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Health Aff (Millwood). 2018 Dec;37(12):2005-2013. doi: 10.1377/hlthaff.2018.05089.

Expansion Of Telestroke Services Improves Quality Of Care Provided In Super Rural Areas.

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Donglan Zhang ( ) is an assistant professor in the Department of Health Policy and Management, University of Georgia, in Athens.
Guijing Wang is an economist at the Centers for Disease Control and Prevention, in Atlanta, Georgia.
Weiming Zhu is an epidemiologist at ProSphere Tek, Inc., in Alexandria, Virginia.
Janani R. Thapa is an assistant professor in the Department of Health Policy and Management, University of Georgia.
Jeffrey A. Switzer is an assistant professor in the Department of Neurology, Augusta University, in Georgia.
David C. Hess is a professor in the Department of Neurology and dean of the Medical College of Georgia, Augusta University.
Matthew L. Smith is an associate professor in the Department of Environmental and Occupational Health, Texas A&M University, in College Station.
Matthew D. Ritchey is a senior scientist in the Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention.


Telestroke is a telemedicine intervention that facilitates communication between stroke centers and lower-resourced facilities to optimize acute stroke management. Using administrative claims data, we assessed trends in telestroke use among fee-for-service Medicare beneficiaries with acute ischemic stroke and the association between providing telestroke services and intravenous tissue plasminogen activator (IV tPA) and mechanical thrombectomy use, mortality, and medical expenditures, by urban versus rural county of residence in the period 2008-15. The proportion of ischemic stroke cases receiving telestroke increased from 0.4 to 3.8 per 1,000 cases, with usage highest among younger, male, non-Hispanic white, and patients in rural or super rural areas (super rural is the bottom quartile of rural areas. Compared with patients receiving usual care, those receiving telestroke had greater IV tPA and mechanical thrombectomy use regardless of county type, while those in super rural counties had lower thirty-day all-cause mortality. Despite increased telestroke use, rural patients remained less likely than urban patients to receive IV tPA. The findings suggest that telestroke service expansion efforts have increased, especially in rural and super rural counties, and have improved outcomes.


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