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Mobile stroke units for acute stroke care in the south of sweden
Malmö University, Faculty of Technology and Society (TS), Department of Computer Science and Media Technology (DVMT).ORCID iD: 0000-0003-2769-4826
Malmö University, Faculty of Technology and Society (TS), Department of Computer Science and Media Technology (DVMT).
Region Skåne.
Region Skåne.
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2021 (English)In: Cogent Engineering, E-ISSN 2331-1916, Vol. 8, no 1, article id 1874084Article in journal (Refereed) Published
Abstract [en]

A Mobile stroke unit (MSU) is a type of ambulance deployed to promote the rapid delivery of stroke care. We present a computational study using a time to treatment estimation model to analyze the potential benefits of using MSUs in Sweden's Southern Health Care Region (SHR). In particular, we developed two scenarios (MSU1 and MSU2) each including three MSUs, which we compared with a baseline scenario containing only regular ambulances. For each MSU scenario, we assessed how much the expected time to treatment is estimated to decrease for the whole region and each subregion of SHR, and how the population is expected to benefit from the deployment of MSUs. For example, the average time to treatment in SHR was decreased with 20,4 and 15,6 minutes, respectively, in the two MSU scenarios. Moreover, our computational results show that the locations of the MSUs significantly influence what benefits can be expected. While MSU1 is expected to improve the situation for a higher share of the population, MSU2 is expected to have a higher impact on the patients who currently have the longest time to treatment.

Place, publisher, year, edition, pages
Taylor & Francis, 2021. Vol. 8, no 1, article id 1874084
Keywords [en]
driving time estimation, mobile stroke unit, MSU, stroke transport, time to treatment
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
URN: urn:nbn:se:mau:diva-41078DOI: 10.1080/23311916.2021.1874084ISI: 000613349600001Scopus ID: 2-s2.0-85100213272OAI: oai:DiVA.org:mau-41078DiVA, id: diva2:1535445
Available from: 2021-03-09 Created: 2021-03-09 Last updated: 2024-02-05Bibliographically approved
In thesis
1. On the Use of Simulation and Optimization for the Analysis and Planning of Prehospital Stroke Care
Open this publication in new window or tab >>On the Use of Simulation and Optimization for the Analysis and Planning of Prehospital Stroke Care
2022 (English)Licentiate thesis, comprehensive summary (Other academic)
Abstract [en]

Immediate treatment is of extreme importance for stroke patients. However, providing fast enough treatment for stroke patients is far from trivial, mainly due to logistical challenges and difficulties in diagnosing the correct stroke type. One way to reduce the time to treatment is to use so-called Mobile Stroke Units (MSUs), which allows to diagnose and provide treatment for stroke patients already at the patient scene. A well-designed stroke transport policy is vital to improve the access to treatment for stroke patients. Simulation and mathematical optimization are useful approaches for assessing and optimizing stroke transport policies, without endangering the health of the patients.

The main purpose of this thesis is to contribute to improving the situation for stroke patients and to reducing the social impacts of stroke. The aim is to study how to use simulation and optimization to achieve improved analysis and planning of prehospital stroke care. In particular, we focus on assessing the potential use of MSUs in a geographic area. In this thesis, optimization is used to identify the optimal locations of MSUs, and simulation is used to assess different stroke transport policies, including MSU locations. The results of this thesis aim to support public health authorities when making decisions in the prehospital stroke care domain.

In order to fulfill the aim of this thesis, we develop and analyze a number of different simulation and optimization models. First, we propose a macro-level simulation model, an average time to treatment estimation model, used to estimate the expected time to treatment for different parts of a geographic region. Using the proposed model, we generate two different MSU scenarios to explore the potential benefits of employing MSUs in Sweden’s southern healthcare region (SHR).  

Second, we present an optimization model to identify the best placement of MSUs while making a trade-off between the efficiency and equity perspectives, providing maximum population coverage and equal service for all patients, respectively. The trade-off function used in the model makes use of the concepts of weighted average time to treatment to model efficiency and the time difference between the expected time to treatment for different geographical areas to model equity. In a scenario study applied in the SHR, we evaluate our optimization model by comparing the current situation with three MSU scenarios, including 1, 2, and 3 MSUs.

Third, we present a micro-level discrete event simulation model to assess stroke transport policies, including MSUs, allowing us to model the behaviors of individual entities, such as patients and emergency vehicles, over time. We generate a synthetic set of stroke patients using a Poisson distribution, used as input in a scenario study.

Finally, we present a modeling framework with reusable components, which aims to facilitate the construction of discrete event simulation models in the emergency medical services domain. The framework consists of a number of generic activities, which can be used to represent healthcare chains modeled in the form of flowcharts. As the framework includes activities and policies modeled on the general level, the framework can be used to create models only by providing input data and a care chain specification. We evaluate the framework by using it to build a model for simulating EMS activities related to the complex case of acute stroke.

Place, publisher, year, edition, pages
Malmö: Malmö universitet, 2022. p. 55
Series
Studies in Computer Science ; 21
Keywords
Stroke Transport Policies, EMS, Mobile Stroke Unit, MSU, Simulation, Optimization, Modeling Framework.
National Category
Engineering and Technology
Identifiers
urn:nbn:se:mau:diva-55489 (URN)10.24834/isbn.9789178773039 (DOI)978-91-7877-304-6 (ISBN)978-91-7877-303-9 (ISBN)
Presentation
2022-10-18, 13:00 (English)
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Note: The papers are not included in the fulltext online.

Available from: 2022-10-25 Created: 2022-10-24 Last updated: 2024-02-26Bibliographically approved

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Mahdiraji, Saeid AmouzadMihailescu, Radu-CasianPetersson, Jesper

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