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

项目总结 在选定的患者中，急性中风的早期再灌注挽救了生命，减少了残疾。问题是如何 确保向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小组 这将快速评估疑似中风患者并确定是否符合条件。不幸的是，大多数较小的农村地区 医院手头没有这方面的专业知识，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措施和最佳护理。 远程中风是一个潜在的解决方案。在远程中风中，身体相距遥远的中风专家使用技术和 视频会议，以帮助评估患者。在急诊科和医院提供电话中风服务 全国各地的医院都在增加。人们希望，远程中风将增加再灌注率，减少 残疾和死亡率，并导致中风护理的区域化--大多数患者在家中附近接受护理 而危重病人则被有效地转移到专门的中心。关于这一问题的量化数据有限 远程中风对这些结果的影响。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类似的中风患者进行匹配 在没有远程中风的类似医院的患者量化远程中风对护理模式的更大影响(目标1) 以及再灌注、死亡率和长期残疾(目标2)。我们用定性来补充这一点 从一线提供者、障碍和促进者的角度分析远程中风的影响 有效利用(目标3)。这项拟议的研究将是关于远程中风的最大规模和最全面的研究 约会。我们希望这些发现将为更多基于证据的远程中风政策和临床决策提供参考。 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.