200663 Geographic analysis of travel time to certified stroke centers in the Tri-State Stroke Network region

Monday, November 9, 2009: 8:30 AM

Jenna A. Khan, MPH , Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, GA
Michele Casper, PhD , Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, GA
Andrew W. Asimos, MD , Department of Emergency Medicine, Carolinas Medical Center, Charlotte, NC
Lydia Clarkson, MPH , Division of Public Health, Georgia Department of Human Resources, Atlanta, GA
Dianne Enright, GISP , North Carolina State Center for Health Statistics, Raleigh, NC
Laura J. Fehrs, MD , Division of Public Health, Georgia Department of Human Resources, Atlanta, GA
Khosrow Heidari, MA, MS, MS , SC DHEC, Columbia, SC
Sara L. Huston, PhD , N.C. Heart Disease & Stroke Prevention Branch, N.C. Division of Public Health and UNC-Chapel Hill Epidemiology, Raleigh, NC
Laurie H. Mettam, MEd , NC HDSP Branch, Tri-State Stroke Network, Raleigh, NC
Mary George, MD, MSPH , Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, GA
Ishmael G. Williams, MA , Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, GA
Introduction

Tissue plasminogen activator (tPA) improves clinical outcomes for ischemic stroke when administered within 3 hours of symptom onset. Within those 3 hours, three important steps must occur: recognition of stroke symptoms, transportation to a facility that administers tPA, and emergency department evaluation. Joint Commission Primary Stroke Center (JCPSC) certification recognizes hospitals capable of administering intravenous tPA. We designed this study to analyze population access to JCPSCs in a tri-state region of the southeast with high stroke rates.

Methods

We created maps of drive time areas to JCPSCs (n=67) within North Carolina, South Carolina and Georgia using ArcGIS 9.3 Network Analyst. We defined service areas based upon 30 and 60 minute drive times, and overlaid age-adjusted stroke hospitalization discharges and county mortality rates, aggregated over the years 2001-2005.

Results

Most JCPSCs were concentrated in the northwestern urban areas of the tri-state region. The eastern, rural counties not within JCPSC drive time areas have some of the highest stroke mortality rates in the region. Of the total population in NC, SC and GA (n= 20,235,720), 49.2% reside within 30 minutes drive time and 72.8% reside within 60 minutes travel time to a JCPSC.

Discussion

These maps and statistics can serve as a guide for determining additional locations of JCPSCs or other acute stroke treatment capable facilities in areas of need in the tri-state region.

Learning Objectives:
(1) Identify areas of North Carolina, South Carolina and Georgia that lack access to Joint Commission Primary Stroke Centers (JCPSC). (2) Assess the population of the tri-state region with timely access to JCPSCs. (3) Discuss recommendations to increase access to acute stroke care in areas lacking JCPSCs.

Keywords: Strokes, Access to Health Care

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have an MPH in epidemiology and this reseach was conducted as I was working as a fellow in the Small Area Analysis Team of the Division for Heart Disease and Stroke Prevention at the Centers for Disease Control and Prevention. I worked under the supervision of the Team Lead and we also collaborated with the Tri-State Stroke Network.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

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