Accessibility to Tertiary Stroke Centers in Hokkaido, Japan: Use of Novel Metrics to Assess Acute Stroke Care Quality

作者：Fujiwara Kensuke; Osanai Toshiya; Kobayashi Eiichi; Tanikawa Takumi; Kazumata Ken; Tokairin Kikutaro; Houkin Kiyohiro; Ogasawara Katsuhiko^*

来源：Journal of Stroke and Cerebrovascular Diseases, 2018, 27(1): 177-184.

DOI：10.1016/j.jstrokecerebrovasdis.2017.08.013

• Acute ischemic stroke
• regional disparity
• spatial accessibility
• intravenous rt-PA
• mechanical thrombectomy

Background: Both the accessibility and availability of stroke specialists are major determinants of patient outcomes following acute ischemic stroke (AIS). The purpose of this study was to implement novel metrics to assess the accessibility of tertiary stroke centers as well as to evaluate regional disparities in stroke specialists. Methods: Using network analysis in a geographic information system, we calculated areas within 30- and 60-minute travel times to facilities providing intravenous recombinant tissue-type plasminogen activator and mechanical thrombectomy. We further evaluated the accessibility for the proportion of the population aged 65 years or older that resided outside of these areas. Uniformity in the geographical distribution of stroke specialists was then evaluated using optimal statistical analysis. Results: Accessibility varied widely from region to region, with low accessibility being concentrated in rural areas with low population density. Accessibility to facilities providing mechanical thrombectomy was especially low, and 17.8% of elderly individuals lived >= 60 minutes from treatment facilities. In addition, the distribution of stroke specialists was uneven compared with the distribution of hospital beds and full-time medical doctors. Conclusion: The results of this study revealed regional disparities in the spatial accessibility to treatment facilities, as well as in the distribution of stroke specialists in Hokkaido. These findings provide useful information that could be employed to appropriately allocate resources toward the formation of a medical supply system for patients with AIS.

• 出版日期2018-1