Access to hyperacute stroke services across Canadian provinces: a geospatial analysis

Abstract

Background: Canada's vast geography creates challenges for ensuring prompt transport to hospital of patients who have had a stroke. We sought to determine the proportion of people across various Canadian provinces for whom hyperacute stroke services are accessible within evidence-based time targets. Methods:We calculated, for the 8 provinces with available data, drive-time polygons on a map of Canada that delineated the area around stroke centres and emergency medical services (EMS) base centres to which one can drive in 3.5-6 hours. We calculated the proportional area of each forward sortation area (first 3 digits of the postal code) contained within a drive-time polygon. We applied this ratio to the 2011 Canadian census population of the forward sortation area to estimate the population that can reach a stroke centre in a designated time.Results: A total of 47.1%-96.4% of Canadians live within a 4.5-hour drive to a stroke centre via road EMS, and 53.3%-96.8% live within a 6-hour drive. Assuming a total travel time of 5 hours by EMS from base centre to patient and patient to hospital, 84.7%-99.8% of the population has access to a current or proposed endovascular thrombectomy site. Interpretation:Most Canadians live within 6 hours' road access to a stroke centre. Geospatial mapping could be used to inform decisions for additional sites and identify gaps in service accessibility. Coordinated systems of care and ambulance bypass agreements must continue to evolve to ensure maximal access to time-sensitive emergency stroke services. AbstractResearch Research CMAJ OPENCMAJ OPEN, 5(2) E455 lations may not be able to benefit from either alteplase or endovascular thrombectomy. Canada's vast geography creates challenges for ensuring prompt transport to hospital. To inform ongoing efforts to plan and improve the health care system with the goal of optimizing delivery of stroke services, we sought to determine the proportion of people across several provinces for whom hyperacute stroke services are currently accessible via EMS. MethodsWe estimated the population with access to stroke centres in sufficient time for treatment, by province, using the 2011 Canadian population census. We compared the area within which residents could be reached by an ambulance (travelling by road) and then driven to a stroke hospital to the population in those regions (based on forward sortation area [first 3 digits of postal code]) to determine the proportion of residents who could reach a hospital 3.5-6 hours after contacting EMS or by driving themselves to hospital (Figure 1). Postal codes in Canada are assigned based on a combination of geography, population and city planning. Generally speaking, more densely populated areas have smaller postal code geographic areas than do more sparsely populated areas.We used geospatial analyses with geographic information systems technology [11][12][13] to generate drive-time polygons. A drive-time polygon represents a shape on a map that contains all points a driver can theoretically reach from a s...

Geographic Access to Stroke Care Services in Rural Communities in Ontario, Canada

“…Previous studies evaluating geographic access to stroke services have estimated that over 80% of the US population has access to thrombolysis-capable hospitals within 60 minutes, with similar results seen in Ontario and other Canadian provinces. 10,12,19 However, these studies assessed the entire population rather than rural communities, where access might be anticipated to be lower. Our finding that over 81% of rural residents lived within 60 minutes of driving time to thrombolysis centers provides evidence of very good rural access to this treatment.…”

“…Previous geospatial analyses have provided important information on access to stroke care across Ontario and Canada, but did not specifically evaluate access to care for rural residents. [10][11][12] We aimed to quantify geographic access to stroke care for rural residents of Ontario, Canada, using linked population-based administrative data sources to estimate the proportion of people in rural communities who were within 30, 60, and 240 minutes of travel time by car (at posted speed limits) from stroke care services, including neuroimaging, thrombolysis, EVT, stroke unit care, stroke prevention clinics, and inpatient rehabilitation facilities.…”

Measuring access to primary healthcare services after stroke: A spatial analytic approach

“…As the first step in understanding accessibility to healthcare services for Australian stroke survivors, this study applied Geographic Information System (GIS) techniques to map and then examine the spatial distribution of primary healthcare services in one Primary Health Network (PHN) in South-East Queensland to determine whether these services are located in geographically accessible areas relative to the discharge location of patients with stroke. Internationally, GIS technology was recently used in Canada to determine the drive time for accessibility to stroke centres and emergency medical services for hyperacute stroke management (Eswaradass, Swartz, Rosen, Hill & Lindsay, 2017), with the researchers concluding that most Canadians live within 6-h road access of stroke centres and emergency medical services. A second study exploring stroke prevention services (services that provide assessment and intervention to minimise the risk of subsequent stroke) in Canada found that just over 87% of Canadians can access a stroke prevention service within a 1-hour drive time (Jewett et al, 2018).…”

Collateral vessels on magnetic resonance angiography in endovascular-treated acute ischemic stroke patients associated with clinical outcomes

“…Acute ischemic stroke (AIS) is the most common type of stroke, accounting for about 80% of the total cerebral apoplexy [ 1 ]. It is the third leading cause of death worldwide.…”