Design approach for region-specific improvement of acute stroke care: simulation modeling to enhance organization

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    Abstract

    For stroke patients one of the most important predictors in outcome is the time from stroke onset to the start of treatment. In this thesis the organization of acute stroke care for patients eligible for endovascular thrombectomy (EVT) was examined. Literature analysis showed that optimization efforts for acute stroke care will depend on the regional health- and transport infrastructure, and appears to be mainly dependent on region-specific characteristics and the stroke onset location.
    Simulation modeling was used to examine different organizational models in a specific region, starting with the northern part of the Netherlands. Results show that workflow improvements could potentially reduce the time to the start of EVT by one hour. Adding more hospitals that offer EVT would have modest impact for this region, while a hypothetical implementation of a mobile doctor for EVT on location will reduce the time to treatment by more than 45 minutes. Reuse of the Northern Netherlands model in the Southwestern region of the Netherlands shows that multiple scenarios can be tested with little effort. For this region, the implementation of a mobile doctor or routing based on pre-hospital triage might reduce the time to EVT up to one hour.
    The main conclusion of this thesis is that no single generic improvement in the organization of acute stroke care will work everywhere. A region-specific design approach is required. Simulation modeling, based on patient-level data, is an useful approach to evaluate and test different interventions for the improvement of acute stroke care in specific regions.
    Original languageEnglish
    QualificationDoctor of Philosophy
    Awarding Institution
    • University of Groningen
    Supervisors/Advisors
    • Buskens, Erik, Supervisor
    • van der Zee, Durk, Co-supervisor
    • Uyttenboogaart, Maarten, Co-supervisor
    • Lahr, Maarten, Co-supervisor
    Award date12-Jun-2023
    Place of Publication[Groningen]
    Publisher
    Print ISBNs978-94-6473-124-8
    DOIs
    Publication statusPublished - 2023

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