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Population Health Indicators Associated with a Statewide Telestroke Program.

Annie N Simpson1,2, Jillian B Harvey1,2, Steven M DiLembo1,3

  • 1Department of Health Care Leadership and Management, Medical University of South Carolina, Charleston, South Carolina, USA.

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Summary

Implementing telestroke (TS) services improved access to acute ischemic stroke (AIS) care in South Carolina. This expansion led to increased use of treatments like tissue plasminogen activator and better patient outcomes, demonstrating a population health benefit.

Keywords:
EVT stroke outcomespopulation healthtPAtelehealthtelemedicinetelestroke

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Area of Science:

  • Neurology
  • Public Health
  • Health Services Research

Background:

  • Telestroke (TS) services are known to improve rural access to stroke care and patient outcomes.
  • However, the broader population health impacts of TS implementation remain largely unknown.
  • This study investigates the effects of South Carolina's statewide TS network on acute ischemic stroke (AIS) patients across the state.

Purpose of the Study:

  • To examine the population health impacts of a statewide telestroke network on acute ischemic stroke patients.
  • To assess changes in the utilization of thrombolysis and endovascular therapy (EVT) as the network diffused.
  • To report changes in stroke mortality rates and discharge destinations at the county level.

Main Methods:

  • A population health study utilizing Donabedian's conceptual model and an ecological design.
  • Analysis of changes in thrombolysis and EVT rates over time correlating with TS network diffusion across South Carolina counties.
  • Logistic regression was used to estimate relative risks, adjusted for age >75 years, with county of residence defining patient cohorts.

Main Results:

  • The overall rate of tissue plasminogen activator (tPA) use was 6.28%, and EVT use was 1.10%.
  • Patients in areas with TS network availability had a 25% higher likelihood of receiving tPA (ARR=1.25).
  • Access to TS was associated with lower risks of mortality (ARR=0.91) and discharge to skilled nursing facilities (ARR=0.93).

Conclusions:

  • The diffusion of telestroke networks influences healthcare system structure and emergency department care processes.
  • These changes are linked to significant improvements in population health outcomes for stroke patients.
  • The findings support the positive population-level benefits of implementing telestroke services.