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Perm J. 2016 Fall;20(4):11-15. doi: 10.7812/TPP/15-217. Epub 2016 Jul 25.

Safe and Effective Implementation of Telestroke in a US Community Hospital Setting.

Author information

1
Assistant Professor in the Department of Emergency Medicine at Massachusetts General Hospital and Harvard Medical School in Boston. ksauser@mgh.harvard.edu.
2
Biostatistician in the Department of Research and Evaluation for Kaiser Permanente in Pasadena, CA. ernest.shen@kp.org.
3
Neurologist at the Los Angeles Medical Center in CA. navdeep.x.sangha@kp.org.
4
Neurologist at the Los Angeles Medical Center in CA. zahra.a.ajani@kp.org.
5
Neurologist at the San Diego Medical Center in CA. william.p.neil@kp.org.
6
Research Scientist in the Department of Research and Evaluation for Kaiser Permanente in Pasadena, CA. michael.k.gould@kp.org.
7
Emergency Physician at the San Rafael Medical Center in CA. dustin.ballard@kp.org.
8
Physician in the Department of Research and Evaluation for Kaiser Permanente in Pasadena, CA. adam.l.sharp@kp.org.

Abstract

CONTEXT:

There is substantial hospital-level variation in use of tissue plasminogen activator (tPA) for treatment of acute ischemic stroke. Telestroke services can bring neurologic expertise to hospitals with fewer resources.

OBJECTIVE:

To determine whether implementation of a telestroke intervention in a large integrated health system would lead to increased tPA utilization and would change rates of hemorrhagic complications.

DESIGN:

A stepped-wedge cluster randomized trial of 11 community hospitals connected to 2 tertiary care centers via telestroke, implemented at each hospital incrementally during a 1-year period. We examined pre- and postimplementation data from July 2013 through January 2015. A 2-level mixed-effects logistic regression model accounted for the staggered rollout.

MAIN OUTCOME MEASURES:

Receipt of tPA. Secondary outcome was the rate of significant hemorrhagic complications.

RESULTS:

Of the 2657 patients, demographic and clinical characteristics were similar in pre- and postintervention cohorts. Utilization of tPA increased from 6.3% before the intervention to 10.9% after the intervention, without a significant change in complication rates. Postintervention patients were more likely to receive tPA than were preintervention patients (odds ratio = 2.0; 95% confidence interval = 1.2-3.4). Before implementation, 8 of the 10 community hospitals were significantly less likely to administer tPA than the highest-volume tertiary care center; however, after implementation, 9 of the 10 were at least as likely to administer tPA as the highest-volume center.

CONCLUSION:

Telestroke implementation in a regional integrated health system was safe and effective. Community hospitals' rates of tPA utilization quickly increased and were similar to the largest-volume tertiary care center.

PMID:
27479951
PMCID:
PMC5101084
DOI:
10.7812/TPP/15-217
[Indexed for MEDLINE]
Free PMC Article

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