Ischemic stroke is a devastating disease which without appropriate treatment can result in severe disability or death. There are two treatments for ischemic stroke: 1) medical treatment with intravenous alteplase, and 2) a minimally invasive surgical procedure, endovascular therapy (EVT). Alteplase is widely available at smaller community hospitals; however, is not very effective. Endovascular therapy is only available at urban tertiary hospitals, but is highly effective. Both treatments are time sensitive. For patients outside of the catchment area of an EVT centre there are two transport options: 1) transport to the closest hospital for alteplase and then transfer to an EVT capable hospital for EVT (drip-and-ship); or 2) direct transport to an EVT capable hospital (bypassing a closer community hospital) for alteplase and EVT (mothership). The choice between drip-and-ship and mothership transport is multi-factorial and there is not one size fits all solution.
DESTINE is an interactive decision support tool which uses an evidence-based algorithm to predict whether drip-and-ship or mothership transport will result in the best patient outcomes at the population level. This is a complex decision based on several factors including: geography, travel time, hospital treatment efficiency, and the probable diagnostic distribution of potential stroke patients identified in the field by EMS. DESTINE takes this complex problem and produces a simple visualization which can be used as a decision support tool to assist healthcare administrators in planning their stroke systems. DESTINE software is interactive and cloud-based; it uses a proprietary algorithm based off years of peer-reviewed research to create map visualizations. Healthcare administrators use these maps to create evidence-based transport protocols for their stroke systems. The maps further show how transport protocols change as stroke system efficiency or hospital treatment designation changes.
DESTINE Health was born as an academic project in the Departments of Clinical Neurosciences and Community Health Sciences at the University of Calgary. To read more about the science behind DESTINE Health please see the below academic publications.