They call it the golden hour: that first sixty minutes after a patient begins to experience stroke systems is the critical window for providing care that can minimize long-term disabilities or prevent a stroke death. But immediate access to high-quality emergency care is less comprehensive than one might think, leading to strokes being the fourth most common cause of death in the United States. A new study from the Perelman School of Medicine at the University of Pennsylvania indicates that access to a telemedicine link with a stroke expert can effectively provide the necessary intervention and increase the geographical coverage area by approximately 40%.
Research by Brendan Carr, MD, MA and colleagues showed that only 54% of residents in Oregon could reach a stroke center by ground within 60 minutes of experiencing symptoms, and 20% had no access to a telemedicine network or a stroke center at all. While stroke centers were most often located in urban areas, telemedicine systems, including high-quality streaming video viewable by remote specialists, reached rural areas around the clock. “Telestroke programs can reach patients in smaller communities and provide time-critical treatment to previously unreached people,” Carr said. “Increasing telestroke networks gives everyone a better chance of surviving a stroke.”
A separate telestroke survey released in June of 2012 noted that 44% of hospitals that participated in a telemedicine program had a dedicated software package for the initiative, while an additional 26% were able to record a patient’s information in an EHR, either at the “hub” hospital where the stroke expert is located or at a “spoke” hospital where a patient is taken by paramedics.
While many hospitals recognize the enormous benefits of providing immediate treatment to a patient using technology, insurance plans are unlikely to cover the charges, and lack of financial support was cited by a third of hospitals as significantly limiting the growth of their programs. “When a lifetime perspective is analyzed, telestroke seems cost-effective compared with usual care, mostly because telestroke costs are upfront and benefits of better stroke care are lifelong,” the study argued.
Technological barriers, such as the absence of a robust, secure internet connection that can stream high-quality video, also prevented some hospitals from joining in regional programs. “Increasingly, inequities in access to information technology will translate into disparities in access to health care, and therefore government and private initiatives will be necessary to ensure ubiquitous access to secure high-quality and high-speed bandwidth for telehealth applications,” the study predicts.
With an expanded telestroke network implemented in Oregon, 80% of residents now have access to expert care, even if they are located in remote areas far from an urban medical center with a specialist on staff.