Impact of Telemedicine on Access to Acute Stroke Care in the State of Texas

doi:10.1002/acn3.20

. 2014 Jan 1;1(1):27-33.

doi: 10.1002/acn3.20.

Impact of Telemedicine on Access to Acute Stroke Care in the State of Texas

Affiliations

¹ Stroke Program, Department of Neurology, University of Texas-Houston Memorial Hermann Medical Center, Houston, TX 77030.
² Department of Neurology, School of Medicine, University of Alabama at Birmingham, Birmingham, AL 35294.
³ Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, AL 35294 ; Health Services and Outcomes Research Center for Outcome and Effectiveness Research and Education (COERE),University of Alabama at Birmingham, Birmingham, AL 35294 ; Center of Excellence in Comparative Effectiveness Research for Eliminating Disparities (CERED) Minority Health & Health Disparities Research Center (MHRC),University of Alabama at Birmingham, Birmingham, AL 35294.
⁴ Department of Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA 19104.
⁵ Department of Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA 19104 ; Department of Emergency Medicine, University of Pennsylvania, Philadelphia, PA 19104.

PMID: 24535938
PMCID: PMC3925075
DOI: 10.1002/acn3.20

Impact of Telemedicine on Access to Acute Stroke Care in the State of Texas

Tzu-Ching Wu et al. Ann Clin Transl Neurol. 2014.

. 2014 Jan 1;1(1):27-33.

doi: 10.1002/acn3.20.

Authors

Affiliations

¹ Stroke Program, Department of Neurology, University of Texas-Houston Memorial Hermann Medical Center, Houston, TX 77030.
² Department of Neurology, School of Medicine, University of Alabama at Birmingham, Birmingham, AL 35294.
³ Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, AL 35294 ; Health Services and Outcomes Research Center for Outcome and Effectiveness Research and Education (COERE),University of Alabama at Birmingham, Birmingham, AL 35294 ; Center of Excellence in Comparative Effectiveness Research for Eliminating Disparities (CERED) Minority Health & Health Disparities Research Center (MHRC),University of Alabama at Birmingham, Birmingham, AL 35294.
⁴ Department of Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA 19104.
⁵ Department of Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA 19104 ; Department of Emergency Medicine, University of Pennsylvania, Philadelphia, PA 19104.

PMID: 24535938
PMCID: PMC3925075
DOI: 10.1002/acn3.20

Abstract

Background: To examine the impact of telemedicine on access to acute stroke care and expertise in the state of Texas.

Methods: Texas hospitals were surveyed using a standard questionnaire and categorized as: (1) stand-alone Primary Stroke Centers not using telemedicine for acute stroke care, (2) Primary Stroke Centers using telemedicine for acute stroke care, (3) non-Primary Stroke Center hospitals using telemedicine for acute stroke care, or (4) non-Primary Stroke Center hospitals not using telemedicine for acute stroke care. Population data were obtained from the US Census Bureau and the Neilson Claritas Demographic Estimation Program. Access within 60 minutes to a designated facility was calculated at the block group level.

Results: Over 75% of Texans had 60-minute access to a stand-alone Primary Stroke Center. Including Primary Stroke Centers using telemedicine increased access by 6.5%. Adding non- Primary Stroke Centers that use telemedicine for acute stroke care provided 60-minute access for an additional 2% of Texans, leaving 16% of Texans without 60-minute access to acute stroke care. Approximately 62% of Texans had 60-minute access to more than one type of facility that provided acute stroke care.

Conclusion: The use of telemedicine in the state of Texas brought 60-minute access to >2 million Texans who otherwise would not have had access to acute stroke expertise. Our findings demonstrate that using telemedicine for acute stroke has the ability to provide neurologically underserved areas access to acute stroke care.

Keywords: Telemedicine; access to care; ischemic stroke.

PubMed Disclaimer

Figures

**Figure 2**
Population with 60-min ground transport access to in-state acute stroke care in Texas. (A) Displays access to stand-alone certified stroke centers that reported not using telemedicine for acute stroke care (PSCs). (B) Shows the increased access provided when centers that reported using telemedicine for acute stroke care were included. (C) Depicts the population density for Texas. (D) Illustrates areas of duplicate access.

**Figure 3**
Areas marked Pre-TM access indicate population with 60-min ground transport to in-state stand-alone certified stroke centers that reported not using telemedicine for acute stroke care. Areas marked Post-TM additional access indicate population with 60-min ground transport to in-state centers that reported using telemedicine for acute stroke care.

See this image and copyright information in PMC

Cited by

Rationale and design of a statewide telestroke registry: Lone Star Stroke Consortium Telestroke Registry (LeSteR).
Astudillo C, Ankrom C, Trevino A, Malazarte RM, Bambhroliya AB, Savitz S, Topel CH, Milling TJ, Wu TC. Astudillo C, et al. BMJ Open. 2019 Sep 4;9(9):e026496. doi: 10.1136/bmjopen-2018-026496. BMJ Open. 2019. PMID: 31488463 Free PMC article.
Telemedicine Training in Undergraduate Medical Education: Mixed-Methods Review.
Waseh S, Dicker AP. Waseh S, et al. JMIR Med Educ. 2019 Apr 8;5(1):e12515. doi: 10.2196/12515. JMIR Med Educ. 2019. PMID: 30958269 Free PMC article. Review.
Outcomes Among Patients With Ischemic Stroke Treated With Intravenous tPA (Tissue-Type Plasminogen Activator) via Telemedicine.
Wysocki NA, Bambhroliya A, Ankrom C, Vahidy F, Astudillo C, Trevino A, Malazarte R, Cossey TC, Jagolino-Cole A, Savitz S, Wu TC, Sharrief A. Wysocki NA, et al. Stroke. 2019 Apr;50(4):895-900. doi: 10.1161/STROKEAHA.118.024703. Stroke. 2019. PMID: 30852962 Free PMC article.
Sex Disparities in Access to Acute Stroke Care: Can Telemedicine Mitigate this Effect?
Wolff C, Boehme AK, Albright KC, Wu TC, Mullen MT, Branas CC, Grotta JC, Savitz SI, Carr BG. Wolff C, et al. J Health Dispar Res Pract. 2016 Spring;9(1):5. J Health Dispar Res Pract. 2016. PMID: 27668134 Free PMC article.
A call for formal telemedicine training during stroke fellowship.
Jagolino AL, Jia J, Gildersleeve K, Ankrom C, Cai C, Rahbar M, Savitz SI, Wu TC. Jagolino AL, et al. Neurology. 2016 May 10;86(19):1827-33. doi: 10.1212/WNL.0000000000002568. Epub 2016 Mar 25. Neurology. 2016. PMID: 27016522 Free PMC article.

See all "Cited by" articles

References

1. Albers GW, Olivot JM. Intravenous alteplase for ischaemic stroke. Lancet. 2007;369:249–250. - PubMed
1. Katzan IL, Furlan AJ, Lloyd LE, et al. Use of tissue-type plasminogen activator for acute ischemic stroke: the cleveland area experience. JAMA. 2000;283:1151–1158. - PubMed
1. Barber PA, Zhang J, Demchuk AM, et al. Why are stroke patients excluded from tpa therapy? An analysis of patient eligibility. Neurology. 2001;56:1015–1020. - PubMed
1. Gebhardt JG, Norris TE. Acute stroke care at rural hospitals in idaho: challenges in expediting stroke care. J Rural Health. 2006;22:88–91. - PubMed
1. Schwamm LH, Holloway RG, Amarenco P, et al. A review of the evidence for the use of telemedicine within stroke systems of care: a scientific statement from the American Heart Association/American Stroke Association. Stroke. 2009;40:2616–2634. - PubMed

Grants and funding

LinkOut - more resources

Full Text Sources
Other Literature Sources
- scite Smart Citations

[1] Albers GW, Olivot JM. Intravenous alteplase for ischaemic stroke. Lancet. 2007;369:249–250. - PubMed

[2] Albers GW, Olivot JM. Intravenous alteplase for ischaemic stroke. Lancet. 2007;369:249–250. - PubMed

[3] Katzan IL, Furlan AJ, Lloyd LE, et al. Use of tissue-type plasminogen activator for acute ischemic stroke: the cleveland area experience. JAMA. 2000;283:1151–1158. - PubMed

[4] Katzan IL, Furlan AJ, Lloyd LE, et al. Use of tissue-type plasminogen activator for acute ischemic stroke: the cleveland area experience. JAMA. 2000;283:1151–1158. - PubMed

[5] Barber PA, Zhang J, Demchuk AM, et al. Why are stroke patients excluded from tpa therapy? An analysis of patient eligibility. Neurology. 2001;56:1015–1020. - PubMed

[6] Barber PA, Zhang J, Demchuk AM, et al. Why are stroke patients excluded from tpa therapy? An analysis of patient eligibility. Neurology. 2001;56:1015–1020. - PubMed

[7] Gebhardt JG, Norris TE. Acute stroke care at rural hospitals in idaho: challenges in expediting stroke care. J Rural Health. 2006;22:88–91. - PubMed

[8] Gebhardt JG, Norris TE. Acute stroke care at rural hospitals in idaho: challenges in expediting stroke care. J Rural Health. 2006;22:88–91. - PubMed

[9] Schwamm LH, Holloway RG, Amarenco P, et al. A review of the evidence for the use of telemedicine within stroke systems of care: a scientific statement from the American Heart Association/American Stroke Association. Stroke. 2009;40:2616–2634. - PubMed

[10] Schwamm LH, Holloway RG, Amarenco P, et al. A review of the evidence for the use of telemedicine within stroke systems of care: a scientific statement from the American Heart Association/American Stroke Association. Stroke. 2009;40:2616–2634. - PubMed

Save citation to file

Email citation

Add to Collections

Add to My Bibliography

Your saved search

Create a file for external citation management software

Your RSS Feed

Impact of Telemedicine on Access to Acute Stroke Care in the State of Texas

Affiliations

Impact of Telemedicine on Access to Acute Stroke Care in the State of Texas

Authors

Affiliations

Abstract

Figures

Similar articles

Cited by

References

Grants and funding

LinkOut - more resources

Full Text Sources

Other Literature Sources

Abstract

Figures

Similar articles

Cited by

References

Related information

Grants and funding

LinkOut - more resources

Full Text Sources

Other Literature Sources