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 - van der Linden, M. Christien
AU - van der Linden, Naomi
AU - Lam, Rianne C.
AU - Stap, Peter
AU - van den Brand, Crispijn L.
AU - Vermeulen, Tamara
AU - Jellema, Korné
AU - van den Wijngaard, Ido R.
PY - 2021
Y1 - 2021
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.
KW - Centralization
KW - Emergency department
KW - Stroke care
UR - http://www.scopus.com/inward/record.url?scp=85108279261&partnerID=8YFLogxK
U2 - 10.1016/j.healthpol.2021.06.003
DO - 10.1016/j.healthpol.2021.06.003
M3 - Article
C2 - 34162490
AN - SCOPUS:85108279261
SN - 0168-8510
VL - 125
SP - 1040
EP - 1046
JO - Health Policy
JF - Health Policy
IS - 8
ER -