Improving stroke outcomes in rural areas through telestroke programs: an examination of barriers, facilitators, and state policies

Telemed J E Health. 2014 Jan;20(1):3-10. doi: 10.1089/tmj.2013.0048. Epub 2013 Nov 28.


Introduction: Every year in the United States more than 600,000 ischemic stroke patients do not receive proven, effective stroke treatment or may not be medically eligible to receive the one medication endorsed by the U.S. Food and Drug Administration for acute ischemic stroke. The lack of treatment is due partly to shortages of neurological experts in rural and underserved areas. Telestroke programs can improve stroke care for stroke patients in rural and underserved settings by using interactive telecommunication technology that connects centrally located neurological experts to rural healthcare facilities. Many states have enacted policies and practices that facilitate telestroke access.

Materials and methods: We reviewed statutes and regulations in all 50 states that affect the adoption of telemedicine programs and describe examples of state-implemented programs in two states with policies that encourage telestroke use.

Results and discussion: This review presents evidence of the value and effectiveness of telestroke programs, as well as an explanation of common barriers and facilitators of telestroke, including licensing and credentialing rules, reimbursement issues, and liability concerns. Most states have adopted policies that affect the adoption of telestroke programs. Georgia and South Carolina are examples of states implementing stroke policies using a telestroke model to treat stroke patients in rural areas.

Publication types

  • Review

MeSH terms

  • Fibrinolytic Agents / administration & dosage*
  • Fibrinolytic Agents / therapeutic use
  • Health Services Accessibility
  • Humans
  • Insurance, Health, Reimbursement
  • Liability, Legal
  • Licensure
  • Policy*
  • Rural Health Services / legislation & jurisprudence
  • Rural Health Services / organization & administration*
  • State Government
  • Stroke / drug therapy*
  • Telemedicine / legislation & jurisprudence
  • Telemedicine / organization & administration*
  • Tissue Plasminogen Activator / administration & dosage*
  • Tissue Plasminogen Activator / therapeutic use
  • United States


  • Fibrinolytic Agents
  • Tissue Plasminogen Activator