1 / 28

Rural Stroke Treatment

Rural Stroke Treatment. Nicholas J Okon, D.O. Vascular Neurologist Billings, Montana. In the US only 4% stroke victims receive the only FDA approved treatment for acute stroke. Patients don’t often recognize their symptoms as stroke and don’t understand the need to seek emergent care via 911

said
Download Presentation

Rural Stroke Treatment

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Rural Stroke Treatment • Nicholas J Okon, D.O. • Vascular Neurologist • Billings, Montana

  2. In the US only 4% stroke victims receive the only FDA approved treatment for acute stroke • Patients don’t often recognize their symptoms as stroke and don’t understand the need to seek emergent care via 911 • Primary providers have very little training or experience in treating stroke victims let alone use of tPA • Neurologists are in short supply and clustered in urban areas • Until recently there was no economic incentive to treat acute stroke victims

  3. Montana Stroke Initiative • The Montana Stroke Initiative is a collaboration between the Montana Department of Public Health Cardiovascular Health Program, American Stroke Association and physicians, nurses, EMS personnel and hospital administrators throughout the State.

  4. MSI Mission • MSI’s mission is to develop a state-wide stroke system of care that allows patients access to the best stroke care regardless of where they live in Montana.

  5. MSI Members • Montana DPHHS-Cardiovascular Health and Chronic Disease • American Stroke Association • Mountain Pacific Quality Health • Yellowstone City-County Health • Stroke Neurologists- Billings, Missoula, Great Falls • Hospitals from Bozeman, White Sulphur, Chester, Dillon, Sidney, Sheridan (WY)

  6. Montana Stroke Initiative Goals • Provide Education- community, EMS, nursing, professional • Develop Regional Acute Stroke Treatment Networks • Protocols and Standardized Order Sets • Access to Neurologists • Employ Registry - acute treatment and inpatient quality measures • Implement Rehabilitation Algorithm • Website

  7. Stroke Treatment in Montana • Assess population density and distribution • Identify resources available for providing treatment of acute stroke with thrombolytic therapy • Develop tools and provide education and support for rural facilities

  8. Population Density and Distribution

  9. Availability of resources in Montana • In 2004 the Montana Stroke Initiative conducted an assessment of resources throughout Montana and Northern Wyoming • Assessment included diagnostic technologies, programs and personnel needed for treatment of acute stroke • Also assessed brain Attack Coalition key elements of Stroke Care

  10. Availability of Diagnostic and Treatment Services for Acute Stroke in Frontier Counties in Montana and Northern WyomingThe Journal of Rural Health Volume 22 Issue 3 Page 237-241, Summer 2006

  11. Regional Stroke Delivery Models • Model 1: Southwestern Ontario Stroke Program London Ontario (ship and drip) • Model 2: Order of Saint Francis (OSF) Peoria, Illinois (drip and ship) • Model 3: Mid America Brain and Stroke Institute Kansas City, Missouri (drip,ship and grip)

  12. London Ontario “Ship and Drip” Outcomes Regional 59 IV ER 53” tPA 148” NIHSS 16 10/33 centers * > 4 pts NIHSS or normal 41 mi. 89” local 23 IV ER 123” tPA172” NIHSS 14

  13. OSF- Illinois 57/900 (6%) “Drip and Ship” Outcomes Regional 23 IV tPA 155” NIHSS 15.5 13/21 centers local 34 IV tPA 141 NIHSS 14

  14. Mid America-KC 142/781 (18%) Outcomes “Drip, Ship and Grip” 89 20 IV 14 IV+IA 55 IA Regional 100 mi. local 53 IV tPA 32 0.9 mg/kg 21 0.6 mg/kg 21/53 IV+IA

  15. Stroke Treatment in Montana • Local treatment is necessary due to Time dependent therapy and long distances between people and tertiary facilities capable and experienced with treatment • Minimum requirements for administering thrombolytic therapy are: • CT scanner 24/7 • EMS Protocol for expediting transport and identification • Acute care/tPA protocol

  16. Population within one-hour drive time from selected locations • Billings 144,952 • Great Falls 85,720 • Missoula/Hamilton 145,621 • Havre 24,720 • Lewistown 17,381 • Glasgow 14,932 • Sidney 21,348 • 14,600 in MT 6,748 in ND • Total (MT) 447,926 • 50% of Montana’s total population reside within

  17. Tele-stroke Tele-stroke Tele-stroke Tele-stroke PSC PSC PSC

More Related