Developing an Operational Model to Address the Causes of Death from Stroke in Suphan Buri

Abstract

          Objective: The purpose of this study is to (1) examine patterns and trends in the population of Suphan Buri Province's premature stroke deaths and (2) develop an operational model to address the causes of stroke deaths.

          Methods: The PAOR process (planning, implementing, observing, reflecting) for action research comprises the following steps: (1) Planning (P) is a quantitative study that used secondary data from the Ministry of Interior's civil register and the Strategy and Planning Division of the Ministry of Public Health between 2014 and 2023. The patterns and trends in stroke-related premature deaths were investigated using these data. Brainstorming was another tool used in qualitative research to identify issues and operational conditions. There were forty executives and related personnel in the sample group. The research instrument used was a semi-structured interview. (2) Action step (A) was to utilize the WHO health systems framework to create an operating model by determining the problem-solving approach through group discussion. The planning stage's sample group was the same as this one. The model was subsequently used in the Doem Bang Nang Buat District pilot project. (3) Observation (O) was gathering operational data in the field through the use of observation forms and satisfaction surveys; and (4) Reflection stage (R), in which the team and the researcher assess performance and provided feedback on the operating model. Statistics used included descriptive statistics, life table models, YLL, and content analysis.

          Results: 1) The results of the analysis of patterns and trends in premature deaths from stroke revealed that the mortality rate tended to increase, the proportion of deaths in males was higher than in females, and death tended to occur in younger age groups, That LE declined by 1.06 years, and YLL tended to increase. 2) The developed model comprised (1) Service delivery, activities focusing on health literacy, comprehensive screening, and developing service systems based on local needs and problems; (2) Health workforce focus on activities that enhance the skills of employees engaged in operations at all levels, with curriculum content tailored to the problems’ context; (3) Information technology system, which offered enough data analysis and a database for planning; (4) Guidelines for stroke alert, stroke fast track, fast pass, EMS 1669, 24-hour consulting system, and refer back system  provided to facilitate access to necessary medications; (5) Financial system by offering a strategy for investments that aligns with the service plan; and (6) Leadership and governance element by putting in place a plan for efficient control, supervision, monitoring, and evaluation and strengthening the participation of all sectors. The results of operating the model were as follows: the number of hemorrhagic stroke patients decreased, the rate of access to stroke care within 2 hours increased, and the rate of access to rt-PA within 60 minutes was 100%.

          Conclusions: The developing model to address the causes of deaths from stroke in Suphan Buri Province can be practically applied in the area. The operating model reduced morbidity and deaths from hemorrhage stroke, and people's satisfaction with the operation at the highest level.