TY - JOUR
T1 - Impact of ongoing centralization of acute stroke care from “drip and ship” into “direct-to-mothership” model in a Dutch urban area
AU - Linden, M. C. (Christien) van der
AU - van der Linden, Naomi
AU - Lam, Rianne C
AU - Stap, Peter
AU - Brand, Crispijn L. van den
AU - Vermeulen, Tamara
AU - Jellema, Korné
AU - van den Wijngaard, Ido R.
N1 - Funding Information:
This study was funded by a grant from The Netherlands Organisation for Health Research and Development (ZonMw) in collaboration with the National Health Care Institute , grant no. 516022515 . The funding source had no involvement in the study design, the collection, analysis and interpretation of the data, nor in the writing of the report and in the decision to submit the article for publication.
Publisher Copyright:
© 2021
PY - 2021/8
Y1 - 2021/8
N2 - When acute stroke care is organised using a “drip-and-ship” model, patients receive immediate treatment at the nearest primary stroke centre followed by transfer to a comprehensive stroke centre (CSC). When stroke care is further centralised into the “direct-to-mothership” model, patients with stroke symptoms are immediately brought to a CSC to further reduce treatment times and enhance stroke outcomes. We investigated the effects of the ongoing centralization in a Dutch urban setting on treatment times of patients with confirmed ischemic stroke in a 4-year period. Next, in a non-randomized controlled trial, we assessed treatment times of patients with suspected ischemic stroke, and treatment times of patients with neurologic disorders other than suspected ischemic stroke, before and after the intervention in the CSC and the decentralized hospitals, the intervention being the change from “drip and ship” into “direct-to-mothership”. Our findings provide support for the ongoing centralization of acute stroke care in urban areas. Treatment times for patients with ischemic stroke decreased significantly, potentially improving functional outcomes. Improvements in treatment times for patients with suspected ischemic stroke were achieved without negative side effects for self-referrals with stroke symptoms and patients with other neurological disorders.
AB - When acute stroke care is organised using a “drip-and-ship” model, patients receive immediate treatment at the nearest primary stroke centre followed by transfer to a comprehensive stroke centre (CSC). When stroke care is further centralised into the “direct-to-mothership” model, patients with stroke symptoms are immediately brought to a CSC to further reduce treatment times and enhance stroke outcomes. We investigated the effects of the ongoing centralization in a Dutch urban setting on treatment times of patients with confirmed ischemic stroke in a 4-year period. Next, in a non-randomized controlled trial, we assessed treatment times of patients with suspected ischemic stroke, and treatment times of patients with neurologic disorders other than suspected ischemic stroke, before and after the intervention in the CSC and the decentralized hospitals, the intervention being the change from “drip and ship” into “direct-to-mothership”. Our findings provide support for the ongoing centralization of acute stroke care in urban areas. Treatment times for patients with ischemic stroke decreased significantly, potentially improving functional outcomes. Improvements in treatment times for patients with suspected ischemic stroke were achieved without negative side effects for self-referrals with stroke symptoms and patients with other neurological disorders.
U2 - 10.1016/j.healthpol.2021.06.003
DO - 10.1016/j.healthpol.2021.06.003
M3 - Article
SN - 0168-8510
VL - 125
SP - 1040
EP - 1046
JO - Health policy
JF - Health policy
IS - 8
ER -