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• W613726454 abstract "OBJECTIVE: To develop a simulation model to create prototypical acute ischemic stroke (AIS) care process configurations and compare their potential impact on onset-to-treatment (OTT) and door-to-treatment (DTT) times. BACKGROUND: The time elapsed from stroke onset to tissue plasminogen activator (tPA) administration (OTT) is known to be a powerful driver of outcomes in AIS. Reducing this interval has been a major focus of efforts to improve care in AIS. Changes to processes of AIS care have been proposed to reduce OTT, but rigorous approaches to evaluating and comparing the potential impact of the process changes have been lacking. DESIGN/METHODS: Simulated data on 5000 patients with AIS treated at comprehensive stroke centers and outlying spoke hospitals were generated from executable graphical models of acute stroke care. Process configuration variables included the mode of requesting telestroke consultation (either by emergency department [ED] physician or via automatic request at the time of computed tomography [CT] scan), and the transport strategy employed (direct-to-imaging vs ED triage). RESULTS: The results of the model suggest that OTT may be reduced by several minutes by initiating telestroke request in parallel with CT scan and by employing a direct-to-imaging transport strategy instead of ED triage. There is also the possibility for an interaction between these 2 effects, with the greatest benefit emerging from the direct-to-imaging strategy alongside telestroke/CT scan parallel initiation. CONCLUSIONS: We employed a realistic simulation of AIS care to explore performance characteristics of proposed AIS care process configurations during the narrow window of opportunity to deliver thrombolytic therapy. This simulation methodology provides a model for prototyping process reengineering, in which essential details and assumptions in AIS care are identified for critical review by stakeholders. Study Supported by: Genentech, Inc. Disclosure: Dr. Levy has received personal compensation for activities with Genentech. Dr. Norris has received personal compensation for activities with Genentech. Dr. Tayama has received personal compensation for activities with Genentech, Inc." @default.
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• W613726454 date "2015-04-06" @default.
• W613726454 modified "2023-10-03" @default.
• W613726454 title "Systems and Care Process Parameters as Determinants of Onset-to-Treatment Times in Acute Ischemic Stroke: A Simulation Study (P1.018)" @default.
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