Expansion of emergency medical service regional routing for stroke patient care in the United States from 2000-2010

2013-05-09Background: Organized stroke systems of care include preferential emergency medical services (EMS) routing to deliver suspected stroke patients to designated hospitals. EMS transport of stroke patients is regulated at the State and County level in the United States. This study aims to characterize the growth of EMS regional systems of acute stroke care by describing the number and proportion of nationwide stroke hospitalizations in areas with EMS systems of care over a 10-year period. ❧ Methods: Data on ischemic stroke using ICD-9 coding was collected from the Healthcare Cost and Utilization Project Nationwide Inpatient Sample (NIS) database from the years 2000-2010. The NIS contains all discharge data from 1,051 hospitals located in 45 States, approximating a 20-percent stratified sample. Data on EMS systems of care was obtained from a review of archives, reports, and interviews with state EMS officials. ❧ Results: Nationwide stroke hospitalizations remained constant over the course of the study period: 583,000 in 2000 and 573,000 in 2010. However from 2000-2003 there were no states or counties with EMS systems of care. The proportion of US stroke hospitalizations occurring in jurisdictions with established EMS regional systems of acute stroke care increased steadily from 2004 to 2010 (1%, 13%, 28%, 30%, 30%, 34%, 49%). In 2010, 278,538 stroke hospitalizations, 49% of all US stroke hospitalizations, occurred in areas with established EMS routing, with an additional 18,979 (3%) patients in regions undergoing a transition to EMS routing. ❧ Conclusions: In 2010, a majority of stroke patients in the United States were hospitalized in an area with established or transitioning to EMS diversion. This milestone coverage of half the US population is a major advance in systematic stroke care, and emphasizes the need for novel approaches, such as telemedicine, to further extend access to stroke center care to all patients