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GIS Analysis of Access to VA Acute Stroke Care

Phipps MS, Jia H, Litt ER, Cowper Ripley DC, Wang X, Vogel WB, Graham GD. GIS Analysis of Access to VA Acute Stroke Care. Poster session presented at: American Academy of Neurology Annual Meeting; 2012 Apr 22; New Orleans, LA.


OBJECTIVE: Using VA complexity levels as surrogates for level of acute stroke care, we sought to determine veteran access to VA acute stroke care by travel time. BACKGROUND: Stroke is a common reason veterans seek admission or treatment at a Veteran Administration Medical Center (VAMC). However, many veterans are admitted to non-VA hospitals for acute stroke, often due to limited timely access to acute stroke care in a VAMC. A goal of the American Stroke Association is universal access to acute treatment within 1-hour transport time from an acute stroke capable hospital. DESIGN/METHODS: We considered all VA patients with diagnoses of ischemic stroke, transient ischemic attack (TIA), and intracerebral hemorrhage (ICH) as specifically needing access to acute stroke care. We used Geographic Information System (GIS) software to map 60-minute ground travel times to VAMCs nationally, grouped by complexity level, and determined the percentage of VA stroke patients that fell within these travel times. To determine differences in access when local non-VA Primary Stroke Centers (PSCs) are included, we chose one VA region to examine veteran access within 1 hour of both VAMCs and PSCs. RESULTS: An average of 12,556 patients with ischemic stroke/TIA/ICH were admitted to the VA annually from 2006-2010. Only 70% of VA stroke patients are within 60 minutes of any level VAMC, 54% of any Level 1 facility, and just 34% of a Level 1a facility (the highest complexity level). In one southeast VA region, addition of non-VA PSCs to all VAMCs increased 1 hour access from 63% to 83%. CONCLUSIONS: While up to 70% of veterans could potentially receive acute stroke care intramurally if all VAMCs were to become acute stroke capable, creative solutions are required to increase access further, such as the use of telemedicine and/or community PSCs.

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