Efficacy of site-independent telemedicine in the STRokE DOC trial: a randomised, blinded, prospective study

Meyer, Brett C.; Raman, Rema; Hemmen, Thomas; Obler, Richard; Zivin, Justin A.; Rao, Ramesh; Thomas, Ronald G.; Lyden, Patrick D.

doi:10.1016/s1474-4422(08)70171-6

Cited by 344 publications

(288 citation statements)

References 33 publications

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“…Many studies have demonstrated the utility of telestroke for assessing stroke severity [9][10][11][12] and for increasing the use of tPA among eligible patients. [13][14][15][16][17] Our findings add to this body of literature supporting the value of telestroke for improving tPA administration rates among patients with ischemic stroke presenting to community hospitals. We found that telestroke can be implemented safely and effectively in community hospitals, and that the beneficial effects (increased tPA utilization) occurred quickly after implementation without a significant lag period and without any corresponding change in complications.…”

Section: Discussionsupporting

confidence: 57%

Safe and Effective Implementation of Telestroke in a US Community Hospital Setting

Zachrison

Shen

Sangha

et al. 2016

TPJ

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Context: There is substantial hospital-level variation in use of tissue plasminogen activator (tPA) for treatment of acute ischemic stroke. Telestroke services can bring neurologic expertise to hospitals with fewer resources.Objective: To determine whether implementation of a telestroke intervention in a large integrated health system would lead to increased tPA utilization and would change rates of hemorrhagic complications.Design: A stepped-wedge cluster randomized trial of 11 community hospitals connected to 2 tertiary care centers via telestroke, implemented at each hospital incrementally during a 1-year period. We examined pre-and postimplementation data from July 2013 through January 2015. A 2-level mixed-effects logistic regression model accounted for the staggered rollout.Main Outcome Measures: Receipt of tPA. Secondary outcome was the rate of significant hemorrhagic complications.Results: Of the 2657 patients, demographic and clinical characteristics were similar in pre-and postintervention cohorts. Utilization of tPA increased from 6.3% before the intervention to 10.9% after the intervention, without a significant change in complication rates. Postintervention patients were more likely to receive tPA than were preintervention patients (odds ratio = 2.0; 95% confidence interval = 1.2-3.4). Before implementation, 8 of the 10 community hospitals were significantly less likely to administer tPA than the highest-volume tertiary care center; however, after implementation, 9 of the 10 were at least as likely to administer tPA as the highest-volume center.Conclusion: Telestroke implementation in a regional integrated health system was safe and effective. Community hospitals' rates of tPA utilization quickly increased and were similar to the largest-volume tertiary care center.

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Section: Discussionsupporting

confidence: 57%

Safe and Effective Implementation of Telestroke in a US Community Hospital Setting

Zachrison

Shen

Sangha

et al. 2016

TPJ

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“…Management should preferably be led by a neurologist with exp erience in the treatment of acute stroke. When a neurologist is not available on site, management may be led by another trained health care provider under the guidance of a neurologist via telemedicine 25 .…”

Section: Protocol For Rt-pa Infusionmentioning

confidence: 99%

Guidelines for acute ischemic stroke treatment: part II: stroke treatment

Martins¹,

Freitas²,

Pontes-Neto³

et al. 2012

Arq. Neuro-Psiquiatr.

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“…Research in these areas demonstrates that care via telemedicine produces outcomes comparable to those of face-to-face consultations. [13][14][15][16][17] Genetics services are often based on counseling and may therefore also be a specialized field of health care in which telemedicine can be effectively utilized as an alternative to standard face-to-face interactions between health professionals and patients.…”

mentioning

confidence: 99%