Distance From Home to Hospital and Thrombolytic Utilization for Acute Ischemic Stroke

Acharya, Aninda B.; Nyirenda, Joshua C.; Higgs, Gary; Bloomfield, Mark; Cruz‐Flores, Salvador; Connor, Lisa Tabor; J, Lee; Leet, Terry

doi:10.1016/j.jstrokecerebrovasdis.2009.12.009

Cited by 15 publications

(6 citation statements)

References 20 publications

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“…Three association studies reported data for patients with stroke (Table 14). 15,43,44 Acharya et al 43 and Leyden et al 44 both focused on timely receipt of thrombolytic therapy as a major outcome and both concluded that patients living further from stroke units or hospitals with appropriate facilities were less likely to receive thrombolytic therapy. The Swiss National Cohort study reported by Berlin et al 15 analysed data on stroke deaths.…”

Section: Association Studiesmentioning

confidence: 99%

“…In St Louis city and St Louis county, Missouri (USA), patients living further from the hospital were less likely to receive thrombolysis, but the difference was not explained by differences in time taken to reach the hospital. 43 The others suggested that other factors such as type of transport to the hospital or patient awareness of available services may have been important. In a study in South Australia, access to thrombolysis was described as poor in both urban and rural areas.…”

Section: Urban Versus Ruralmentioning

confidence: 99%

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Effects of increased distance to urgent and emergency care facilities resulting from health services reconfiguration: a systematic review

Chambers

Cantrell

Baxter

et al. 2020

Health Serv Deliv Res

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Background Service reconfigurations sometimes increase travel time and/or distance for patients to reach their nearest hospital or other urgent and emergency care facility. Many communities value their local services and perceive that proposed changes could worsen outcomes for patients. Objectives To identify, appraise and synthesise existing research evidence regarding the outcomes and impacts of service reconfigurations that increase the time and/or distance for patients to reach an urgent and emergency care facility. We also aimed to examine the available evidence regarding associations between distance to a facility and outcomes for patients and health services, together with factors that may influence (moderate or mediate) these associations. Data sources We searched seven bibliographic databases in February 2019. The search was supplemented by citation-tracking and reference list checking. A separate search was conducted to identify the current systematic reviews of telehealth to support urgent and emergency care. Methods Brief inclusion and exclusion criteria were as follows: (1) population – adults or children with conditions that required emergency treatment; (2) intervention/comparison – studies comparing outcomes before and after a service reconfiguration, which affects the time/distance to urgent and emergency care or comparing outcomes in groups of people travelling different distances to access urgent and emergency care; (3) outcomes – any patient or health system outcome; (4) setting – the UK and other developed countries with relevant health-care systems; and (5) study design – any. The search results were screened against the inclusion criteria by one reviewer, with a 10% sample screened by a second reviewer. A quality (risk-of-bias) assessment was undertaken using The Joanna Briggs Institute Checklist for Quasi-Experimental Studies. We performed a narrative synthesis of the included studies and assessed the overall strength of evidence using a previously published method. Results We included 44 studies in the review, of which eight originated from the UK. For studies of general urgent and emergency care populations, there was no evidence that reconfiguration that resulted in increased travel time/distance affected mortality rates. By contrast, evidence of increased risk was identified from studies restricted to patients with acute myocardial infarction. Increases in mortality risk were most obvious within the first 1–4 years after reconfiguration. Evidence for other conditions was inconsistent or very limited. In the absence of reconfiguration, evidence mainly from cohort studies indicated that increased travel time or distance is associated with increased mortality risk for the acute myocardial infarction and trauma populations, whereas for obstetric emergencies the evidence was inconsistent. We included 12 systematic reviews of telehealth. Meta-analyses suggested that telehealth technologies can reduce time to treatment for people with stroke and ST elevation myocardial infarction. Limitations Most studies came from non-UK settings and many were at high risk of bias because there was no true control group. Most review processes were carried out by a single reviewer within a constrained time frame. Conclusions We found no evidence that increased distance increases mortality risk for the general population of people requiring urgent and emergency care, although this may not be true for people with acute myocardial infarction or trauma. Increases in mortality risk were most likely in the first few years after reconfiguration. Future work Research is needed to better understand how health systems plan for and adapt to increases in travel time, to quantify impacts on health system outcomes, and to address the uncertainty about how risk increases with distance in circumstances relevant to UK settings. Study registration This study is registered as PROSPERO CRD42019123061. Funding This project was funded by the NIHR Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 8, No. 31. See the NIHR Journals Library website for further project information.

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Section: Association Studiesmentioning

confidence: 99%

Section: Urban Versus Ruralmentioning

confidence: 99%

Effects of increased distance to urgent and emergency care facilities resulting from health services reconfiguration: a systematic review

Chambers

Cantrell

Baxter

et al. 2020

Health Serv Deliv Res

View full text Add to dashboard Cite

show abstract

“…Studies have shown access to and mortality after stroke care to be associated with several hospital-level factors, including hospital volume, type of hospital [ 8 ], presence of a stroke care unit [ 9 , 10 ], and distance from hospital to home [ 11 , 12 ]. Regarding hospital volume, reports have indicated mixed results about the volume-outcome relationship for stroke [ 13 – 17 ].…”

Section: Introductionmentioning

confidence: 99%

Variation in Risk-Standardized Mortality of Stroke among Hospitals in Japan

2015

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Despite recent advances in care, stroke remains a life-threatening disease. Little is known about current hospital mortality with stroke and how it varies by hospital in a national clinical setting in Japan. Using the Diagnosis Procedure Combination database (a national inpatient database in Japan), we identified patients aged ≥20 years who were admitted to the hospital with a primary diagnosis of stroke within 3 days of stroke onset from April 2012 to March 2013. We constructed a multivariable logistic regression model to predict in-hospital death for each patient with patient-level factors, including age, sex, type of stroke, Japan Coma Scale, and modified Rankin Scale. We defined risk-standardized mortality ratio as the ratio of the actual number of in-hospital deaths to the expected number of such deaths for each hospital. A hospital-level multivariable linear regression was modeled to analyze the association between risk-standardized mortality ratio and hospital-level factors. We performed a patient-level Cox regression analysis to examine the association of in-hospital death with both patient-level and hospital-level factors. Of 176,753 eligible patients from 894 hospitals, overall in-hospital mortality was 10.8%. The risk-standardized mortality ratio for stroke varied widely among the hospitals; the proportions of hospitals with risk-standardized mortality ratio categories of ≤0.50, 0.51–1.00, 1.01–1.50, 1.51–2.00, and >2.00 were 3.9%, 47.9%, 41.4%, 5.2%, and 1.5%, respectively. Academic status, presence of a stroke care unit, higher hospital volume and availability of endovascular therapy had a significantly lower risk-standardized mortality ratio; distance from the patient’s residence to the hospital was not associated with the risk-standardized mortality ratio. Our results suggest that stroke-ready hospitals play an important role in improving stroke mortality in Japan.

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“…Perceived accessibility is concerned with the actual use of the health services in question, as this could lead to better health. Hence, research into associations between accessibility and health outcome have been carried out by several researchers [90][91][92][93], focusing on the association between heart disease mortality and geographic access to hospitals in one case [94] and survival from cancer associated with patients' travel time to health care in another [95].…”

Section: Spatial Analysis Of Health Service Planningmentioning

confidence: 99%

“…Examples of the impact of distance on health, e.g. Acharya et al [91] among others [77,78,89,[164][165][166][167] where distance analyses is used to understand how utilization of services are influenced by distance to health services.…”

Section: Health Technologies and Toolsmentioning

confidence: 99%

A Review and Framework for Categorizing Current Research and Development in Health Related Geographical Information Systems (GIS) Studies

Lyseen

Nøhr²,

Sørensen

et al. 2014

Yearb Med Inform

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SummaryObjectives: The application of GIS in health science has increased over the last decade and new innovative application areas have emerged. This study reviews the literature and builds a framework to provide a conceptual overview of the domain, and to promote strategic planning for further research of GIS in health. Method: The framework is based on literature from the library databases Scopus and Web of Science. The articles were identified based on keywords and initially selected for further study based on titles and abstracts. A grounded theory-inspired method was applied to categorize the selected articles in main focus areas. Subsequent frequency analysis was performed on the identified articles in areas of infectious and non-infectious diseases and continent of origin. Results: A total of 865 articles were included. Four conceptual domains within GIS in health sciences comprise the framework: spatial analysis of disease, spatial analysis of health service planning, public health, health technologies and tools. Frequency analysis by disease status and location show that malaria and schistosomiasis are the most commonly analyzed infectious diseases where cancer and asthma are the most frequently analyzed non-infectious diseases. Across categories, articles from North America predominate, and in the category of spatial analysis of diseases an equal number of studies concern Asia. Conclusion: Spatial analysis of diseases and health service planning are well-established research areas. The development of future technologies and new application areas for GIS and data-gathering technologies such as GPS, smartphones, remote sensing etc. will be nudging the research in GIS and health. KeywordsEpidemiology, geographic information system, public health, cluster analysis, spatial analysis Yearb Med Inform 2014:110-24 http://dx

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Distance From Home to Hospital and Thrombolytic Utilization for Acute Ischemic Stroke

Cited by 15 publications

References 20 publications

Effects of increased distance to urgent and emergency care facilities resulting from health services reconfiguration: a systematic review

Effects of increased distance to urgent and emergency care facilities resulting from health services reconfiguration: a systematic review

Variation in Risk-Standardized Mortality of Stroke among Hospitals in Japan

A Review and Framework for Categorizing Current Research and Development in Health Related Geographical Information Systems (GIS) Studies

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