Policy implementation strategies to address rural disparities in access to care for stroke patients
ContextStroke systems of care (SSOC) promote access to stroke prevention, treatment, and rehabilitation and ensure patients receive evidence-based treatment. Stroke patients living in rural areas have disproportionately less access to emergency medical services (EMS). In the United States, rural cou...
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2023-11-01
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| Series: | Frontiers in Health Services |
| Subjects: | |
| Online Access: | https://www.frontiersin.org/articles/10.3389/frhs.2023.1280250/full |
| _version_ | 1797400828500246528 |
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| author | Aysha Rasool Aysha Rasool Moriah Bailey Brittany Lue Nina Omeaku Adebola Popoola Sharada S. Shantharam Amanda A. Brown Erika B. Fulmer |
| author_facet | Aysha Rasool Aysha Rasool Moriah Bailey Brittany Lue Nina Omeaku Adebola Popoola Sharada S. Shantharam Amanda A. Brown Erika B. Fulmer |
| author_sort | Aysha Rasool |
| collection | DOAJ |
| description | ContextStroke systems of care (SSOC) promote access to stroke prevention, treatment, and rehabilitation and ensure patients receive evidence-based treatment. Stroke patients living in rural areas have disproportionately less access to emergency medical services (EMS). In the United States, rural counties have a 30% higher stroke mortality rate compared to urban counties. Many states have SSOC laws supported by evidence; however, there are knowledge gaps in how states implement these state laws to strengthen SSOC.ObjectiveThis study identifies strategies and potential challenges to implementing state policy interventions that require or encourage evidence-supported pre-hospital interventions for stroke pre-notification, triage and transport, and inter-facility transfer of patients to the most appropriate stroke facility.DesignResearchers interviewed representatives engaged in implementing SSOC across six states. Informants (n = 34) included state public health agency staff and other public health and clinical practitioners.OutcomesThis study examined implementation of pre-hospital SSOCs policies in terms of (1) development roles, processes, facilitators, and barriers; (2) implementation partners, challenges, and solutions; (3) EMS system structure, protocols, communication, and supervision; and (4) program improvement, outcomes, and sustainability.ResultsChallenges included unequal resource allocation and EMS and hospital services coverage, particularly in rural settings, lack of stroke registry usage, insufficient technologies, inconsistent use of standardized tools and protocols, collaboration gaps across SSOC, and lack of EMS stroke training. Strategies included addressing scarce resources, services, and facilities; disseminating, training on, and implementing standardized statewide SSOC protocols and tools; and utilizing SSOC quality and performance improvement systems and approaches.ConclusionsThis paper identifies several strategies that can be incorporated to enhance the implementation of evidence-based stroke policies to improve access to timely stroke care for all patient populations, particularly those experiencing disparities in rural communities. |
| first_indexed | 2024-03-09T02:01:16Z |
| format | Article |
| id | doaj.art-e432008c1d444c8db2386c374ff411d7 |
| institution | Directory Open Access Journal |
| issn | 2813-0146 |
| language | English |
| last_indexed | 2024-03-09T02:01:16Z |
| publishDate | 2023-11-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Health Services |
| spelling | doaj.art-e432008c1d444c8db2386c374ff411d72023-12-08T05:18:53ZengFrontiers Media S.A.Frontiers in Health Services2813-01462023-11-01310.3389/frhs.2023.12802501280250Policy implementation strategies to address rural disparities in access to care for stroke patientsAysha Rasool0Aysha Rasool1Moriah Bailey2Brittany Lue3Nina Omeaku4Adebola Popoola5Sharada S. Shantharam6Amanda A. Brown7Erika B. Fulmer8Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, GA, United StatesOak Ridge Institute for Science and Education, Oak Ridge, TN, United StatesApplied Science, Research and Technology, Inc., Atlanta, GA, United StatesChenega Corporation, Anchorage, AK, United StatesApplied Science, Research and Technology, Inc., Atlanta, GA, United StatesDivision for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, GA, United StatesDivision for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, GA, United StatesApplied Science, Research and Technology, Inc., Atlanta, GA, United StatesDivision for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, GA, United StatesContextStroke systems of care (SSOC) promote access to stroke prevention, treatment, and rehabilitation and ensure patients receive evidence-based treatment. Stroke patients living in rural areas have disproportionately less access to emergency medical services (EMS). In the United States, rural counties have a 30% higher stroke mortality rate compared to urban counties. Many states have SSOC laws supported by evidence; however, there are knowledge gaps in how states implement these state laws to strengthen SSOC.ObjectiveThis study identifies strategies and potential challenges to implementing state policy interventions that require or encourage evidence-supported pre-hospital interventions for stroke pre-notification, triage and transport, and inter-facility transfer of patients to the most appropriate stroke facility.DesignResearchers interviewed representatives engaged in implementing SSOC across six states. Informants (n = 34) included state public health agency staff and other public health and clinical practitioners.OutcomesThis study examined implementation of pre-hospital SSOCs policies in terms of (1) development roles, processes, facilitators, and barriers; (2) implementation partners, challenges, and solutions; (3) EMS system structure, protocols, communication, and supervision; and (4) program improvement, outcomes, and sustainability.ResultsChallenges included unequal resource allocation and EMS and hospital services coverage, particularly in rural settings, lack of stroke registry usage, insufficient technologies, inconsistent use of standardized tools and protocols, collaboration gaps across SSOC, and lack of EMS stroke training. Strategies included addressing scarce resources, services, and facilities; disseminating, training on, and implementing standardized statewide SSOC protocols and tools; and utilizing SSOC quality and performance improvement systems and approaches.ConclusionsThis paper identifies several strategies that can be incorporated to enhance the implementation of evidence-based stroke policies to improve access to timely stroke care for all patient populations, particularly those experiencing disparities in rural communities.https://www.frontiersin.org/articles/10.3389/frhs.2023.1280250/fullstrokepolicyemergency medical services (EMS)ruraldisparity |
| spellingShingle | Aysha Rasool Aysha Rasool Moriah Bailey Brittany Lue Nina Omeaku Adebola Popoola Sharada S. Shantharam Amanda A. Brown Erika B. Fulmer Policy implementation strategies to address rural disparities in access to care for stroke patients Frontiers in Health Services stroke policy emergency medical services (EMS) rural disparity |
| title | Policy implementation strategies to address rural disparities in access to care for stroke patients |
| title_full | Policy implementation strategies to address rural disparities in access to care for stroke patients |
| title_fullStr | Policy implementation strategies to address rural disparities in access to care for stroke patients |
| title_full_unstemmed | Policy implementation strategies to address rural disparities in access to care for stroke patients |
| title_short | Policy implementation strategies to address rural disparities in access to care for stroke patients |
| title_sort | policy implementation strategies to address rural disparities in access to care for stroke patients |
| topic | stroke policy emergency medical services (EMS) rural disparity |
| url | https://www.frontiersin.org/articles/10.3389/frhs.2023.1280250/full |
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