Predictive and individualized management of stroke—success story in Czech Republic
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The model of centralized stroke care in the Czech Republic was created in 2010–2012 by Ministry of Health (MH) in cooperation with professional organization—Cerebrovascular Section of the Czech Neurological Society (CSCNS). It defines priorities of stroke care, stroke centers, triage of suspected stroke patients, stroke care quality indicators, their monitoring, and reporting. Thirteen complex cerebrovascular centers (CCC) provide sophisticated stroke care, including intravenous thrombolysis (IVT), mechanical thrombectomy (MTE), as well as other endovascular (stenting, coiling) and neurosurgical procedures. Thirty-two stroke centers (SC) provide stroke care except endovascular procedures and neurosurgery. The triage is managed by emergency medical service (EMS). The most important quality indicators of stroke care are number of hospitalized stroke patients, number of IVT, number of MTE, stenting and coiling, number of neurosurgical procedures, and percentage of deaths within 30 days. Indicators provided into the register of stroke care quality (RES-Q) managed by CSCNS are time from stroke onset to hospital admission, door-to-needle time, door-to-groin time, type of ischemic stroke, and others. Data from RES-Q are shared to all centers. Within the last 5 years, the Czech Republic becomes one of the leading countries in acute stroke care. The model of centralized stroke care is highly beneficial and effective. The quality indicators serve as tool of control of stroke centers activities. The sharing of quality indicators is useful tool for mutual competition and feedback control in each center. This comprehensive system ensures high standard of stroke care. This system respects the substantial principles of personalized medicine—individualized treatment of acute stroke and other comorbidities at the acute disease stage; optimal prevention, diagnosis and treatment of possible complications; prediction of further treatment and outcome; individualized secondary prevention, exactly according to the stroke etiology. The described model of stroke care optimally meets criteria of predictive, preventive, and personalized medicine (PPPM), and could be used in other countries as well with the aim of improving stroke care quality in general.
KeywordsStroke Stroke care organization Centralized stroke care Stroke centers Intravenous thrombolysis Mechanical thrombectomy Quality indicators Personalized medicine Personalized stroke treatment Personalized stroke prevention Centralized stroke care
JP is the project coordinator who has created the main concepts presented in the manuscript. JP, JP Jr., and VR has performed the literature search, analyzed the data, and drafted the manuscript. JP, JP Jr., and VR have designed the final version of the manuscript.
This work was supported by MH CZ—DRO (Faculty Hospital Plzen—FNPl, 00669806), by the Charles University Research Fund (Progres Q39), and by the National Sustainability Program I (NPU I) Nr. LO1503 provided by the Ministry of Education Youth and Sports of the Czech Republic. The implementation of the stroke center was supported by the European Integrated Operational Programme—Modernization and Renovation of Comprehensive Cerebrovascular Center Equipment FN Plzen (CZ.1.06/3.2.01/08.07635).
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Conflict of interest
The authors declare that they have no conflict of interest.
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