One in Four US Hospitals Have Telestroke Capacity

By Lisa Rapaport

May 27, 2020

(Reuters Health) - Telestroke services have become more common at U.S. hospitals in recent decades, and as of 2019, some 27.4% of hospitals had access to this technology in their emergency departments, a new study suggests.

Researchers contacted 15 health systems and private companies they identified as having telemedicine programs to give local emergency physicians access to stroke experts for help with neurological exams, review of imaging, and treatment decisions for stroke patients. This convenience sample included 4,751 hospitals open in 2017 with at least one stroke hospitalization for a patient covered by fee-for-service Medicare.

Tracking growth of telestroke availability between 2001 and 2019, the researchers found that growth rates peaked in 2014 but they continued to climb at a slower pace after that. By 2019, 1,306 hospitals included in the study had telestroke programs, according to the report in JAMA Neurology.

"There has been limited information on how many hospitals have telestroke capacity, how it is growing over time, and which hospitals have it," said senior study author Dr. Ateev Mehrotra, an associate professor of medicine at Harvard Medical School and Beth Israel Deaconess Medical Center in Boston.

"It is notable that so many hospitals have adopted telestroke," Dr. Mehrotra said by email.

Among the hospitals with telestroke services, 336 (35.3%) were in the West, 530 (29.4%) were in the South, 170 (28.8%) were in the Northeast, and 270 (19.2%) were in the Midwest.

Urban hospitals were more likely to offer telestroke services than rural hospitals in 2019, at 30.2% and 23.5%, respectively.

When hospitals were stratified into quartiles, larger facilities were more likely to have these services, with telestroke capacity in 33.5% of hospitals with more than 186 beds, 38.4% of hospitals with 73-186 beds, 22.2% of facilities with 26 to 72 beds, and just 14.8% of hospitals with no more than 25 beds.

Ownership also appeared to impact the odds of availability, with telestroke services at 37.1% of for-profit hospitals, 28.2% of nonprofit hospitals, and 19.3% of government hospitals.

Hospitals without intensive care units were less likely to have telestroke services than hospitals with intensive care units, at 21% and 33.5%, respectively.

In counties with fewer than 2 neurologists per 100,000 residents, 38.3% of hospitals had telestroke services, as did 34.7% of hospitals in counties with 2 to 4.9 neurologists per 100,000 residents. By contrast, 22.1% of hospitals in counties with more than 10 neurologists per 100,000 residents had telestroke services.

The main limitation of the study is the convenience sample, which may overrepresent larger health systems with teaching hospitals or using private telestroke companies, the researchers note.

In addition, telestroke presence at community hospitals may be fluid, and results of the study might not capture this, said Dr. Amanda Jagolino-Cole, a teleneurogist with McGovern Medical School at UTHealth in Houston.

"A community hospital may need telestroke only for certain scenarios or for specific gaps in coverage during a month or year, and a community hospital may have telestroke one day, and not the next, depending on the economics of the system," Dr. Jagolino-Cole, who wasn't involved in the study, said by email.

Even so, the results are important because they offer a glimpse of the characteristics that might make hospitals less likely to have adopted telestroke services, said Dr. Michael Lyerly, physician lead for the eMedicine Telestroke Service at the University of Alabama at Birmingham.

"This will offer clues to barriers to implementation of telestroke, which will hopefully translate into changes in how telestroke can be incentivized to these hospitals and to make it practical and feasible for implementation," Dr. Lyerly, who wasn't involved in the study, said by email.

The recent decline in growth in new hospitals adding telestroke programs has coincided with several landmark clinical trials in stroke that have shown the overwhelming benefit for endovascular thrombectomy for the restoration of blood flow for some stroke patients, Dr. Lyerly said. That makes it even more critical to identify what barriers may prevent hospitals from implementing these programs where they are needed to expand access to care.

"Now more than ever, telestroke is needed to be able to deliver neurologic expertise to more hospitals in order to identify these patients who would benefit from rapid transfer to hospitals capable of performing these lifesaving interventions," Dr. Lyerly said.

SOURCE: JAMA Neurology, online May 26, 2020.