The Impact of Telestroke on Patterns of Care and Long-Term Outcomes

远程中风对护理模式和长期结果的影响

• 批准号: 10553816
• 负责人: Ateev Mehrotra
• 金额: $ 4.23万
• 依托单位: HARVARD MEDICAL SCHOOL
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-04-01 至 2024-01-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10553816
• 关键词: Accident and Emergency department; Adult; Caring; Clinical; Complement; Critical Illness; Data; Decision Making; Eligibility Determination; Goals; Hand; Home; Hospitals; Intervention; Life; Methods; Nurses; Outcome; Patient Selection; Patients; Patterns of Care; Physicians; Policies; Process; Provider; Reperfusion Therapy; Rural Community; Rural Hospitals; Specialized Center; Stroke; Technology; Videoconferencing; acute stroke; disability; evidence base; experience; mortality; stroke patient; telestroke; videoconference

PROJECT SUMMARY In select patients, early reperfusion for acute stroke saves lives and reduces disability. The question is how to ensure that reperfusion is provided to all eligible patients. Larger hospitals typically have on-call stroke teams that quickly assess patients with suspected stroke and determine eligibility. Unfortunately, most smaller, rural hospitals do not have this expertise readily at hand and therefore stroke patients seen at these hospitals may not receive these critical interventions and optimal care. Telestroke is a potential solution. In telestroke a stroke expert who is physically far away uses technology and videoconferencing to help evaluate the patient. Availability of telestroke in emergency departments and hospitals is increasing across the nation. The hope is that telestroke will increase rates of reperfusion, decrease disability and mortality, and lead to regionalization of stroke care - most patients receive care near their home while the critically ill are efficiently transferred to specialized centers. There is limited quantitative data on the impact of telestroke on these outcomes. In this proposed mixed-methods study we use national data from approximately 50 million adults where we match stroke patients at 767 hospitals with telestroke to similar patients at similar hospitals without telestroke to quantify telestroke's larger impact on patterns of care (Aim 1) as well as reperfusion, mortality, and longer-term disability (Aim 2). We complement this with qualitative analyses on the impact of telestroke from the perspective of front-line providers and barriers and facilitators to effective use (Aim 3). The proposed study will be the largest and most comprehensive study on telestroke to date. Our hope is that the findings will inform more evidence-based policy and clinical decisions on telestroke and where patients with acute stroke receive care.

项目概要 在特定患者中，急性中风的早期再灌注可以挽救生命并减少残疾。问题是如何 确保为所有符合条件的患者提供再灌注。较大的医院通常有待命的中风团队 快速评估疑似中风患者并确定资格。不幸的是，大多数较小的农村 医院不具备现成的专业知识，因此在这些医院就诊的中风患者可能会 没有接受这些关键的干预措施和最佳的护理。 远程中风是一个潜在的解决方案。在远程中风中，距离较远的中风专家使用技术和 视频会议以帮助评估患者。急诊室中远程中风的可用性和 全国各地的医院不断增加。希望远程中风能够增加再灌注率，减少 残疾和死亡率，并导致中风护理的区域化——大多数患者在家附近接受护理 而危重病人则被有效地转移到专门的中心。关于该问题的定量数据有限 远程中风对这些结果的影响。在这项拟议的混合方法研究中，我们使用来自 我们在 767 家医院为大约 5000 万成年人匹配远程中风患者和类似的中风患者 类似医院没有远程中风的患者，以量化远程中风对护理模式的更大影响（目标 1） 以及再灌注、死亡率和长期残疾（目标 2）。我们用定性来补充这一点 从一线提供者的角度分析远程中风的影响以及障碍和促进因素 有效利用（目标 3）。拟议的研究将是关于远程中风的最大、最全面的研究 日期。我们希望这些发现将为远程中风提供更多基于证据的政策和临床决策 以及急性中风患者接受护理的地方。

项目成果

Improving Population Access to Stroke Expertise Via Telestroke: Hospitals to Target and the Potential Clinical Benefit.

• DOI: 10.1161/jaha.122.025559
• 发表时间: 2022-04-19
• 期刊: JOURNAL OF THE AMERICAN HEART ASSOCIATION
• 影响因子: 5.4
• 作者: Richard, Jessica V.;Mehrotra, Ateev;Schwamm, Lee H.;Wilcock, Andrew D.;Uscher-Pines, Lori;Majersik, Jennifer J.;Zachrison, Kori S.
• 通讯作者: Zachrison, Kori S.

Association of Hospital Telestroke Adoption With Changes in Initial Hospital Presentation and Transfers Among Patients With Stroke and Transient Ischemic Attacks.

• DOI: 10.1001/jamanetworkopen.2021.26612
• 发表时间: 2021-09-01
• 期刊: JAMA network open
• 影响因子: 13.8
• 作者: Zachrison KS;Richard JV;Wilcock A;Zubizarreta JR;Schwamm LH;Uscher-Pines L;Mehrotra A
• 通讯作者: Mehrotra A

National Trends in Telestroke Utilization in a US Commercial Platform Prior to the COVID-19 Pandemic.

COVID-19 大流行之前美国商业平台远程中风使用的全国趋势。

• DOI: 10.1016/j.jstrokecerebrovasdis.2021.106035
• 发表时间: 2021-10
• 期刊: Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association
• 作者: Zachrison KS;Sharma R;Wang Y;Mehrotra A;Schwamm LH
• 通讯作者: Schwamm LH

Are state telemedicine parity laws associated with greater use of telemedicine in the emergency department?

• DOI: 10.1002/emp2.12359
• 发表时间: 2021-03
• 期刊: Journal of the American College of Emergency Physicians open
• 影响因子: 2.3
• 作者: Zachrison KS;Boggs KM;Cash RE;Burton KR;Espinola JA;Hayden EM;Sauser JP;Mehrotra A;Camargo CA Jr
• 通讯作者: Camargo CA Jr

What Drives Greater Assimilation of Telestroke in Emergency Departments?

• DOI: 10.1016/j.jstrokecerebrovasdis.2020.105310
• 发表时间: 2020-12
• 期刊: Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association
• 作者: Uscher-Pines L;Sousa J;Zachrison K;Guzik A;Schwamm L;Mehrotra A
• 通讯作者: Mehrotra A