke, using an instrumental variable analysis we found that admission to Primary Stroke Centers was associated with 1.8% lower 30-day case-fatality, a significant difference in comparison to their counterparts in non-certified institutions. Traveling for more than 90 minutes to receive care offset the 30-day survival benefit of PSC admission.
MedicalResearch.com: What should clinicians and patients take away from your report?
Response: Among Medicare patients, treatment in a Primary Stroke Center is associated with decreased 7-day, and 30-day post-admission case fatality rates. Traveling for more than 90 minutes to receive care negates the 30-day survival benefit of PSCs. Policy makers should consider these time limits when designing the delivery of emergency medical services for stroke.
MedicalResearch.com: What recommendations do you have for future research as a result of this study?
Response: Further investigations in optimizing access to Primary Stroke Center are necessary. Building on the experience of trauma care, optimal utilization of air services, with the existing PSC locations, could expand access within this time frame for almost all stroke patients. This is just one approach from a plethora of available options to address disparities in access, and follow the recommendations of the Institute of Medicine to maximize the use of local referral centers. Other potential solutions include expanding telemedicine applications, enhancing smaller hospitals into Acute Stroke Ready Hospitals, and creating broader hospital networks.
MedicalResearch.com: Is there anything else you would like to add?
Response: This work would not have been possible without grant support from the National Institute on Aging (P01-AG19783), and the National Institutes of Health Common Fund (U01-AG046830-01). The funders had no role in the design and conduct of the study; the collection, management, analysis, and interpretation of the data; and the preparation, review, or approval of the manuscript; and the decision to submit the manuscript for publication.
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