title: Striking rural-urban disparities observed in acute stroke care capacity and services in the pacific northwest: implications and recommendations.
abstract: OBJECTIVE
  The age-adjusted stroke death rate in adults aged ≥45 years is significantly higher in the Northwest region than in the rest of the United States. Alaska, Idaho, Montana, Oregon, and Washington have substantial rural and frontier areas with unique characteristics and complexities that pose challenges to timely acute stroke care and ultimately affect the patient.
  
  
  METHODS
  A regional needs assessment was conducted to assess acute stroke care capacity and services in the Northwest region. Hospitals with an emergency department were surveyed with a standardized online tool based on the Brain Attack Coalition recommendations and developed by stroke neurologists, emergency medical services leaders, state public health professionals, and American Stroke Association members.
  
  
  RESULTS
  Approximately 76% of hospitals completed the questionnaire. Striking rural-urban differences were seen with rural hospitals having a much lower capacity to adequately care for patients with stroke. Two thirds lacked the necessary personnel, one third lacked necessary neuroimaging equipment, and one fourth were functioning without written emergency department and tissue plasminogen activator stroke protocols.
  
  
  CONCLUSIONS
  This survey represents the first comprehensive regional assessment of stroke care capacity and services both in the Northwest region and the whole United States. The findings have confirmed the need to focus on strengthening stroke personnel, increasing access to care, and promoting written protocols, especially in rural settings. Additionally, promoting stroke center certification, increasing the number of stroke registries throughout the region, encouraging use of inpatient stroke care protocols in rural hospitals, and conducting ongoing stroke care capacity and services surveys is highly recommended.
authors.affiliation: Data Quality and Statistical Services, Center for Health Statistics, Washington State Department of Health, Tumwater, WA 98501-7855, USA.
authors.forename: Wendy
authors.initials: W
authors.lastname: Shultis
authors.forename: Robert
authors.initials: R
authors.lastname: Graff
authors.forename: Chara
authors.initials: C
authors.lastname: Chamie
authors.forename: Cherish
authors.initials: C
authors.lastname: Hart
authors.forename: Palina
authors.initials: P
authors.lastname: Louangketh
authors.forename: Mike
authors.initials: M
authors.lastname: McNamara
authors.forename: Nick
authors.initials: N
authors.lastname: Okon
authors.forename: David
authors.initials: D
authors.lastname: Tirschwell
mesh_terms: D004632:Emergency Medical Services / Q000600:supply & distribution*; D019538:Health Care Surveys; D006297:Health Services Accessibility; D006301:Health Services Needs and Demand; D006780:Hospitals, Rural; D006801:Humans; D015205:Northwestern United States; D012424:Rural Population; D020521:Stroke / Q000628:therapy*; D011795:Surveys and Questionnaires; D014505:Urban Population