Improving Stroke Outcomes in Rural Areas Through Telestroke Programs: An Examination of Barriers, Facilitators, and State Policies
Improving Stroke Outcomes in Rural Areas Through Telestroke Programs: An Examination of Barriers, Facilitators, and State Policies
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DOI：
10.1089/tmj.2013.0048
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发表时间：
2014-01-01
影响因子：
4.7
通讯作者：
George, Mary G.
中科院分区：
文献类型：
--
作者：
Kulcsar, Michael;Gilchrist, Siobhan;George, Mary G.
简介：在美国，每年有超过600，000名缺血性卒中患者未接受经证实的有效卒中治疗，或者可能在医学上不符合接受美国食品和药物管理局批准的一种药物治疗急性缺血性卒中的资格。缺乏治疗的部分原因是农村和服务不足地区缺乏神经学专家。Telestroke项目可以通过使用交互式电信技术将位于中心的神经学专家与农村医疗机构联系起来，改善农村和服务不足环境中中风患者的中风护理。许多国家制定了政策和做法，促进telestroke access.Materials和方法：我们审查了所有50个州的法规和条例，影响通过远程医疗计划，并描述了国家实施的计划，在两个国家的政策，鼓励telestroke use.Results和讨论的例子：本次审查提出的证据的价值和有效性的telestroke计划，以及解释的共同障碍和便利的telestroke，包括许可和资格认证规则，报销问题，和责任问题。大多数州都采取了影响远距离中风计划的政策。格鲁吉亚和南卡罗来纳州是实施中风政策的州的例子，这些州使用远程中风模型来治疗农村地区的中风患者。
Introduction:Every year in the United States more than 600,000 ischemic stroke patients do not receive proven, effective stroke treatment or may not be medically eligible to receive the one medication endorsed by the U.S. Food and Drug Administration for acute ischemic stroke. The lack of treatment is due partly to shortages of neurological experts in rural and underserved areas. Telestroke programs can improve stroke care for stroke patients in rural and underserved settings by using interactive telecommunication technology that connects centrally located neurological experts to rural healthcare facilities. Many states have enacted policies and practices that facilitate telestroke access.Materials and Methods:We reviewed statutes and regulations in all 50 states that affect the adoption of telemedicine programs and describe examples of state-implemented programs in two states with policies that encourage telestroke use.Results and Discussion:This review presents evidence of the value and effectiveness of telestroke programs, as well as an explanation of common barriers and facilitators of telestroke, including licensing and credentialing rules, reimbursement issues, and liability concerns. Most states have adopted policies that affect the adoption of telestroke programs. Georgia and South Carolina are examples of states implementing stroke policies using a telestroke model to treat stroke patients in rural areas.