title: Statewide efforts to narrow the rural-urban gap in acute stroke care.
abstract: BACKGROUND
  Rural-urban gaps in stroke care remain challenging in part because of the lack of resources, personnel, and necessary infrastructure.
  
  
  OBJECTIVE
  The purpose of this study was to assess changes in the acute stroke diagnosis and treatment capacity among rural hospitals before and after implementation of a regionwide stroke initiative.
  
  
  METHODS
  In 2004, the Montana Cardiovascular Health Program partnered with stroke stakeholders throughout the state and surveyed hospitals in Montana and northern Wyoming to assess the availability of technology, services, and personnel for acute stroke care. The Montana Stroke Initiative (MSI) developed protocols, educational material, and stroke awareness campaigns to address the geographic disparities identified in the survey. From 2004 to 2006, protocols and educational material were made available on a website and distributed to rural and critical-access hospitals throughout the region. Stroke awareness campaigns were completed, and MSI members conducted acute stroke care training of prehospital, nursing, and primary providers throughout the region. A follow-up survey in 2008 assessed changes in the stroke systems of care between 2004 and 2008. Data were analyzed in 2009.
  
  
  RESULTS
  There were significant increases in availability of prehospital stroke screens, written emergency department protocols, computed tomographic scanning capability, acute stroke teams, and community stroke awareness programs.
  
  
  CONCLUSIONS
  A systematic statewide effort to improve stroke care led to improved acute stroke care capabilities in necessary infrastructure in rural facilities and a narrowing of the gap between these facilities and the urban facilities.
authors.affiliation: Providence St. Vincent Medical Center, Portland, Oregon, USA.
authors.forename: Nicholas J
authors.initials: NJ
authors.lastname: Okon
authors.forename: Crystelle C
authors.initials: CC
authors.lastname: Fogle
authors.forename: Michael J
authors.initials: MJ
authors.lastname: McNamara
authors.forename: Carrie S
authors.initials: CS
authors.lastname: Oser
authors.forename: Dennis W
authors.initials: DW
authors.lastname: Dietrich
authors.forename: Dorothy
authors.initials: D
authors.lastname: Gohdes
authors.forename: Todd S
authors.initials: TS
authors.lastname: Harwell
authors.forename: Daniel V
authors.initials: DV
authors.lastname: Rodriguez
authors.forename: Steven D
authors.initials: SD
authors.lastname: Helgerson
mesh_terms: D004636:Emergency Service, Hospital / Q000458:organization & administration; D005500:Follow-Up Studies; D006266:Health Education / Q000379:methods; D007722:Health Knowledge, Attitudes, Practice; D006297:Health Services Accessibility; D054625:Healthcare Disparities; D006801:Humans; D008403:Mass Screening / Q000379:methods; D009009:Montana; D011785:Quality Assurance, Health Care / Q000458:organization & administration; D019035:Rural Health Services / Q000458:organization & administration* / Q000592:standards; D020521:Stroke / Q000175:diagnosis / Q000628:therapy*; D014057:Tomography, X-Ray Computed; D019037:Urban Health Services / Q000458:organization & administration / Q000592:standards