The role of stroke care infrastructure on the effectiveness of a hub-and-spoke telestroke model in South Carolina

被引:0
作者
Srinivasan, Mithuna [1 ]
Scott, Amber [2 ,3 ]
Soo, Jackie [4 ]
Sreedhara, Meera [2 ,5 ]
Popat, Shena [1 ]
Beasley, Kincaid Lowe [2 ]
Jackson, Tiara N. [6 ]
Abbas, Amena [2 ,7 ]
Keaton, W. Alexander [2 ,3 ]
Holmstedt, Christine [8 ]
Harvey, Jillian [8 ]
Kruis, Ryan [8 ]
Mcleod, Shay [8 ]
机构
[1] Univ Chicago, NORC, 4350 East-West Hwy 8th Floor, Bethesda, MD 20814 USA
[2] Natl Ctr Chron Dis Prevent & Hlth Promot, CDCP, Atlanta, GA USA
[3] Oak Ridge Inst Sci Educ, Oak Ridge, TN USA
[4] Univ Chicago, NORC, Chicago, IL USA
[5] Cherokee Nation Operat Solut, Tulsa, OK USA
[6] Decis Informat Resources Inc, Houston, TX USA
[7] ASRT Inc, Atlanta, GA USA
[8] Med Univ South Carolina, Charleston, SC USA
关键词
Stroke; Quality of healthcare; Program evaluation; Telemedicine; Remote consultation; SCIENTIFIC STATEMENT; ISCHEMIC-STROKE; HEALTH-CARE; TELEMEDICINE; OUTCOMES; NETWORK; VOLUME;
D O I
10.1016/j.jstrokecerebrovasdis.2024.107702
中图分类号
Q189 [神经科学];
学科分类号
071006 ;
摘要
Objective: To examine the relationship between stroke care infrastructure and stroke quality-of-care outcomes at 29 spoke hospitals participating in the Medical University of South Carolina (MUSC) hub-and-spoke telestroke network. Materials and methods: Encounter-level data from MUSC's telestroke patient registry were filtered to include encounters during 2015-2022 for patients aged 18 and above with a clinical diagnosis of acute ischemic stroke, and who received intravenous tissue plasminogen activator. Unadjusted and adjusted generalized estimating equations assessed associations between time-related stroke quality-of-care metrics captured during the encounter and the existence of the two components of stroke care infrastructure-stroke coordinators and stroke center certifications-across all hospitals and within hospital subgroups defined by size and rurality. Results: Telestroke encounters at spoke hospitals with stroke coordinators and stroke center certifications were associated with shorter door-to-needle (DTN) times (60.9 min for hospitals with both components and 57.3 min for hospitals with one, vs. 81.2 min for hospitals with neither component, p <.001). Similar patterns were observed for the percentage of encounters with DTN time of <= 60 min (63.8% and 68.9% vs. 32.0%, p <.001) and <= 45 min (34.0% and 38.4% vs. 8.42%, p <.001). Associations were similar for other metrics (e.g., door-to-registration time), and were stronger for smaller (vs. larger) hospitals and rural (vs. urban) hospitals. Conclusions: Stroke coordinators or stroke center certifications may be important for stroke quality of care, especially at spoke hospitals with limited resources or in rural areas.
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页数:7
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