Journal
TELEMEDICINE AND E-HEALTH
Volume 24, Issue 9, Pages 678-683Publisher
MARY ANN LIEBERT, INC
DOI: 10.1089/tmj.2017.0252
Keywords
telestroke; thrombolysis; care delivery
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Funding
- Massachusetts General Hospital Center for Diversity and Inclusion Summer Research Training Program
- AHRQ [K08HS024561]
- American Heart Association [16MCPRP27260221]
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Background:For acute ischemic stroke patients, shorter time to thrombolytic (tissue plasminogen activator [tPA]) is associated with improved outcomes.Introduction:Telestroke increases tPA use at spoke hospitals, yet its effect on door-to-needle (DTN) times for tPA administration is unknown. We hypothesize that spoke hospitals with more frequent contact to a hub hospital will have shorter DTN times than those with less frequent contact.Materials and Methods:We identified 375 patients treated with tPA by conventional or telestroke methods in an academic hub-and-spoke telestroke network for whom date and time data were available. Strength of the spoke-hub connection was the primary predictor variable, defined as the number of all telestroke consults (tPA and non-tPA) done at each spoke hospital during the year of the patient's presentation. Patient-level regression analyses examined the relationship between DTN time and spoke-hub connection during the year of the patient's presentation, controlling for temporal trends and clustering within hospitals.Results:Sixteen spoke hospitals contributed data on 375 tPA-treated patients from 2006-2015. Hospitals treated a median of 13.5 patients with tPA per year; median hospital-level DTN was 78.8min (interquartile range [IQR] 71.3-85). Median number of telestroke consults per year was 34 (range 3-137). Among all 375 patients, median DTN was 76min (IQR 60-97). Strength of spoke-hub connection was significantly associated with faster DTN time for patients (1.3min gain per 10 additional consults, p=0.048).Conclusions:More frequent contact between a telestroke spoke and its hub was associated with faster tPA delivery for patients, even after accounting for secular trends in DTN improvements.
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