Telestroke Adoption Among Community Hospitals in North Carolina: A Cross-Sectional Study

J Stroke Cerebrovasc Dis. 2018 Sep;27(9):2411-2417. doi: 10.1016/j.jstrokecerebrovasdis.2018.04.032. Epub 2018 May 18.


Objective: This study identifies community and hospital characteristics associated with adoption of telestroke among acute care hospitals in North Carolina (NC).

Methods: Our sample included 107 hospitals located in NC. Our analytic dataset included variables from the American Hospital Association (AHA) annual survey, AHA Health IT supplement, Healthcare Cost Report Information System, and Centers for Disease Control and Prevention's WONDER online database. We supplemented our secondary sources with data on telestroke adoption and market-level variables developed for NC. We used the Consolidated Framework for Implementation Research and previous telehealth studies to guide selection of variables. We conducted a multivariate logistic regression to determine associations with telestroke adoption.

Results: Proportion of discharges that are Medicare (odds ratio [OR] = 1.93, P < .04) and total operating margin (OR = 2.89, P = .00) were positively associated with telestroke adoption. Critical access hospital status was positively associated with telestroke adoption, although not at P < .05 (OR = 5.61, P = .07). Distance to the nearest hospital with a telestroke program (OR = .91, P = .01) and volume of emergency department visits (OR = .98, P < .05) were both negatively associated with telestroke adoption.

Conclusions: Our study is novel in its focus on telestroke adoption and use of variables not included in previous telehealth analyses. Our findings suggest some hospitals have neither the financial resources nor the ability to pool resources for acquiring needed technology, and differences in adoption may result in geographic inequities in access to telestroke services.

Keywords: Stroke; emergency health services; hospitals; medical care; organizational innovation; rural health services; telemedicine; telestroke.

MeSH terms

  • Cross-Sectional Studies
  • Hospitals, Community*
  • Humans
  • Logistic Models
  • Medicare
  • Multivariate Analysis
  • North Carolina
  • Rural Population
  • Stroke / therapy*
  • Telemedicine / statistics & numerical data*
  • United States