Table2_Policy implementation strategies to address rural disparities in access to care for stroke patients.docx

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.

卒中医疗照护系统（Stroke Systems of Care, SSOC）旨在提升卒中预防、治疗与康复服务的可及性，并确保患者获得基于证据的诊疗服务。农村地区的卒中患者获取急诊医疗服务（Emergency Medical Services, EMS）的可及性显著偏低，且这种差异存在不成比例的失衡情况。在美国，农村县的卒中死亡率较城市县高出30%。美国多个州已出台有证据支撑的SSOC相关法案，但在各州如何落实这些法案以强化卒中医疗照护系统方面，仍存在认知空白。
研究目标：本研究旨在明确落实州级政策干预措施的相关策略与潜在挑战——这类政策要求或鼓励采用基于证据的院前干预手段，涵盖卒中院前预警、分诊转运以及患者跨机构转诊至最适宜卒中诊疗机构的全流程。
研究设计：研究人员对美国6个州参与卒中医疗照护系统落地工作的代表开展了访谈。受访对象共计34名，包括州公共卫生机构工作人员以及其他公共卫生与临床从业者。
研究结果维度：本研究从以下4个维度对院前SSOC政策的落地情况进行了考察：(1) 相关职责制定、实施流程、促进因素与阻碍因素；(2) 落地合作方、面临挑战及解决方案；(3) 急诊医疗服务系统的架构、操作规程、沟通机制与监督管理；(4) 项目改进、实施效果与可持续性。
研究结果：本次研究识别出的挑战包括资源分配不均、急诊医疗服务与医院服务覆盖不足（尤其是在农村地区）、卒中登记系统使用率偏低、技术支持不足、标准化工具与操作规程执行不一致、卒中医疗照护系统跨主体协作存在缺口，以及急诊医疗服务人员卒中相关培训缺失。相应的优化策略包括：弥补资源、服务与设施的短缺问题；推广、培训并落实全州统一的SSOC标准化操作规程与工具；运用SSOC质量与绩效改进体系及相关方法。
研究结论：本研究明确了多项可用于优化循证卒中政策落地的策略，旨在提升所有患者群体，尤其是农村地区存在医疗服务可及性差异的人群，获得及时卒中诊疗服务的机会。