title: Availability of diagnostic and treatment services for acute stroke in frontier counties in Montana and Northern Wyoming.
abstract: BACKGROUND
  Rapid diagnosis and treatment of ischemic stroke can lead to improved patient outcomes. Hospitals in rural and frontier counties, however, face unique challenges in providing diagnostic and treatment services for acute stroke.
  
  
  OBJECTIVE
  The aim of this study was to assess the availability of key diagnostic technology and programs for acute stroke evaluation and treatment in Montana and northern Wyoming.
  
  
  METHODS
  In 2004, hospital medical directors or their designees were mailed a survey about the availability of diagnostic technology, programs, and personnel for acute stroke care.
  
  
  RESULTS
  Fifty-eight of 67 (87%) hospitals responded to the survey. Seventy-nine percent (46/58) of responding hospitals were located in frontier counties, with an average bed size of 18 (11 SD). Of the hospitals in frontier counties, 44% reported emergency medical services prehospital stroke identification programs, 39% had 24-hour computed tomography capability, 44% had an emergency department stroke protocol, and 61% had a recombinant tissue plasminogen activator protocol. Thirty percent of hospitals in frontier counties reported that they met 6-10 of the criteria established by the Brain Attack Coalition to improve acute stroke care compared to 67% of hospitals in the nonfrontier counties.
  
  
  CONCLUSIONS
  A stroke network model could enhance care and improve outcomes for stroke victims in frontier counties.
authors.affiliation: Stroke Center, St. Vincent Healthcare, Billings, Montana, USA.
authors.forename: Nicholas J
authors.initials: NJ
authors.lastname: Okon
authors.forename: Daniel V
authors.initials: DV
authors.lastname: Rodriguez
authors.forename: Dennis W
authors.initials: DW
authors.lastname: Dietrich
authors.forename: Carrie S
authors.initials: CS
authors.lastname: Oser
authors.forename: Lynda L
authors.initials: LL
authors.lastname: Blades
authors.forename: Anne M
authors.initials: AM
authors.lastname: Burnett
authors.forename: Joseph A
authors.initials: JA
authors.lastname: Russell
authors.forename: Martha J
authors.initials: MJ
authors.lastname: Allen
authors.forename: Linda
authors.initials: L
authors.lastname: Chasson
authors.forename: Steven D
authors.initials: SD
authors.lastname: Helgerson
authors.forename: Dorothy
authors.initials: D
authors.lastname: Gohdes
authors.forename: Todd S
authors.initials: TS
authors.lastname: Harwell
mesh_terms: D000208:Acute Disease; D006297:Health Services Accessibility; D006780:Hospitals, Rural; D006801:Humans; D008507:Medically Underserved Area; D009009:Montana; D020521:Stroke / Q000175:diagnosis* / Q000628:therapy*; D014959:Wyoming