This research was published in Academic Emergency Medicine. The full study can be found here. A press release about the study is here.
When someone has an acute stroke, early access to specialized care is crucial. Whenever possible, experts recommend people receive medical help at a hospital with advanced stroke capability like a comprehensive stroke center (CSC).
This study, by researchers at the Keck School of Medicine of USC and the Schaeffer Center for Health Policy & Economics, analyzed how long it took Los Angeles County emergency medical services to transport patients to CSCs, and found that traffic conditions affect consistent access, particularly in socioeconomically disadvantaged neighborhoods.
Los Angeles County has 16 CSCs spread across the county, which provide advanced stroke care often not available at other hospitals. Emergency medical services protocols in Los Angeles County specify that patients who are showing symptoms of certain acute stroke be transported to a CSC if the expected transport time is less than 30 minutes, even if a non-CSC hospital is closer.
The researchers assessed the driving time to the county’s CSCs by picking central points within LA county’s 6,415 census block groups. Transit times were measured 12 times during non-holiday weekdays, including morning and evening rush hours, over the course of two weeks.
They found three categories of neighborhoods:
- Always has access, regardless of traffic
- Never has access, regardless of traffic
- Intermittent access
Nearly 20 percent of the population has only intermittent access to CSCs, and many of these individuals live in the urban core of the city, including South Los Angeles and East Los Angeles. The researchers point out that these areas with limited CSC access have also historically been under resourced in a number of ways.
Across LA County, almost 80 percent of the population have access to a CSC within 30 minutes. Less than five percent have no access to a CSC. Those without access live in more rural areas, such as northeast Los Angeles County.
All told, transport time ranged from less than 1 minute to over 2 hours, with a median time of about 15 minutes.
The researchers hope these findings will influence how planners and public health professionals allocate resources and think about access. For example, based on their findings, South Los Angeles, with a population of 1.14 million, might have a greater need for advanced stroke care than northeast Los Angeles County, with only 479,000 residents.
Citation: Dworkis, D., Axeen, S., Arora, S. (2020). Rubber Meeting the Road: Access to Comprehensive Stroke Care in the Face of Traffic. Academic Emergency Medicine. DOI: https://doi.org/10.1111/acem.13909