The role of stroke care infrastructure on the effectiveness of a hub-and-spoke telestroke model in South Carolina
Copyright © 2024. Published by Elsevier Inc..
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.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2024 |
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| Erschienen: |
2024 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:33 |
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| Enthalten in: |
Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association - 33(2024), 6 vom: 29. März, Seite 107702 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Srinivasan, Mithuna [VerfasserIn] |
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| Links: |
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| Themen: |
Journal Article |
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| Anmerkungen: |
Date Revised 07.04.2024 published: Print-Electronic Citation Status Publisher |
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| doi: |
10.1016/j.jstrokecerebrovasdis.2024.107702 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM370455894 |
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| 100 | 1 | |a Srinivasan, Mithuna |e verfasserin |4 aut | |
| 245 | 1 | 4 | |a The role of stroke care infrastructure on the effectiveness of a hub-and-spoke telestroke model in South Carolina |
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| 500 | |a Date Revised 07.04.2024 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a Citation Status Publisher | ||
| 520 | |a Copyright © 2024. Published by Elsevier Inc. | ||
| 520 | |a 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 | ||
| 520 | |a 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 | ||
| 520 | |a 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 | ||
| 520 | |a 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 | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Program evaluation | |
| 650 | 4 | |a Quality of healthcare | |
| 650 | 4 | |a Remote consultation | |
| 650 | 4 | |a Stroke | |
| 650 | 4 | |a Telemedicine | |
| 700 | 1 | |a Scott, Amber |e verfasserin |4 aut | |
| 700 | 1 | |a Soo, Jackie |e verfasserin |4 aut | |
| 700 | 1 | |a Sreedhara, Meera |e verfasserin |4 aut | |
| 700 | 1 | |a Popat, Shena |e verfasserin |4 aut | |
| 700 | 1 | |a Beasley, Kincaid Lowe |e verfasserin |4 aut | |
| 700 | 1 | |a Jackson, Tiara N |e verfasserin |4 aut | |
| 700 | 1 | |a Abbas, Amena |e verfasserin |4 aut | |
| 700 | 1 | |a Keaton, W Alexander |e verfasserin |4 aut | |
| 700 | 1 | |a Holmstedt, Christine |e verfasserin |4 aut | |
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| 700 | 1 | |a McLeod, Shay |e verfasserin |4 aut | |
| 700 | 1 | |a Ahn, Roy |e verfasserin |4 aut | |
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