A Network Approach to Stroke Systems of Care

Circ Cardiovasc Qual Outcomes. 2019 Aug;12(8):e005526. doi: 10.1161/CIRCOUTCOMES.119.005526. Epub 2019 Aug 13.


The landscape of stroke systems of care is evolving as patients are increasingly transferred between hospitals for access to higher levels of care. This is driven by time-sensitive disability-reducing interventions such as mechanical thrombectomy. However, coordination and triage of patients for such treatment remain a challenge worldwide, particularly given complex eligibility criteria and varying time windows for treatment. Network analysis is an approach that may be applied to this problem. Hospital networks interlinked by patients moved from facility to facility can be studied using network modeling that respects the interdependent nature of the system. This allows understanding of the central hubs, the change of network structure over time, and the diffusion of innovations. This topical review introduces the basic principles of network science and provides an overview on the applications and potential interventions in stroke systems of care.

Keywords: diffusion of innovation; hospital; stroke; thrombectomy; triage.

Publication types

  • Research Support, U.S. Gov't, P.H.S.
  • Review

MeSH terms

  • Delivery of Health Care, Integrated / organization & administration*
  • Diffusion of Innovation
  • Humans
  • Neural Networks, Computer
  • Outcome and Process Assessment, Health Care / organization & administration*
  • Patient Transfer / organization & administration*
  • Quality Improvement / organization & administration
  • Quality Indicators, Health Care / organization & administration
  • Social Networking
  • Stroke / diagnosis
  • Stroke / mortality
  • Stroke / physiopathology
  • Stroke / therapy*
  • Thrombectomy* / adverse effects
  • Thrombectomy* / mortality
  • Time Factors
  • Time-to-Treatment / organization & administration*
  • Treatment Outcome
  • Triage / organization & administration*