TY - JOUR
T1 - Evaluation of the Experience of Spoke Hospitals in an Academic Telestroke Network
AU - Gadhia, Rajan
AU - Schwamm, Lee H.
AU - Viswanathan, Anand
AU - Whitney, Cynthia
AU - Moreno, Arianna
AU - Zachrison, Kori S.
N1 - Funding Information:
The authors are grateful to the staff at the following hospitals for their study participation: Bridgton Hospital, Central Maine Medical Center, Cooley Dickinson Hospital, Concord Hospital, Elliot Hospital, Exeter Hospital, Franklin Regional Hospital, Lakes Region General Hospital, Martha’s Vineyard Hospital, Mercy Hospital, Nantucket Cottage Hospital, Rumford Hospital, Southern New Hampshire Medical Center, Carney Hospital, Wentworth Douglas Hospital, and York Hospital. K.S.Z. reports funding from AHRQ (K08-HS0245601).
Publisher Copyright:
© Copyright 2019, Mary Ann Liebert, Inc., publishers 2019.
PY - 2019/7
Y1 - 2019/7
N2 - Background/Introduction: Implementation of telestroke has been associated with improved thrombolysis rates and clinical outcomes in remote or neurologically underserved spoke hospitals. Yet, the experience of spoke hospitals using telestroke has not been well described. We sought to characterize spoke hospitals' perceptions of telestroke to understand perceived advantages, challenges, and barriers to use. Design/Methods: Within our northeastern US telestroke network, we conducted scripted interviews with representatives (stroke coordinators, nurse managers, and emergency physicians) from each of the 15 spoke hospitals connected to a single academic hub hospital. Interview questions included both open-ended and Likert scale responses. We used descriptive and nonparametric analyses (e.g., logit) to present the results. Results: Of the 15 spoke hospitals interviewed, the majority felt that telestroke enabled them to treat more patients with the tissue plasminogen activator (tPA; 93.3%, n = 14) and to achieve faster door-to-needle times for tPA treatment (80%, n = 12). Higher Likert scores were not correlated with hospitals' consult volume or tPA volume. The most commonly reported barriers to using telestroke were providers who were not familiar or comfortable using the technology (66%, n = 10). Few hospitals had concerns that telestroke led to overtreatment with tPA (13.3%, n = 2) or led to unnecessary transfers (20%, n = 3). None of the hospitals felt that the physician-patient relationship was compromised, nor was there a concern that patients would have a negative perception of the spoke hospital with utilization of services. Conclusions: Within this single hub-spoke telestroke system in the northeast, we found that spoke hospitals perceive the advantages of telestroke to be in enabling improved rates and efficiency of tPA administration. Barriers to use were most often related to technological challenges rather than concerns about patient care or patients' perceptions. Future work should further explore how to better meet the needs of spoke hospitals in caring for stroke patients.
AB - Background/Introduction: Implementation of telestroke has been associated with improved thrombolysis rates and clinical outcomes in remote or neurologically underserved spoke hospitals. Yet, the experience of spoke hospitals using telestroke has not been well described. We sought to characterize spoke hospitals' perceptions of telestroke to understand perceived advantages, challenges, and barriers to use. Design/Methods: Within our northeastern US telestroke network, we conducted scripted interviews with representatives (stroke coordinators, nurse managers, and emergency physicians) from each of the 15 spoke hospitals connected to a single academic hub hospital. Interview questions included both open-ended and Likert scale responses. We used descriptive and nonparametric analyses (e.g., logit) to present the results. Results: Of the 15 spoke hospitals interviewed, the majority felt that telestroke enabled them to treat more patients with the tissue plasminogen activator (tPA; 93.3%, n = 14) and to achieve faster door-to-needle times for tPA treatment (80%, n = 12). Higher Likert scores were not correlated with hospitals' consult volume or tPA volume. The most commonly reported barriers to using telestroke were providers who were not familiar or comfortable using the technology (66%, n = 10). Few hospitals had concerns that telestroke led to overtreatment with tPA (13.3%, n = 2) or led to unnecessary transfers (20%, n = 3). None of the hospitals felt that the physician-patient relationship was compromised, nor was there a concern that patients would have a negative perception of the spoke hospital with utilization of services. Conclusions: Within this single hub-spoke telestroke system in the northeast, we found that spoke hospitals perceive the advantages of telestroke to be in enabling improved rates and efficiency of tPA administration. Barriers to use were most often related to technological challenges rather than concerns about patient care or patients' perceptions. Future work should further explore how to better meet the needs of spoke hospitals in caring for stroke patients.
KW - cerebrovascular disease/stroke
KW - cost-effectiveness
KW - quality of healthcare
KW - stroke care
KW - stroke management
KW - telemedicine
KW - thrombolytic therapy
UR - http://www.scopus.com/inward/record.url?scp=85068916694&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85068916694&partnerID=8YFLogxK
U2 - 10.1089/tmj.2018.0133
DO - 10.1089/tmj.2018.0133
M3 - Article
C2 - 30256724
AN - SCOPUS:85068916694
SN - 1530-5627
VL - 25
SP - 584
EP - 590
JO - Telemedicine and e-Health
JF - Telemedicine and e-Health
IS - 7
ER -