The Association Between Stroke Mortality and Time of Admission and Participation in a Telestroke Network

Witrick, Brian; Zhang, Donglan; Switzer, Jeffrey A.; Hess, David C.; Shi, Lu

doi:10.1016/j.jstrokecerebrovasdis.2019.104480

Cited by 11 publications

(6 citation statements)

References 37 publications

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“…Confounding variables were age, sex, race/ethnicity, neighborhood median household income 11 , payers 12 , calendar quarter of discharge 13 , number of comorbidities 14 , hospital's location (rural or urban) 15 , hospital teaching status 16,17 , and bed size [16][17][18] . We divided age groups into 18-44, 45-64, 65-74, and 75 and older.…”

Section: Variable Selectionmentioning

confidence: 99%

Weekend Effect on in-Hospital Mortality for Ischemic and Hemorrhagic Stroke in US Rural and Urban Hospitals

Mekonnen

Wang

Rajbhandari‐Thapa

et al. 2020

Journal of Stroke and Cerebrovascular Diseases

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Introduction: Previous studies have reported a "weekend effect" on stroke mortality, whereby stroke patients admitted during weekends have a higher risk of in-hospital death than those admitted during weekdays. Aims:We aimed to investigate whether patients with different types of stroke admitted during weekends have a higher risk of in-hospital mortality in rural and urban hospitals in the US. Methods:We used data from the 2016 National Inpatient Sample and used logistic regression to assess in-hospital mortality for weekday and weekend admissions among stroke patients aged 18 and older by stroke type (ischemic or hemorrhagic) and rural or urban status.Results: Crude stroke mortality was higher in weekend admissions (p <0.001). After adjusting for confounding variables, in-hospital mortality among hemorrhagic stroke patients was significantly greater (22.0%) for weekend admissions compared to weekday admissions (20.2%, p

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Section: Variable Selectionmentioning

confidence: 99%

Weekend Effect on in-Hospital Mortality for Ischemic and Hemorrhagic Stroke in US Rural and Urban Hospitals

Mekonnen

Wang

Rajbhandari‐Thapa

et al. 2020

Journal of Stroke and Cerebrovascular Diseases

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“…This approach enables broader coverage of specialized stroke care through the hub-and-spoke network model, reduces patient travel distance, 18 improves the use of acute stroke care treatment, 19 and reduces in-hospital mortality. 20 With expansion of such practice to ambulatory care by establishing a specialist referral network or remote care network, support could be provided to rural or underserved areas through physician-to-physician consultation. 21 Consultation could be provided by e-consults, remote second opinions, and phone calls.…”

Section: Discussionmentioning

confidence: 99%

Patient Travel Distance to Neurologist Visits

Lin,

Hill,

Kerber

et al. 2023

Neurology

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Background and Objectives: The density of neurologists within a given geographic region varies greatly across the US. We aimed to measure patient travel distance and travel time to neurologist visits, across neurologic conditions and subspecialties. Our secondary goal was to identify factors associated with long-distance travel for neurologic care. Methods: We performed a cross-sectional analysis using a 2018 Medicare sample of patients with at least one outpatient neurologist visit. Long-distance travel was defined as driving distance ≥50 miles one-way to the visit. Travel time was measured as driving time in minutes. Multilevel generalized linear mixed models with logistic link function, which accounted for clustering of patients within hospital referral region (HRR) and allowed modeling of region-specific random effects, were used to determine the association of patient and regional characteristics with long-distance travel. Results: We identified 563,216 Medicare beneficiaries with a neurologist visit in 2018. Of these, 96,213 (17%) traveled long-distance for care. Median driving distance and time were 81.3 (IQR:59.9-144.2) miles and 90 (IQR:69-149) minutes for patients with long-distance travel compared to 13.2 (IQR:6.5-23) miles and 22 (IQR:14-33) minutes for patients without long-distance travel. Comparing across neurologic conditions, long-distance travel was most common for nervous system cancer care (39.6%), ALS(32.1%) and MS(22.8%). Many factors were associated with long-distance travel, most notably low neurologist density (1st quintile: OR 3.04[95%CI:2.41-3.83]vs. 5th quintile), rural setting (4.89[4.79-4.99]), long-distance travel to primary care physician visit (3.6 [3.51-3.69]), and visits for ALS and nervous system cancer care (3.41[3.14-3.69] and 5.27[4.72-5.89], respectively). Nearly one third of patients bypassed the nearest neurologist by 20+ miles and 7.3% of patients crossed state lines for neurologist care Conclusions: We found that nearly 1 in 5 Medicare beneficiaries who saw a neurologist traveled ≥50 miles one-way for care and travel burden was most common for lower prevalence neurologic conditions that required coordinated multidisciplinary care. Important potentially addressable predictors of long-distance travel were low neurologist density and rural location, suggesting interventions to improve access to care such as telemedicine or neurological subspecialist support to local neurologists. Future work should evaluate differences in clinical outcomes between patients with long-distance travel and those without.

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“…Telestroke has the potential to improve access to best-practice stroke care and reduce mortality ( 13 , 30 ). This protocol and statistical analysis plan provides an outline of the methods for the economic evaluation of the VST Program.…”

Section: Discussionmentioning

confidence: 99%

Economic Evaluation Protocol and Statistical Analysis Plan for the Cost-Effectiveness of a Novel Australian Stroke Telemedicine Program; the Victorian Stroke Telemedicine (VST) program

et al. 2021

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Introduction: Telemedicine can address limited access to medical specialists in rural hospitals. Stroke provides an important case study because: it is a major cause of disease burden; effective treatments to reduce disability (e.g., thrombolysis) can be provided within the initial hours of stroke onset; careful selection of patients is needed by skilled doctors to minimize adverse events from thrombolysis; and there are major treatment gaps (only about half of regional hospitals in Australia provide thrombolysis for stroke). Few economic analyses have been undertaken on telestroke and the majority have been simulation models. The aim of this protocol and statistical analysis plan is to outline the methods for the cost-effectiveness evaluation of a large, multicentre acute stroke telemedicine program being conducted in Victoria, Australia.Methods: Using a historical- and prospective-controlled design, we will compare patient-level data obtained in the 12 months prior to the Victorian Stroke Telemedicine (VST) program implementation and during the first 12 months of VST to determine the incremental difference in costs and patient outcomes at 3 and 12 months. Secondary aims include assessing the cost per additional patient receiving intravenous thrombolysis and the cost per additional patient receiving intravenous thrombolysis within 60 min. Tertiary aims include assessing the potential longer-term cost-effectiveness in the second year of the program at the hospitals to determine whether any program benefits are sustained once site coordinators are no longer employed; and modeling the potential net life-time costs and benefits from a societal perspective. Multivariable uncertainty and one-way sensitivity analyses will be performed to assess the robustness of results.Results: Sixteen hospitals participated. Patient-level data collection including 12-month outcomes for the cohorts obtained in the first and second year of the program for each hospital was completed in January 2020.Conclusion: The results from this real-world study with patient-level data will provide high quality evidence of the costs, health benefits and policy implications of telestroke programs, including the potential for application in other locations within Australia or other countries with similar health system delivery and financing.

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The Association Between Stroke Mortality and Time of Admission and Participation in a Telestroke Network

Cited by 11 publications

References 37 publications

Weekend Effect on in-Hospital Mortality for Ischemic and Hemorrhagic Stroke in US Rural and Urban Hospitals

Weekend Effect on in-Hospital Mortality for Ischemic and Hemorrhagic Stroke in US Rural and Urban Hospitals

Patient Travel Distance to Neurologist Visits

Economic Evaluation Protocol and Statistical Analysis Plan for the Cost-Effectiveness of a Novel Australian Stroke Telemedicine Program; the Victorian Stroke Telemedicine (VST) program

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