Over the last decade, telestroke networks have been established across the U.S. to address this issue by connecting resource-strapped facilities with neurology specialists in stroke centers. But, do telestroke services help rural patients?
Research from the University of Georgia is seeking to answer that question.
Advanced technology by itself does not necessarily result in better care, says Dr. Donglan Zhang, an assistant professor of health policy and management at UGA’s College of Public Health.
Dr. Zhang recently published two studies both looking at whether telestroke services improved quality of stroke care.
The first, a study appearing in the December issue of Health Affairs, analyzed seven years of Medicare claims to learn what treatment patients received and how they fared in the weeks following their stroke.
Dr. Zhang found a correlation between the expansion of telestroke services nationwide with an improvement in quality of care in very rural communities.
“When we look at the national level, we observed a significant improvement in quality of care in both urban and rural counties, and we also observed a reduction in mortality outcome in very rural communities, with a modest increase in cost,” said Dr. Zhang.
Her second study focused on a Georgia-based telestroke program, named Remote Evaluation for Acute Ischemic Stroke (REACH). A cut-and-dry improvement in patient care in Georgia is less clear.
Dr. Zhang and her co-authors found that death rates decreased, but they didn’t find significant improvements in other quality of care indicators. For example, they didn’t find that program participants were using more tissue plasminogen activator, or tPA.
tPA is used to break down blood clots that occur during stroke, preventing further damage to the brain and other organs. An increased use of tPA usually suggests an improvement in care. Yet, patients were surviving more often.
“It seems there isn’t a causal link, but what changed during the process that leads to a favorable outcome in mortality?” said Dr. Zhang.
She posits that medical staff at rural hospitals may have picked up some indirect training in stroke assessment simply by participating in the telestroke service network, and her analysis of another less common indicator – complications associated with tPA treatment – support the idea.