Details:

• Alternative Title:
  J Stroke Cerebrovasc Dis
• Personal Author:
  Srinivasan, Mithuna ; Scott, Amber ; Soo, Jackie ; Sreedhara, Meera ; Popat, Shena ; ... More +

  Srinivasan, Mithuna ; Scott, Amber ; Soo, Jackie ; Sreedhara, Meera ; Popat, Shena ; Beasley, Kincaid Lowe ; Jackson, Tiara N. ; Abbas, Amena ; Keaton, W. Alexander ; Holmstedt, Christine ; Harvey, Jillian ; Kruis, Ryan ; McLeod, Shay ; Ahn, Roy Less -
• Description:
  Objective:
  
  To examine the relationship between stroke care infrastructure and stroke quality-of-care outcomes at 29 spoke hospitals participating in the Medical University of South Carolina (MUSC) hub-and-spoke telestroke network.
  
  Materials and methods:
  
  Encounter-level data from MUSC’s telestroke patient registry were filtered to include encounters during 2015-2022 for patients aged 18 and above with a clinical diagnosis of acute ischemic stroke, and who received intravenous tissue plasminogen activator. Unadjusted and adjusted generalized estimating equations assessed associations between time-related stroke quality-of-care metrics captured during the encounter and the existence of the two components of stroke care infrastructure—stroke coordinators and stroke center certifications—across all hospitals and within hospital subgroups defined by size and rurality.
  
  Results:
  
  Telestroke encounters at spoke hospitals with stroke coordinators and stroke center certifications were associated with shorter door-to-needle (DTN) times (60.9 min for hospitals with both components and 57.3 min for hospitals with one, vs. 81.2 min for hospitals with neither component, p <.001). Similar patterns were observed for the percentage of encounters with DTN time of ≤60 min (63.8% and 68.9% vs. 32.0%, p <.001) and ≤45 min (34.0% and 38.4% vs. 8.42%, p <.001). Associations were similar for other metrics (e.g., door-to-registration time), and were stronger for smaller (vs. larger) hospitals and rural (vs. urban) hospitals.
  
  Conclusions:
  
  Stroke coordinators or stroke center certifications may be important for stroke quality of care, especially at spoke hospitals with limited resources or in rural areas.
  
  
• Subjects:
  [+]

  Aged Aged, 80 And Over Delivery Of Health Care, Integrated Female Fibrinolytic Agents Hospital Bed Capacity Hospitals, Rural Humans Ischemic Stroke Male Middle Aged Models, Organizational Outcome And Process Assessment, Health Care Quality Indicators, Health Care Registries Rural Health Services South Carolina Stroke Telemedicine Thrombolytic Therapy Time-to-Treatment Time Factors Tissue Plasminogen Activator Treatment Outcome Urban Health Services
• Keywords:
  [+]

  Program Evaluation Quality Of Healthcare Remote Consultation
• Source:
  J Stroke Cerebrovasc Dis. 33(6):107702
• Pubmed ID:
  38556068
• Pubmed Central ID:
  PMC11088489
• Document Type:
  Journal Article
• Funding:
  CC999999/ImCDC/Intramural CDC HHSUnited States/ ; HHSD2002013M53955B/CC/CDC HHSUnited States/

  CC999999/ImCDC/Intramural CDC HHSUnited States/ ; HHSD2002013M53955B/CC/CDC HHSUnited States/ Less -
• Volume:
  33
• Issue:
  6
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  [+]

  urn:sha-512:92e2e661551d1491b740d92ca64f5c97cd09c0c614efcad602a37abfc9300fce762e8e092d777d2ec58f9b5f0360e40371aa4b881a9c55aa9e28c89a067e80bc
• File Type:

• Supporting Files:
  No Additional Files