Nicholas M Mohr1,2,3, Tracy Young1,4, Karisa K Harland1, Brian Skow5, Amy Wittrock5, Amanda Bell5, Marcia M Ward6. 1. 1 Department of Emergency Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa. 2. 2 Department of Anesthesia, University of Iowa Carver College of Medicine, Iowa City, Iowa. 3. 3 Department of Epidemiology, University of Iowa College of Public Health, Iowa City, Iowa. 4. 4 Injury Prevention Research Center, University of Iowa College of Public Health, Iowa City, Iowa. 5. 5 Avera eCARE, Sioux Falls, South Dakota. 6. 6 Department of Health Management and Policy, University of Iowa College of Public Health, Iowa City, Iowa.
Abstract
BACKGROUND: Meeting time goals for patients with time-sensitive conditions can be challenging in rural emergency departments (EDs), and adopting policies is critical. ED-based telemedicine has been proposed to improve quality and timeliness of care in rural EDs. INTRODUCTION: The objective of this study was to test the hypothesis that diagnostic testing in telemedicine-supplemented ED care for patients with myocardial infarction (MI) and stroke would be faster than nontelemedicine care in rural EDs. MATERIALS AND METHODS: This observational cohort study included all ED patients with MI or stroke in 19 rural critical access hospitals served by a single real-time contract-based telemedicine provider in the upper Midwest (2007-2015). The primary outcome for the MI cohort was time-to-electrocardiogram (EKG) and for the stroke cohort was time-to-head computed tomography (CT) interpretation. To measure the relationship between telemedicine and timeliness parameters, generalized estimating equations models were used, clustering on presenting hospital. RESULTS: Of participating ED visits, 756 were included in the MI cohort (29% used telemedicine) and 140 were included in the stroke cohort (30% used telemedicine). Time-to-EKG did not differ when telemedicine was used (1% faster, 95% confidence interval [CI] -4% to 7%), or after telemedicine was implemented (4% faster, 95% CI -3% to 10%). Head CT interpretation was faster for telemedicine cases (15% faster, 95% CI 4-26%). No differences were observed in time to reperfusion therapy. CONCLUSIONS: Telemedicine implementation was associated with more timely head CT interpretation for rural patients with stroke, but no difference in early MI care. Future work will focus on the specific manner in which telemedicine changes ED care processes and ongoing professional education.
BACKGROUND: Meeting time goals for patients with time-sensitive conditions can be challenging in rural emergency departments (EDs), and adopting policies is critical. ED-based telemedicine has been proposed to improve quality and timeliness of care in rural EDs. INTRODUCTION: The objective of this study was to test the hypothesis that diagnostic testing in telemedicine-supplemented ED care for patients with myocardial infarction (MI) and stroke would be faster than nontelemedicine care in rural EDs. MATERIALS AND METHODS: This observational cohort study included all ED patients with MI or stroke in 19 rural critical access hospitals served by a single real-time contract-based telemedicine provider in the upper Midwest (2007-2015). The primary outcome for the MI cohort was time-to-electrocardiogram (EKG) and for the stroke cohort was time-to-head computed tomography (CT) interpretation. To measure the relationship between telemedicine and timeliness parameters, generalized estimating equations models were used, clustering on presenting hospital. RESULTS: Of participating ED visits, 756 were included in the MI cohort (29% used telemedicine) and 140 were included in the stroke cohort (30% used telemedicine). Time-to-EKG did not differ when telemedicine was used (1% faster, 95% confidence interval [CI] -4% to 7%), or after telemedicine was implemented (4% faster, 95% CI -3% to 10%). Head CT interpretation was faster for telemedicine cases (15% faster, 95% CI 4-26%). No differences were observed in time to reperfusion therapy. CONCLUSIONS: Telemedicine implementation was associated with more timely head CT interpretation for rural patients with stroke, but no difference in early MI care. Future work will focus on the specific manner in which telemedicine changes ED care processes and ongoing professional education.
Authors: Aspen C Miller; Marcia M Ward; Fred Ullrich; Kimberly A S Merchant; Morgan B Swanson; Nicholas M Mohr Journal: Telemed J E Health Date: 2020-02-28 Impact factor: 3.536
Authors: Jayamalathi Priyanka Vakkalanka; Karisa K Harland; Amy Wittrock; Margaret Schmidt; Luke Mack; Matthew Nipe; Elaine Himadi; Marcia M Ward; Nicholas M Mohr Journal: J Epidemiol Community Health Date: 2019-09-06 Impact factor: 3.710
Authors: Morgan B Swanson; Aspen C Miller; Marcia M Ward; Fred Ullrich; Kimberly As Merchant; Nicholas M Mohr Journal: J Telemed Telecare Date: 2019-11-04 Impact factor: 6.344
Authors: Nicholas M Mohr; Chaorong Wu; Michael J Ward; Candace D McNaughton; Kelly Richardson; Peter J Kaboli Journal: BMC Health Serv Res Date: 2020-02-12 Impact factor: 2.655
Authors: Marc Felzen; Stefan Kurt Beckers; Felix Kork; Frederik Hirsch; Sebastian Bergrath; Anja Sommer; Jörg Christian Brokmann; Michael Czaplik; Rolf Rossaint Journal: J Med Internet Res Date: 2019-10-08 Impact factor: 5.428
Authors: Sarah Heppner; Nicholas M Mohr; Knute D Carter; Fred Ullrich; Kimberly A S Merchant; Marcia M Ward Journal: PLoS One Date: 2021-01-12 Impact factor: 3.240
Authors: Nicholas M Mohr; Kalyn D Campbell; Morgan B Swanson; Fred Ullrich; Kimberly A Merchant; Marcia M Ward Journal: J Telemed Telecare Date: 2020-01-05 Impact factor: 6.344
Authors: Lina T M Quadflieg; Stefan K Beckers; Sebastian Bergrath; Ann-Katrin Brockert; Hanna Schröder; Anja Sommer; Jörg C Brokmann; Rolf Rossaint; Marc Felzen Journal: Sci Rep Date: 2020-10-22 Impact factor: 4.379