Association of Hospital Telestroke Adoption With Changes in Initial Hospital Presentation and Transfers Among Patients With Stroke and Transient Ischemic Attacks.
Association of Hospital Telestroke Adoption With Changes in Initial Hospital Presentation and Transfers Among Patients With Stroke and Transient Ischemic Attacks.
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卒中和短暂性脑缺血发作患者采用医院远程卒中与初次入院和转院变化的相关性
DOI：
10.1001/jamanetworkopen.2021.26612
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发表时间：
2021-09-01
影响因子：
13.8
通讯作者：
Mehrotra A
中科院分区：
文献类型：
--
作者：
Zachrison KS;Richard JV;Wilcock A;Zubizarreta JR;Schwamm LH;Uscher-Pines L;Mehrotra A
医院远程中风服务的实施是否与中风护理系统组织的变化有关？在这项使用 593 家远程中风医院和 593 家匹配对照医院的全国样本的横断面研究中，没有发现远程中风实施与医院的中风量、转移率或患者转移到的医院之间存在显着关联。这项研究表明，医院实施远程中风与患者就诊地点、转院决定或转院医院的变化无关。有人提议实施远程中风服务（一种基于网络的方法，在入院前使用视频通信来治疗中风患者）改变有中风症状的患者接受护理的方式，但该提议尚未经过严格评估。评估远程中风服务的实施是否与患者最初出现中风症状的地点和方式的变化、他们决定转移到另一家医院以及他们被转移到哪家医院有关。这项横断面研究比较了 593 家在 2009 年至 2016 年间采用远程卒中但不属于综合性卒中中心、主要教学医院或具备血栓切除能力的医院与 593 家没有远程卒中的匹配对照医院之间的卒中护理系统的变化，这些医院基于农村地区、关键通道医院状况、床位大小、主要卒中中心状况、社区中是否存在替代医院、医院卒中量、人口普查区域和所有权。通过使用 100% 医疗保险按服务付费受益人的数据，确定了 2008 年至 2018 年所有中风和短暂性脑缺血发作入院人数。对于每对医院（远程卒中加匹配对照），远程卒中医院的实施日期和双重差分法用于量化远程卒中实施与实施前 2 年至实施后 2 年护理变化之间的关联。模型还控制了观察到的患者特征的差异。医院每搏输出量、患者到初始医院的救护车运送距离、医院病例结构、院间转院比例以及转院患者接收医院的规模。在669家远程卒中医院和2143家潜在对照医院中，匹配了593个医院对；在每个类别中，261 家医院 (44.0%) 位于农村地区，179 家 (30.2%) 为初级卒中中心，130 家 (21.9%) 为重症医院。远程卒中医院和对照医院的平均年每搏量在实施前与实施后的变化相似（远程卒中医院，从 79.6 名患者减少到 76.3 名患者；对照医院，从 78.8 名患者减少到 75.5 名患者 [每年均减少 3.3 名患者；双重差分，0.009；P ≥ .99]）。同样，转运患者的救护车运输距离、病例组合、院间转运或接收医院床位大小也没有差异。这项研究表明，在全国实施远程中风的医院样本中，没有发现远程中风的采用与中风护理系统的变化之间存在关联。这项横断面研究评估了远程中风服务的实施是否与患者最初出现中风症状的地点和方式的变化、他们决定转移到另一家医院以及他们被转移到哪家医院有关。
Was the implementation of telestroke services at hospitals associated with changes in the organization of stroke systems of care? In this cross-sectional study using a national sample of 593 telestroke hospitals and 593 matched control hospitals, no significant association was found between telestroke implementation and a hospital’s stroke volume, rate of transfers, or the hospitals to which patients are transferred. This study suggests that a hospital’s implementation of telestroke was not associated with changes in where patients present, in their decision to transfer, or which hospital they are transferred to. It has been proposed that the implementation of telestroke services (a web-based approach to using video telecommunication to treat patients with stroke before hospital admission) changes where patients with stroke symptoms receive care, but this proposal has not been rigorously assessed. To assess whether the implementation of telestroke services is associated with changes in where and how patients initially present with stroke symptoms, in their decision to be transferred to another hospital, and which hospitals they are transferred to. This cross-sectional study compared changes in stroke systems of care between a sample of 593 US hospitals that adopted telestroke during the period from 2009 to 2016 but were not comprehensive stroke centers, major teaching hospitals, or thrombectomy-capable hospitals vs 593 matched control hospitals without telestroke based on rural location, critical access hospital status, bed size, primary stroke center status, presence of hospital alternatives in the community, hospital stroke volume, census region, and ownership. With the use of data on 100% of Medicare fee-for-service beneficiaries, all stroke and transient ischemic attack admissions from 2008 to 2018 were identified. For each hospital pair (telestroke plus matched control), the telestroke hospital’s implementation date and difference-in-differences approach were used to quantify the association between telestroke implementation and changes in care from 2 years before implementation to 2 years after implementation. Models also controlled for differences in observed patient characteristics. Hospital stroke volume, patients’ ambulance transport distance to initial hospital, hospital case mix, interhospital transfer proportion, and size of the receiving hospital for transferred patients. Of the 669 telestroke hospitals and 2143 potential control hospitals, 593 hospital pairs were matched; in each category, 261 hospitals (44.0%) were located in a rural area, 179 (30.2%) were primary stroke centers, and 130 (21.9%) were critical access hospitals. The changes in the preimplementation to postimplementation period were similar at telestroke and control hospitals in mean annual stroke volume (telestroke hospitals, decreased from 79.6 to 76.3 patients; control hospitals, decreased from 78.8 to 75.5 patients [–3.3 patients per year for both; difference-in-differences, 0.009; P ≥ .99]). Similarly, no differences were seen in ambulance transport distance, case mix, interhospital transfers, or bed size of receiving hospitals among transferred patients. This study suggests that, across a national sample of hospitals implementing telestroke, no association between telestroke adoption and changes in stroke systems of care were found. This cross-sectional study assesses whether the implementation of telestroke services is associated with changes in where and how patients initially present with stroke symptoms, in their decision to be transferred to another hospital, and which hospitals they are transferred to.
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影响因子：
4.8
作者：
Chalouhi, Nohra;Dressler, Jeremy A.;Tjoumakaris, Stavropoula
通讯作者：
Tjoumakaris, Stavropoula
影响因子：
8.3
作者：
Saposnik, Gustavo;Hill, Michael D.;Kapral, Moira K.
通讯作者：
Kapral, Moira K.
影响因子：
8.3
作者：
Sauser K;Burke JF;Levine DA;Scott PA;Meurer WJ
通讯作者：
Meurer WJ
影响因子：
29
作者：
Sauser, Kori;Levine, Deborah A.;Reeves, Mathew J.
通讯作者：
Reeves, Mathew J.
影响因子：
4.4
作者：
Lu, George Y.;Wong, David W.
通讯作者：
Wong, David W.