Andrew D Wilcock1, Lee H Schwamm2,3, Jose R Zubizarreta4,5,6, Kori S Zachrison2,7, Lori Uscher-Pines8, Jessica V Richard4, Ateev Mehrotra4,9. 1. Center for Health Services Research, Department of Family Medicine, The Larner College of Medicine, University of Vermont, Burlington. 2. Department of Emergency Medicine, Massachusetts General Hospital, Boston. 3. Department of Neurology, Harvard Medical School, Boston, Massachusetts. 4. Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts. 5. Harvard T. H. Chan School of Public Health, Boston, Massachusetts. 6. Harvard University, Cambridge, Massachusetts. 7. Department of Emergency Medicine, Harvard Medical School, Boston, Massachusetts. 8. RAND Corporation, Arlington, Virginia. 9. Beth Israel Deaconess Medical Center, Boston, Massachusetts.
Abstract
Importance: Telestroke is increasingly used in hospital emergency departments, but there has been limited research on its impact on treatment and outcomes. Objective: To describe differences in care patterns and outcomes among patients with acute ischemic stroke who present to hospitals with and without telestroke capacity. Design, Setting, and Participants: Patients with acute ischemic stroke who first presented to hospitals with telestroke capacity were matched with patients who presented to control hospitals without telestroke capacity. All traditional Medicare beneficiaries with a primary diagnosis of acute ischemic stroke (approximately 2.5 million) who presented to a hospital between January 2008 and June 2017 were considered. Matching was based on sociodemographic and clinical characteristics, hospital characteristics, and month and year of admission. Hospitals included short-term acute care and critical access hospitals in the US without local stroke expertise. In 643 hospitals with telestroke capacity, there were 76 636 patients with stroke who were matched 1:1 to patients at similar hospitals without telestroke capacity. Data were analyzed in July 2020. Main Outcomes and Measures: Receipt of reperfusion treatment through thrombolysis with alteplase or thrombectomy, mortality at 30 days from admission, spending through 90 days from admission, and functional status as measured by days spent living in the community after discharge. Results: In the final sample of 153 272 patients, 88 386 (57.7%) were female, and the mean (SD) age was 78.8 (10.4) years. Patients cared for at telestroke hospitals had higher rates of reperfusion treatment compared with those cared for at control hospitals (6.8% vs 6.0%; difference, 0.78 percentage points; 95% CI, 0.54-1.03; P < .001) and lower 30-day mortality (13.1% vs 13.6%; difference, 0.50 percentage points; 95% CI, 0.17-0.83, P = .003). There were no differences in days spent living in the community following discharge or in spending. Increases in reperfusion treatment were largest in the lowest-volume hospitals, among rural residents, and among patients 85 years and older. Conclusions and Relevance: Patients with ischemic stroke treated at hospitals with telestroke capacity were more likely to receive reperfusion treatment and have lower 30-day mortality.
Importance: Telestroke is increasingly used in hospital emergency departments, but there has been limited research on its impact on treatment and outcomes. Objective: To describe differences in care patterns and outcomes among patients with acute ischemic stroke who present to hospitals with and without telestroke capacity. Design, Setting, and Participants: Patients with acute ischemic stroke who first presented to hospitals with telestroke capacity were matched with patients who presented to control hospitals without telestroke capacity. All traditional Medicare beneficiaries with a primary diagnosis of acute ischemic stroke (approximately 2.5 million) who presented to a hospital between January 2008 and June 2017 were considered. Matching was based on sociodemographic and clinical characteristics, hospital characteristics, and month and year of admission. Hospitals included short-term acute care and critical access hospitals in the US without local stroke expertise. In 643 hospitals with telestroke capacity, there were 76 636 patients with stroke who were matched 1:1 to patients at similar hospitals without telestroke capacity. Data were analyzed in July 2020. Main Outcomes and Measures: Receipt of reperfusion treatment through thrombolysis with alteplase or thrombectomy, mortality at 30 days from admission, spending through 90 days from admission, and functional status as measured by days spent living in the community after discharge. Results: In the final sample of 153 272 patients, 88 386 (57.7%) were female, and the mean (SD) age was 78.8 (10.4) years. Patients cared for at telestroke hospitals had higher rates of reperfusion treatment compared with those cared for at control hospitals (6.8% vs 6.0%; difference, 0.78 percentage points; 95% CI, 0.54-1.03; P < .001) and lower 30-day mortality (13.1% vs 13.6%; difference, 0.50 percentage points; 95% CI, 0.17-0.83, P = .003). There were no differences in days spent living in the community following discharge or in spending. Increases in reperfusion treatment were largest in the lowest-volume hospitals, among rural residents, and among patients 85 years and older. Conclusions and Relevance: Patients with ischemic stroke treated at hospitals with telestroke capacity were more likely to receive reperfusion treatment and have lower 30-day mortality.
Authors: Kori S Zachrison; Emily M Hayden; Krislyn M Boggs; Tehnaz P Boyle; Jingya Gao; Margaret E Samuels-Kalow; James P Marcin; Carlos A Camargo Journal: J Med Internet Res Date: 2022-06-20 Impact factor: 7.076
Authors: Andrew D Wilcock; Lee H Schwamm; Jose R Zubizarreta; Kori S Zachrison; Lori Uscher-Pines; Jennifer J Majersik; Jessica V Richard; Ateev Mehrotra Journal: Health Aff (Millwood) Date: 2022-03 Impact factor: 9.048
Authors: Gordian J Hubert; Nikolai D Hubert; Christian Maegerlein; Frank Kraus; Hanni Wiestler; Peter Müller-Barna; Wolfgang Gerdsmeier-Petz; Christoph Degenhart; Katharina Hohenbichler; Dennis Dietrich; Thomas Witton-Davies; Angelika Regler; Laura Paternoster; Miriam Leitner; Florian Zeman; Michael Koller; Ralf A Linker; Philip M Bath; Heinrich J Audebert; Roman L Haberl Journal: JAMA Date: 2022-05-10 Impact factor: 157.335
Authors: Eméfah C Loccoh; Karen E Joynt Maddox; Yun Wang; Dhruv S Kazi; Robert W Yeh; Rishi K Wadhera Journal: J Am Coll Cardiol Date: 2022-01-25 Impact factor: 24.094
Authors: Christopher Uschnig; Florian Recker; Michael Blaivas; Yi Dong; Christoph F Dietrich Journal: Ultrasound Med Biol Date: 2022-01-10 Impact factor: 3.694
Authors: Kori S Zachrison; Jessica V Richard; Andrew Wilcock; Jose R Zubizarreta; Lee H Schwamm; Lori Uscher-Pines; Ateev Mehrotra Journal: JAMA Netw Open Date: 2021-09-01
Authors: Kori S Zachrison; Margaret E Samuels-Kalow; Sijia Li; Zhiyu Yan; Mathew J Reeves; Renee Y Hsia; Lee H Schwamm; Carlos A Camargo Journal: J Am Coll Emerg Physicians Open Date: 2022-03-14
Authors: Kori S Zachrison; Rebecca E Cash; Opeolu Adeoye; Krislyn M Boggs; Lee H Schwamm; Ateev Mehrotra; Carlos A Camargo Journal: JAMA Netw Open Date: 2022-02-01