Comparison of Stroke Outcomes of Hub and Spoke Hospital Treated Patients in Mayo Clinic Telestroke Program

Bart M Demaerschalk, Erica L. Boyd, Kevin M Barrett, Dale M. Gamble, Sarah Sonchik, Meghan M. Comer, Judith Wieser, Joseph G. Hentz, Dennis Fitz-Patrick, Yu Hui H. Chang

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Purpose: To examine telemedicine as it applies to acute ischemic stroke care at a spoke hospital and the effect on patient outcomes, including the timeliness of response, quality of care, safety, morbidity, and mortality when compared to standard hub hospital stroke center care. Methods: Retrospective review of prospectively entered quality/performance stroke/telestroke patient catalog data were completed for 1000 adult patients who presented with an acute ischemic stroke to the Mayo Clinic Hospitals (500 patients) or to one of thirteen Mayo Clinic affiliated telestroke spoke hospitals in the regions (500 patients). The primary outcome of interest was the percentage of accurate decision making for eligibility of IV alteplase administration assessed by blinded adjudication and the secondary outcomes pertained to complications, discharge parameters, and standard quality metrics. Results: There was no difference in the spoke hospital versus hub hospital groups in identifying and making the correct decision regarding which patients were eligible for IV alteplase administration (96% [95% confidence interval (CI): 94%-97%] versus 97% [95% CI: 95%-98%]; P = 0.32). There was no difference among the groups in proportion receiving IV alteplase, sustaining symptomatic intracranial hemorrhage, and mortality. Patients in the spoke group were less likely to have a favorable outcome at discharge, as defined by National Institutes of Health Stroke Scale (NIHSS): 0-1 or mRS: 0-1 or Glasgow Outcome Scale (GOS): 0-1 (21% versus, 35%; P < 0.001), were less likely to have venous thromboembolism prophylaxis (46% versus 63%; P < 0.01), were less likely to have received antithrombotic therapy (85% versus 90%; P =.02), were less likely to be discharged on anticoagulation when indicated (56% versus 64%; P =.01), and were less likely to be prescribed cholesterol reducing treatment (68% versus 72%; P <.001). The initial acute care hospital length of stay was longer for the spoke hospital group by one day (median: 4 versus 3; P <.001). Conclusion: The key findings were that evidence-based stroke thrombolysis eligibility decision making, thrombolysis administration, and thrombolysis emergency stroke metrics were uniformly excellent for the spoke hospital group when compared to the standard hub hospital group. However, evidence-based stroke hospitalization and discharge metrics were inferior for the spoke hospital group when compared to the standard hub hospital.

Original languageEnglish (US)
JournalJournal of Stroke and Cerebrovascular Diseases
DOIs
StateAccepted/In press - Jan 1 2018

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Stroke
Tissue Plasminogen Activator
Decision Making
Length of Stay
Confidence Intervals
Glasgow Outcome Scale
Mortality
Intracranial Hemorrhages
Telemedicine
Quality of Health Care
Venous Thromboembolism
National Institutes of Health (U.S.)
Hospitalization
Emergencies
Cholesterol
Morbidity
Safety
Therapeutics

Keywords

  • emergency medicine
  • outcomes
  • stroke
  • telemedicine
  • Telestroke

ASJC Scopus subject areas

  • Surgery
  • Rehabilitation
  • Clinical Neurology
  • Cardiology and Cardiovascular Medicine

Cite this

Comparison of Stroke Outcomes of Hub and Spoke Hospital Treated Patients in Mayo Clinic Telestroke Program. / Demaerschalk, Bart M; Boyd, Erica L.; Barrett, Kevin M; Gamble, Dale M.; Sonchik, Sarah; Comer, Meghan M.; Wieser, Judith; Hentz, Joseph G.; Fitz-Patrick, Dennis; Chang, Yu Hui H.

In: Journal of Stroke and Cerebrovascular Diseases, 01.01.2018.

Research output: Contribution to journalArticle

Demaerschalk, Bart M ; Boyd, Erica L. ; Barrett, Kevin M ; Gamble, Dale M. ; Sonchik, Sarah ; Comer, Meghan M. ; Wieser, Judith ; Hentz, Joseph G. ; Fitz-Patrick, Dennis ; Chang, Yu Hui H. / Comparison of Stroke Outcomes of Hub and Spoke Hospital Treated Patients in Mayo Clinic Telestroke Program. In: Journal of Stroke and Cerebrovascular Diseases. 2018.
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abstract = "Purpose: To examine telemedicine as it applies to acute ischemic stroke care at a spoke hospital and the effect on patient outcomes, including the timeliness of response, quality of care, safety, morbidity, and mortality when compared to standard hub hospital stroke center care. Methods: Retrospective review of prospectively entered quality/performance stroke/telestroke patient catalog data were completed for 1000 adult patients who presented with an acute ischemic stroke to the Mayo Clinic Hospitals (500 patients) or to one of thirteen Mayo Clinic affiliated telestroke spoke hospitals in the regions (500 patients). The primary outcome of interest was the percentage of accurate decision making for eligibility of IV alteplase administration assessed by blinded adjudication and the secondary outcomes pertained to complications, discharge parameters, and standard quality metrics. Results: There was no difference in the spoke hospital versus hub hospital groups in identifying and making the correct decision regarding which patients were eligible for IV alteplase administration (96{\%} [95{\%} confidence interval (CI): 94{\%}-97{\%}] versus 97{\%} [95{\%} CI: 95{\%}-98{\%}]; P = 0.32). There was no difference among the groups in proportion receiving IV alteplase, sustaining symptomatic intracranial hemorrhage, and mortality. Patients in the spoke group were less likely to have a favorable outcome at discharge, as defined by National Institutes of Health Stroke Scale (NIHSS): 0-1 or mRS: 0-1 or Glasgow Outcome Scale (GOS): 0-1 (21{\%} versus, 35{\%}; P < 0.001), were less likely to have venous thromboembolism prophylaxis (46{\%} versus 63{\%}; P < 0.01), were less likely to have received antithrombotic therapy (85{\%} versus 90{\%}; P =.02), were less likely to be discharged on anticoagulation when indicated (56{\%} versus 64{\%}; P =.01), and were less likely to be prescribed cholesterol reducing treatment (68{\%} versus 72{\%}; P <.001). The initial acute care hospital length of stay was longer for the spoke hospital group by one day (median: 4 versus 3; P <.001). Conclusion: The key findings were that evidence-based stroke thrombolysis eligibility decision making, thrombolysis administration, and thrombolysis emergency stroke metrics were uniformly excellent for the spoke hospital group when compared to the standard hub hospital group. However, evidence-based stroke hospitalization and discharge metrics were inferior for the spoke hospital group when compared to the standard hub hospital.",
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AU - Demaerschalk, Bart M

AU - Boyd, Erica L.

AU - Barrett, Kevin M

AU - Gamble, Dale M.

AU - Sonchik, Sarah

AU - Comer, Meghan M.

AU - Wieser, Judith

AU - Hentz, Joseph G.

AU - Fitz-Patrick, Dennis

AU - Chang, Yu Hui H.

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N2 - Purpose: To examine telemedicine as it applies to acute ischemic stroke care at a spoke hospital and the effect on patient outcomes, including the timeliness of response, quality of care, safety, morbidity, and mortality when compared to standard hub hospital stroke center care. Methods: Retrospective review of prospectively entered quality/performance stroke/telestroke patient catalog data were completed for 1000 adult patients who presented with an acute ischemic stroke to the Mayo Clinic Hospitals (500 patients) or to one of thirteen Mayo Clinic affiliated telestroke spoke hospitals in the regions (500 patients). The primary outcome of interest was the percentage of accurate decision making for eligibility of IV alteplase administration assessed by blinded adjudication and the secondary outcomes pertained to complications, discharge parameters, and standard quality metrics. Results: There was no difference in the spoke hospital versus hub hospital groups in identifying and making the correct decision regarding which patients were eligible for IV alteplase administration (96% [95% confidence interval (CI): 94%-97%] versus 97% [95% CI: 95%-98%]; P = 0.32). There was no difference among the groups in proportion receiving IV alteplase, sustaining symptomatic intracranial hemorrhage, and mortality. Patients in the spoke group were less likely to have a favorable outcome at discharge, as defined by National Institutes of Health Stroke Scale (NIHSS): 0-1 or mRS: 0-1 or Glasgow Outcome Scale (GOS): 0-1 (21% versus, 35%; P < 0.001), were less likely to have venous thromboembolism prophylaxis (46% versus 63%; P < 0.01), were less likely to have received antithrombotic therapy (85% versus 90%; P =.02), were less likely to be discharged on anticoagulation when indicated (56% versus 64%; P =.01), and were less likely to be prescribed cholesterol reducing treatment (68% versus 72%; P <.001). The initial acute care hospital length of stay was longer for the spoke hospital group by one day (median: 4 versus 3; P <.001). Conclusion: The key findings were that evidence-based stroke thrombolysis eligibility decision making, thrombolysis administration, and thrombolysis emergency stroke metrics were uniformly excellent for the spoke hospital group when compared to the standard hub hospital group. However, evidence-based stroke hospitalization and discharge metrics were inferior for the spoke hospital group when compared to the standard hub hospital.

AB - Purpose: To examine telemedicine as it applies to acute ischemic stroke care at a spoke hospital and the effect on patient outcomes, including the timeliness of response, quality of care, safety, morbidity, and mortality when compared to standard hub hospital stroke center care. Methods: Retrospective review of prospectively entered quality/performance stroke/telestroke patient catalog data were completed for 1000 adult patients who presented with an acute ischemic stroke to the Mayo Clinic Hospitals (500 patients) or to one of thirteen Mayo Clinic affiliated telestroke spoke hospitals in the regions (500 patients). The primary outcome of interest was the percentage of accurate decision making for eligibility of IV alteplase administration assessed by blinded adjudication and the secondary outcomes pertained to complications, discharge parameters, and standard quality metrics. Results: There was no difference in the spoke hospital versus hub hospital groups in identifying and making the correct decision regarding which patients were eligible for IV alteplase administration (96% [95% confidence interval (CI): 94%-97%] versus 97% [95% CI: 95%-98%]; P = 0.32). There was no difference among the groups in proportion receiving IV alteplase, sustaining symptomatic intracranial hemorrhage, and mortality. Patients in the spoke group were less likely to have a favorable outcome at discharge, as defined by National Institutes of Health Stroke Scale (NIHSS): 0-1 or mRS: 0-1 or Glasgow Outcome Scale (GOS): 0-1 (21% versus, 35%; P < 0.001), were less likely to have venous thromboembolism prophylaxis (46% versus 63%; P < 0.01), were less likely to have received antithrombotic therapy (85% versus 90%; P =.02), were less likely to be discharged on anticoagulation when indicated (56% versus 64%; P =.01), and were less likely to be prescribed cholesterol reducing treatment (68% versus 72%; P <.001). The initial acute care hospital length of stay was longer for the spoke hospital group by one day (median: 4 versus 3; P <.001). Conclusion: The key findings were that evidence-based stroke thrombolysis eligibility decision making, thrombolysis administration, and thrombolysis emergency stroke metrics were uniformly excellent for the spoke hospital group when compared to the standard hub hospital group. However, evidence-based stroke hospitalization and discharge metrics were inferior for the spoke hospital group when compared to the standard hub hospital.

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