Geographic modeling of best transport options for treatment of acute ischemic stroke patients applied to policy decision making in the USA and Northern Ireland

AbstractIschemic stroke is a treatable disease with alteplase, a clot-busting medical treatment, and endovascular therapy (EVT), mechanical removal of the clot through a minimally invasive procedure. The effectiveness of both treatments is time dependent, and they are usually given together. Alteplase is less effective than EVT, but is widely available at community hospitals; EVT is highly effective, but it is only available at large urban tertiary hospitals. There is uncertainty if it is better to receive alteplase early and delay EVT or vice versa. We developed a conditional probability model based on decay curves that were generated from pooled clinical trials, and then created a software solution using C# that interfaced with ArcGIS’s Software Development Kit and Google’s Distance Matrix API. The maps were developed based on pre-specified time interval variables to determine the best transportation for multiple US states (Colorado, Arizona, Tennessee, and Massachusetts/Rhode Island) and Northern Ireland. The overall objective of this work was to determine if these maps could be used to influence health policy decision making for acute stroke patients.