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Original Investigation
March 1, 2021

Reperfusion Treatment and Stroke Outcomes in Hospitals With Telestroke Capacity

Author Affiliations
  • 1Center for Health Services Research, Department of Family Medicine, The Larner College of Medicine, University of Vermont, Burlington
  • 2Department of Emergency Medicine, Massachusetts General Hospital, Boston
  • 3Department of Neurology, Harvard Medical School, Boston, Massachusetts
  • 4Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
  • 5Harvard T. H. Chan School of Public Health, Boston, Massachusetts
  • 6Harvard University, Cambridge, Massachusetts
  • 7Department of Emergency Medicine, Harvard Medical School, Boston, Massachusetts
  • 8RAND Corporation, Arlington, Virginia
  • 9Beth Israel Deaconess Medical Center, Boston, Massachusetts
JAMA Neurol. 2021;78(5):527-535. doi:10.1001/jamaneurol.2021.0023
Key Points

Question  What is the association between telestroke capacity and care patterns and outcomes for patients with acute ischemic stroke?

Findings  In this study including 153 272 patients treated for stroke, those who received care at hospitals with telestroke capacity had higher rates of reperfusion treatment and lower 30-day mortality compared with those treated at hospitals without telestroke. Increases in reperfusion treatment were largest in smaller hospitals, among rural residents, and among patients 85 years and older.

Meaning  Patients who present to hospitals with telestroke capacity were more likely to receive reperfusion treatment and have lower mortality.

Abstract

Importance  Telestroke is increasingly used in hospital emergency departments, but there has been limited research on its impact on treatment and outcomes.

Objective  To describe differences in care patterns and outcomes among patients with acute ischemic stroke who present to hospitals with and without telestroke capacity.

Design, Setting, and Participants  Patients with acute ischemic stroke who first presented to hospitals with telestroke capacity were matched with patients who presented to control hospitals without telestroke capacity. All traditional Medicare beneficiaries with a primary diagnosis of acute ischemic stroke (approximately 2.5 million) who presented to a hospital between January 2008 and June 2017 were considered. Matching was based on sociodemographic and clinical characteristics, hospital characteristics, and month and year of admission. Hospitals included short-term acute care and critical access hospitals in the US without local stroke expertise. In 643 hospitals with telestroke capacity, there were 76 636 patients with stroke who were matched 1:1 to patients at similar hospitals without telestroke capacity. Data were analyzed in July 2020.

Main Outcomes and Measures  Receipt of reperfusion treatment through thrombolysis with alteplase or thrombectomy, mortality at 30 days from admission, spending through 90 days from admission, and functional status as measured by days spent living in the community after discharge.

Results  In the final sample of 153 272 patients, 88 386 (57.7%) were female, and the mean (SD) age was 78.8 (10.4) years. Patients cared for at telestroke hospitals had higher rates of reperfusion treatment compared with those cared for at control hospitals (6.8% vs 6.0%; difference, 0.78 percentage points; 95% CI, 0.54-1.03; P < .001) and lower 30-day mortality (13.1% vs 13.6%; difference, 0.50 percentage points; 95% CI, 0.17-0.83, P = .003). There were no differences in days spent living in the community following discharge or in spending. Increases in reperfusion treatment were largest in the lowest-volume hospitals, among rural residents, and among patients 85 years and older.

Conclusions and Relevance  Patients with ischemic stroke treated at hospitals with telestroke capacity were more likely to receive reperfusion treatment and have lower 30-day mortality.

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