The Impact of Telestroke on Patterns of Care and Long-Term Outcomes

项目摘要 在选定的患者中，急性卒中的早期再灌注可以挽救生命并减少残疾。问题是如何 确保为所有符合条件的患者提供再灌注。较大的医院通常有随叫随到的中风治疗小组 快速评估疑似中风患者并确定其资格。不幸的是，大多数较小的，农村 医院没有现成的这方面的专业知识，因此在这些医院就诊的中风患者可能 得不到这些关键的干预和最佳护理。 Telestroke是一个潜在的解决方案。在远距中风中，一位身体上离得很远的中风专家使用技术， 视频会议，以帮助评估病人。急诊室的遥距电击可用性， 全国的医院越来越多。我们希望远距电击能提高再灌注率， 残疾和死亡率，并导致中风护理的区域化-大多数患者在家附近接受护理 而危重病人则被有效地转移到专门的中心。关于这方面的定量数据有限。 远距离电击对这些结果的影响。在这项拟议的混合方法研究中，我们使用了来自 大约5000万成年人，我们将767家医院的中风患者与远程中风患者进行匹配， 患者在类似的医院没有远程中风量化远程中风的更大的影响模式的护理（目标1） 以及再灌注、死亡率和长期残疾（目标2）。我们补充这一定性 从一线提供者的角度分析远程中风的影响， 有效使用（目标3）。拟议的研究将是最大和最全面的研究遥距， 约会我们希望这些发现能为远程卒中的循证政策和临床决策提供信息 以及急性中风患者接受护理的地方。

PROJECT SUMMARY In select patients, early reperfusion for acute stroke saves lives and reduces disability. The question is how to ensure that reperfusion is provided to all eligible patients. Larger hospitals typically have on-call stroke teams that quickly assess patients with suspected stroke and determine eligibility. Unfortunately, most smaller, rural hospitals do not have this expertise readily at hand and therefore stroke patients seen at these hospitals may not receive these critical interventions and optimal care. Telestroke is a potential solution. In telestroke a stroke expert who is physically far away uses technology and videoconferencing to help evaluate the patient. Availability of telestroke in emergency departments and hospitals is increasing across the nation. The hope is that telestroke will increase rates of reperfusion, decrease disability and mortality, and lead to regionalization of stroke care - most patients receive care near their home while the critically ill are efficiently transferred to specialized centers. There is limited quantitative data on the impact of telestroke on these outcomes. In this proposed mixed-methods study we use national data from approximately 50 million adults where we match stroke patients at 767 hospitals with telestroke to similar patients at similar hospitals without telestroke to quantify telestroke's larger impact on patterns of care (Aim 1) as well as reperfusion, mortality, and longer-term disability (Aim 2). We complement this with qualitative analyses on the impact of telestroke from the perspective of front-line providers and barriers and facilitators to effective use (Aim 3). The proposed study will be the largest and most comprehensive study on telestroke to date. Our hope is that the findings will inform more evidence-based policy and clinical decisions on telestroke and where patients with acute stroke receive care.