تحقیق در عملیات برای سیستم های مراقبت از سکته مغزی: فرصتی برای دانش انجام بهتر این کار

Stroke is one of the three most common causes of death around the world and the sixth most common cause of disability worldwide. Building effective and efficient stroke care systems is a critical step in improving patient outcomes in the prevention, treatment, and rehabilitation of stroke. Despite what seems like a great potential for Operations Research (often referred to as The Science of Better) to contribute to the design and operation of effective and efficient stroke care systems, OR contribution so far has been limited. The objectives of this paper are to review the field of stroke care systems for OR professionals, to illustrate existing OR contribution to stroke care systems and to propose an agenda for how The Science of Better could better contribute to the effort of designing and operating stroke care systems.

Stroke is one of the three most common causes of death around the world and the sixth most common cause of disability worldwide. Building effective and efficient stroke care systems is a critical step in improving patient outcomes in the prevention, treatment, and rehabilitation of stroke. Despite what seems like great potential for Operations Research (often referred to as The Science of Better) to contribute to the design and operation of effective and efficient stroke care systems, OR contribution so far has been limited. This paper has been co-authored by an OR professional working in the area of stroke systems and a stroke clinician, with the three-fold objective: (a) to provide a relatively self-contained “primer” of stroke and stroke care systems for OR professionals; (b) to illustrate existing OR contributions related to stroke care systems; (c) to propose an agenda for OR to contribute to the effort of designing and operating effective and efficient stroke care systems. The paper is organized as follows. Section 2 provides a concise review of stroke, focusing on its epidemiology and burden, prognosis, risk factors, acute interventions and prevention strategies. In Section 3 we provide an overview of the issues involved in design and operations of stroke care systems world-wide through the prism of several key public policy documents: American Heart Association Public Policy Agenda 2010–13 report [1]; NHS Department of Health: National Stroke Strategy for England [2]; Canadian Stroke Strategy Core Performance Indicators 2010 report [3]; and Australian National Stroke Foundation Clinical Guidelines for Stroke Management [4]. Section 4 is dedicated to an analysis of the existing published contributions of OR to stroke care. In Section 5 we present our vision for an agenda for Operations Research in stroke care by listing ten broad problem areas that, in our view, present the most pressing need from the stroke care services and systems perspective, as well as constituting interesting and productive targets for a concentrated OR effort. Concluding remarks are made in Section 6.

A systems approach is necessary to improve how stroke is treated so that patients have access to the most appropriate treatment in centres that are best equipped to deal with their critical and time-sensitive needs. The success on this path depends, among other factors, upon successful integrated effort of both OR and stroke care professionals, which, in turn, depends on a common understanding of the subject domain and common vision for problems to attack. In this paper we have provided OR professionals with a stroke primer, summarized key policy documents in stroke care systems around the world, reviewed existing OR contribution to stroke care systems, and proposed an agenda for OR contribution to stroke care systems with the aim to unleash the potential of OR in the effort of designing and operating effective and efficient stroke care systems. While there is current evidence of increasing attention by the OR profession towards stroke care systems as demonstrated by published OR work, stroke care systems present plenty of scope for The Science of Better to do much better! It could be envisaged that the discussion in this paper would contribute to “bridging the gap” between the OR offerings and stroke care systems needs by encouraging OR professionals to direct their effort towards important problems of stroke care systems design and operations.