Expansion Of Telestroke Services Improves Quality Of Care Provided In Super Rural Areas
Expansion Of Telestroke Services Improves Quality Of Care Provided In Super Rural Areas
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DOI：
10.1377/hlthaff.2018.05089
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发表时间：
2018-12-01
期刊：
影响因子：
9.7
通讯作者：
Ritchey, Matthew D.
中科院分区：
文献类型：
--
作者：
Zhang, Donglan;Wang, Guijing;Ritchey, Matthew D.
Telestroke是一种远程医疗干预，可促进卒中中心与资源较低的设施之间的通信，以优化急性卒中管理。使用行政索赔数据，我们评估了2008- 2015年期间城市与农村居住县的急性缺血性卒中按服务付费医疗保险受益人的远程卒中使用趋势，以及提供远程卒中服务与静脉注射组织纤溶酶原激活剂（IV tPA）和机械血栓切除术使用、死亡率和医疗支出之间的关联。接受远程卒中的缺血性卒中病例比例从0.4/1000例增加到3.8/1000例，其中年轻、男性、非西班牙裔白色和农村或超级农村地区（超级农村是农村地区的最低四分之一）患者的使用率最高。与接受常规治疗的患者相比，无论县类型如何，接受远程卒中的患者的IV tPA和机械血栓切除术使用率较高，而超级农村县的患者的30天全因死亡率较低。尽管远程卒中的使用增加，农村患者仍然不太可能比城市患者接受N tPA。调查结果表明，远程中风服务的扩展工作有所增加，特别是在农村和超级农村县，并改善了结果。
Telestroke is a telemedicine intervention that facilitates communication between stroke centers and lower-resourced facilities to optimize acute stroke management. Using administrative claims data, we assessed trends in telestroke use among fee-for-service Medicare beneficiaries with acute ischemic stroke and the association between providing telestroke services and intravenous tissue plasminogen activator (IV tPA) and mechanical thrombectomy use, mortality, and medical expenditures, by urban versus rural county of residence in the period 2008-15. The proportion of ischemic stroke cases receiving telestroke increased from 0.4 to 3.8 per 1,000 cases, with usage highest among younger, male, non-Hispanic white, and patients in rural or super rural areas (super rural is the bottom quartile of rural areas. Compared with patients receiving usual care, those receiving telestroke had greater IV tPA and mechanical thrombectomy use regardless of county type, while those in super rural counties had lower thirty-day all-cause mortality. Despite increased telestroke use, rural patients remained less likely than urban patients to receive N tPA. The findings suggest that telestroke service expansion efforts have increased, especially in rural and super rural counties, and have improved outcomes.