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

远程中风对护理模式和长期结果的影响

基本信息

批准号：
9894872
负责人：
Ateev Mehrotra
金额：
$ 65.67万
依托单位：
HARVARD MEDICAL SCHOOL
依托单位国家：
美国
项目类别：
财政年份：
2019
资助国家：
美国
起止时间：
2019-04-01 至 2023-01-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/9894872
关键词：
Accident and Emergency department Acute Address Adopted Adoption Adult Alteplase Ambulances Assimilations Blood Vessels Blood flow Brain Caring Characteristics Clinical Communities Complement Congresses Critical Illness Data Decision Making Developed Countries Diffusion Eligibility Determination Emergency Medicine Ensure Goals Growth Hand Home Care Services Home Nursing Care Home environment Hospitals Image Impact evaluation Independent Living Insurance Insurance Claim Review Intervention Interview Intravenous Ischemic Stroke Knowledge Lead Life Measures Mechanics Medicare Methods Morbidity - disease rate National Institute of Neurological Disorders and Stroke Neurologic Nurses Outcome Patients Patterns of Care Perception Physicians Policies Population Process Provider Quality of Care Reperfusion Therapy Research Rural Community Rural Hospitals Sampling Savings Series Services Specialized Center Stroke Structure Supportive care System Technology Thrombectomy Time Translating Travel United States National Institutes of Health Videoconferences Videoconferencing acute stroke disability evidence base experience functional outcomes implementation strategy improved innovation interest long-term rehabilitation mortality provider-level barriers rehabilitative care stroke patient uptake

项目摘要

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.

项目摘要在某些患者中，急性中风的早期再灌注可以挽救生命并减少残疾。问题是如何确保向所有合格患者提供再灌注。较大的医院通常有呼叫中风团队迅速评估可疑中风的患者并确定资格。不幸的是，最小的农村医院没有任何专业知识，因此在这些医院看到的中风患者可能没有得到这些关键的干预措施和最佳护理。遥雷克是一个潜在的解决方案。在远程电视剧中视频会议有助于评估患者。在急诊室的遥控性和可用性全国医院正在增加。希望远程脑杆菌会提高再灌注率，降低残疾和死亡率，并导致中风护理的区域化 - 大多数患者在他们家附近接受护理危害病有效地转移到专业中心。关于远程推荐对这些结果的影响。在此拟议的混合方法研究中，我们使用了来自大约有5000万成年人与767位医院的中风患者相匹配，并将没有遥控的类似医院的患者，可以量化遥测对护理模式的更大影响（AIM 1）以及再灌注，死亡率和长期残疾（AIM 2）。我们用定性补充从一线提供商，障碍和促进者的角度来分析远程电视的影响有效使用（目标3）。拟议的研究将是关于遥雷克的最大，最全面的研究日期。我们的希望是，这些发现将为您提供有关遥测的更多基于证据的政策和临床决策以及急性中风患者接受护理的地方。