Title: Abstract TP296: Telestroke Associated With Increased Levels of Acute Stroke Care
Abstract: Introduction/Hypothesis: Telestroke may be used to augment hospitals’ acute stroke services. The Department of Veterans Affairs launched a National TeleStroke Program (NTSP) in September 2017 that provides emergency stroke consultative services at 30 VA hospitals as of August 2019. NTSP uses a virtual hub/spoke model, with transfer to community hospitals when required. We examined the hypothesis that NTSP sites would be overrepresented among VA medical centers increasing their level of acute stroke care between 2012 and 2019. Methods: All VA hospitals with an emergency department or urgent care center were required to submit their stroke policies in 2012 certifying the level of acute stroke care offered: VA primary stroke centers provide alteplase evaluation and treatment 24/7/365, limited hours stroke facilities provide alteplase evaluation and treatment typically during business hours, or supporting stroke facilities which transfer all stroke patients for acute care. Re-attestation was required in 2019, with an additional category of comprehensive stroke center added, reflecting availability of both alteplase and endovascular thrombectomy 24/7/365. All submitted documents were reviewed by a single stroke neurologist and the level of acute stroke services was tabulated. Results: Of the 115 VA hospitals submitting complete documents, 25 increased their level of acute stroke care, and only 2 decreased their level of acute stroke care between 2012 and 2019. Sixteen of 30 NTSP sites (53%) enhanced acute stroke care in 2019 vs. 2012, compared to 9 of 85 hospitals (11%) not using telestroke. The difference was highly significant (p < 0.0001, Chi-square test). Conclusions: In a large, national health care system less driven by financial incentives than most US medical care, adoption of telestroke services was successful in enhancing local VA hospital stroke care. This difference was especially apparent at smaller, rural VA hospitals with limited access to VA neurology services and (in some cases) non-VA care options.
Publication Year: 2020
Publication Date: 2020-02-01
Language: en
Type: article
Indexed In: ['crossref']
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