Forecasting for a clearer view
Delivering improved stroke care across Australia is a complicated and intricate task. It requires humans to make complex decisions quickly, supported by modelling that has already predicted best practice. Enter one of our chief investigators, Professor Leonid Churilov, his colleague Dr Hannah Johns and Ambulance Victoria’s Professor Karen Smith. This collaboration is the first of several to involve Stroke Alliance modelling with our aeromedical and ambulance partners. The planning conducted now will influence care long beyond the lifetime of our five-year research program.
Deciding the location of first responders, ambulances, aircraft, and specialist services is especially important if the Australian Stroke Alliance is to improve response times for stroke patients around the country. We must define barriers to rapid treatment and open the way for ‘the right care at the right time for the right patient’.
Together with our partners at ambulance services around Australia and the Royal Flying Doctor Service, we are using modelling to identify the possible consequences, both good and bad, of different decisions relating to resource allocation and care processes.
“In a nutshell, humans make decisions in complex environments, often facing risk and uncertainty. Modelling is important because it lets you ask questions about what the consequences of your decisions might be before you make them.”
This sort of modelling is everywhere and it is used for everything from making weather forecasts to designing roads. It has also been front and centre in the media throughout the pandemic, where it has been used to help guide public health decision making.
Both Leonid and Dr Hannah Johns have backgrounds in operations research and statistical modelling – constructing reasonably accurate representations of the world that can be used to help people make better decisions in complex environments.
According to Hannah: “Our work with the Stroke Alliance is centred around using this modelling to optimise clinical decisions and stroke care processes”.
Leonid and Hannah are working with epidemiologist Professor Karen Smith, the director of the Centre for Research and Evaluation at Ambulance Victoria, to scope the landscape prior to the arrival of mobile brain scanning devices and stroke-capable road ambulances.
“We are using our Ambulance Victoria electronic patient care record data and our CAD data to look at the location of people experiencing stroke or transient ischaemic attack when attended by paramedics,” Karen says.
“We plan to look at quite a few factors for patients experiencing a stroke in rural locations, such as areas with the greatest patient numbers and the current level of service cover – looking at access to stroke units, stroke telemedicine, distance from hospitals. From this we will most likely derive a risk score to determine the areas with the greatest need. “It also allows us to select the best location for future mobile stroke units, to allow for maximum coverage and maximum patient benefit.”
The goal behind all modelling is to provide an environment when stroke is treated faster and to then be able to measure improved patient outcomes.
“There are likely to be significant benefits – increased accuracy of diagnosis, decreased time to life saving treatment and increased access to gold standard care. This will help reduce the inequities between patients experiencing a stroke in rural regions versus metropolitan regions.”
According to Hannah, the project is exciting for its potential to deliver significant benefits to patients. “In general, modelling work is full of interesting challenges and technical puzzles, but there’s something incredibly exciting about the potential to help shape the treatment of stroke in Australia going into the future.
“One of the things I enjoy most about modelling is the opportunity to work with people who are experts in other areas. I’m looking forward to working closely with Karen to help the alliance optimise the delivery of stroke care.”
Karen agrees and is keen to take lessons from improved care delivered on the mobile stroke unit to rural settings. “Collaboration is everything in healthcare and research. I really enjoy working with people with such varied skills and experience. Working with the broader team is exciting as the optimisation work being done by Leonid is very interesting.”