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Chhabra N, English SW, Butterfield RJ, Zhang N, Hanus AE, Basharath R, Miller M, Demaerschalk BM. Poor prediction of stroke mimics using validated stroke mimic scales in a large academic telestroke network. J Telemed Telecare 2024:1357633X241273762. [PMID: 39158498 DOI: 10.1177/1357633x241273762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/20/2024]
Abstract
INTRODUCTION Telestroke enables timely and remote evaluation of patients with acute stroke syndromes. However, stroke mimics represent more than 30% of this population. Given the resources required for the management of suspected acute ischemic stroke, several scales have been developed to help identify stroke mimics. Our objective was to externally validate four mimic scales (Khan Score (KS), TeleStroke Mimic Score (TS), simplified FABS (sFABS), and FABS) in a large, academic telestroke network. METHODS This is a retrospective, Institutional Review Board-exempt study of all patients who presented with suspected acute stroke syndromes and underwent video evaluation between 2019 and 2020 at a large academic telestroke network. Detailed chart review was conducted to extract both the variables needed to apply the mimic scales, the final diagnosis confirmed by final imaging, and discharge diagnosis (cerebral ischemic vs stroke mimic). Overall score performance was assessed by calculating the area under curve (AUC). Youden cutpoint was established for each scale and used to calculate sensitivity, specificity, negative predictive value (NPV), positive predictive value (PPV), and accuracy. RESULTS A total of 1043 patients were included in the final analysis. Final diagnosis of cerebral ischemia was made in 63.5% of all patients, and stroke mimic was diagnosed in 381 patients (36.5%). To predict stroke mimic, TS had the highest AUC (68.3), sensitivity (99.2%), and NPV (77.3%); KS had the highest accuracy (67.5%); FABS had the highest specificity (55.1%), and PPV (72.5%). CONCLUSIONS While each scale offers unique strengths, none was able to identify stroke mimics effectively enough to confidently apply in clinical practice. There remains a need for significant clinical judgment to determine the likelihood of stroke mimic at presentation.
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Affiliation(s)
- Nikita Chhabra
- Department of Neurology, Mayo Clinic College of Medicine and Science, Phoenix, AZ, USA
| | - Stephen W English
- Department of Neurology, Mayo Clinic College of Medicine and Science, Jacksonville, FL, USA
| | | | - Nan Zhang
- Department of Biostatistics, Mayo Clinic, Phoenix, AZ, USA
| | - Abigail E Hanus
- Department of Neurology, Mayo Clinic College of Medicine and Science, Jacksonville, FL, USA
| | - Rida Basharath
- Department of Neurology, Mayo Clinic College of Medicine and Science, Jacksonville, FL, USA
| | - Monet Miller
- Department of Neurology, Mayo Clinic College of Medicine and Science, Jacksonville, FL, USA
| | - Bart M Demaerschalk
- Department of Neurology, Mayo Clinic College of Medicine and Science, Phoenix, AZ, USA
- Center for Digital Health, Mayo Clinic, Rochester, MN, USA
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Jones EC, Kummer BR, Wilkinson JR. Teleneurology and Artificial Intelligence in Clinical Practice. Continuum (Minneap Minn) 2024; 30:904-914. [PMID: 38830075 DOI: 10.1212/con.0000000000001430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2024]
Abstract
ABSTRACT As teleheath becomes integrated into the practice of medicine, it is important to understand the benefits, limitations, and variety of applications. Telestroke was an early example of teleneurology that arose from a need for urgent access to neurologists for time-sensitive treatments for stroke. It made a scarce resource widely available via video conferencing technologies. Additionally, applications such as outpatient video visits, electronic consultation (e-consult), and wearable devices developed in neurology, as well. Telehealth dramatically increased during the COVID-19 pandemic when offices were closed and hospitals were overwhelmed; a multitude of both outpatient and inpatient programs developed and matured during this time. It is helpful to explore what has been learned regarding the quality of telehealth, disparities in care, and how artificial intelligence can interact with medical practices in the teleneurology context.
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Srinivasan M, Scott A, Soo J, Sreedhara M, Popat S, Beasley KL, Jackson TN, Abbas A, Keaton WA, Holmstedt C, Harvey J, Kruis R, McLeod S, Ahn R. The role of stroke care infrastructure on the effectiveness of a hub-and-spoke telestroke model in South Carolina. J Stroke Cerebrovasc Dis 2024; 33:107702. [PMID: 38556068 PMCID: PMC11088489 DOI: 10.1016/j.jstrokecerebrovasdis.2024.107702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Revised: 03/21/2024] [Accepted: 03/28/2024] [Indexed: 04/02/2024] Open
Abstract
OBJECTIVE To examine the relationship between stroke care infrastructure and stroke quality-of-care outcomes at 29 spoke hospitals participating in the Medical University of South Carolina (MUSC) hub-and-spoke telestroke network. MATERIALS AND METHODS Encounter-level data from MUSC's telestroke patient registry were filtered to include encounters during 2015-2022 for patients aged 18 and above with a clinical diagnosis of acute ischemic stroke, and who received intravenous tissue plasminogen activator. Unadjusted and adjusted generalized estimating equations assessed associations between time-related stroke quality-of-care metrics captured during the encounter and the existence of the two components of stroke care infrastructure-stroke coordinators and stroke center certifications-across all hospitals and within hospital subgroups defined by size and rurality. RESULTS Telestroke encounters at spoke hospitals with stroke coordinators and stroke center certifications were associated with shorter door-to-needle (DTN) times (60.9 min for hospitals with both components and 57.3 min for hospitals with one, vs. 81.2 min for hospitals with neither component, p <.001). Similar patterns were observed for the percentage of encounters with DTN time of ≤60 min (63.8% and 68.9% vs. 32.0%, p <.001) and ≤45 min (34.0% and 38.4% vs. 8.42%, p <.001). Associations were similar for other metrics (e.g., door-to-registration time), and were stronger for smaller (vs. larger) hospitals and rural (vs. urban) hospitals. CONCLUSIONS Stroke coordinators or stroke center certifications may be important for stroke quality of care, especially at spoke hospitals with limited resources or in rural areas.
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Affiliation(s)
- Mithuna Srinivasan
- NORC at the University of Chicago, 4350 East-West Hwy 8th Floor, Bethesda, MD 20814, United States.
| | - Amber Scott
- Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Atlanta, GA, United States; Oak Ridge Institute for Science and Education, Oak Ridge, TN, United States
| | - Jackie Soo
- NORC at the University of Chicago, Chicago, IL, United States
| | - Meera Sreedhara
- Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Atlanta, GA, United States; Cherokee Nation Operational Solutions, Tulsa, OK, United States
| | - Shena Popat
- NORC at the University of Chicago, 4350 East-West Hwy 8th Floor, Bethesda, MD 20814, United States
| | - Kincaid Lowe Beasley
- Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Atlanta, GA, United States
| | - Tiara N Jackson
- Decision Information Resources, Inc., Houston, TX, United States
| | - Amena Abbas
- Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Atlanta, GA, United States; ASRT, Inc., Atlanta, GA, United States
| | - W Alexander Keaton
- Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Atlanta, GA, United States; Oak Ridge Institute for Science and Education, Oak Ridge, TN, United States
| | | | - Jillian Harvey
- Medical University of South Carolina, Charleston, SC, United States
| | - Ryan Kruis
- Medical University of South Carolina, Charleston, SC, United States
| | - Shay McLeod
- Medical University of South Carolina, Charleston, SC, United States
| | - Roy Ahn
- NORC at the University of Chicago, Chicago, IL, United States
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Jackson TN, Sreedhara M, Bostic M, Spafford M, Popat S, Lowe Beasley K, Jordan J, Ahn R. Telehealth Use to Address Cardiovascular Disease and Hypertension in the United States: A Systematic Review and Meta-Analysis, 2011-2021. TELEMEDICINE REPORTS 2023; 4:67-86. [PMID: 37283852 PMCID: PMC10240316 DOI: 10.1089/tmr.2023.0011] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 04/13/2023] [Indexed: 06/08/2023]
Abstract
Background The use of telehealth for the management and treatment of hypertension and cardiovascular disease (CVD) has increased across the United States (U.S.), especially during the COVID-19 pandemic. Telehealth has the potential to reduce barriers to accessing health care and improve clinical outcomes. However, implementation, outcomes, and health equity implications related to these strategies are not well understood. The purpose of this review was to identify how telehealth is being used by U.S. health care professionals and health systems to manage hypertension and CVD and to describe the impact these telehealth strategies have on hypertension and CVD outcomes, with a special focus on social determinants of health and health disparities. Methods This study comprised a narrative review of the literature and meta-analyses. The meta-analyses included articles with intervention and control groups to examine the impact of telehealth interventions on changes to select patient outcomes, including systolic and diastolic blood pressure. A total of 38 U.S.-based interventions were included in the narrative review, with 14 yielding data eligible for the meta-analyses. Results The telehealth interventions reviewed were used to treat patients with hypertension, heart failure, and stroke, with most interventions employing a team-based care approach. These interventions utilized the expertise of physicians, nurses, pharmacists, and other health care professionals to collaborate on patient decisions and provide direct care. Among the 38 interventions reviewed, 26 interventions utilized remote patient monitoring (RPM) devices mostly for blood pressure monitoring. Half the interventions used a combination of strategies (e.g., videoconferencing and RPM). Patients using telehealth saw significant improvements in clinical outcomes such as blood pressure control, which were comparable to patients receiving in-person care. In contrast, the outcomes related to hospitalizations were mixed. There were also significant decreases in all-cause mortality when compared to usual care. No study explicitly focused on addressing social determinants of health or health disparities through telehealth for hypertension or CVD. Conclusions Telehealth appears to be comparable to traditional in-person care for managing blood pressure and CVD and may be seen as a complement to existing care options for some patients. Telehealth can also support team-based care delivery and may benefit patients and health care professionals by increasing opportunities for communication, engagement, and monitoring outside a clinical setting.
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Affiliation(s)
| | - Meera Sreedhara
- Centers for Disease Control and Prevention, Division for Heart Disease and Stroke Prevention, Atlanta, Georgia, USA
- Cherokee Nation Operational Solutions, Tulsa, Oklahoma, USA
| | - Myles Bostic
- Centers for Disease Control and Prevention, Division for Heart Disease and Stroke Prevention, Atlanta, Georgia, USA
- Veritas Management Group, Inc., Atlanta, Georgia, USA
| | | | - Shena Popat
- NORC at the University of Chicago, Chicago, Illinois, USA
| | - Kincaid Lowe Beasley
- Centers for Disease Control and Prevention, Division for Heart Disease and Stroke Prevention, Atlanta, Georgia, USA
| | - Julia Jordan
- Centers for Disease Control and Prevention, Division for Heart Disease and Stroke Prevention, Atlanta, Georgia, USA
| | - Roy Ahn
- NORC at the University of Chicago, Chicago, Illinois, USA
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Current Use and Future Considerations for Concussion Telemedicine Healthcare in Canada. Can J Neurol Sci 2023; 50:257-261. [PMID: 35272736 DOI: 10.1017/cjn.2022.18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To examine the use of telemedicine among Canadian concussion providers and clinics before and after the COVID-19 pandemic onset and identify barriers and facilitators for future use. METHODS Ninety-nine concussion clinics and healthcare providers across Canada that offered one or more clinical concussion-related service were identified using standardized online searches and approached to complete a cross-sectional online survey. RESULTS Thirty clinics or providers completed the survey and two completed subsections of the survey (response rate of 32.3%). Only 28.1% of respondents indicated that they used telemedicine to provide care prior to the COVID-19 pandemic. Providers most commonly using telemedicine prior to the pandemic were occupational therapists and physicians, while the most commonly used services were in-person videoconferencing and eConsultation. Most respondents (87%) indicated their clinic's use of telemedicine changed following the onset of the COVID-19 pandemic including new use of in-person video-conferencing, telephone calls, and eConsultation. Ninety-three percent indicated that they would consider using telemedicine to provide care to their concussion patients once the pandemic was over. Barriers needed to be overcome to facilitate use or greater use of telemedicine-based services were the inability to conduct a complete physical examination, lack of appropriate reimbursement, lack of start-up, and maintenance funding and medico-legal risk. CONCLUSION Telemedicine was used by a minority of Canadian concussion clinics and providers prior to the COVID-19 pandemic but was rapidly adopted by many facilities. This study provides important insight into the factors that must be considered to optimize use of telemedicine in concussion care in the future.
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Zhang S, Xue W, Boorman EP, Ruvalcaba E, David M, Lanzkron SM, Eakin MN. Accessible Care with High Patient Satisfaction: Telemedicine Use in Sickle Cell Disease. Telemed J E Health 2022. [DOI: 10.1089/tmj.2022.0387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Affiliation(s)
- Shu Zhang
- Division of Hematology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Wingel Xue
- Division of Hematology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Eric Pickering Boorman
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Elizabeth Ruvalcaba
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Mandy David
- Division of Hematology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Sophie Miriam Lanzkron
- Division of Hematology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Michelle Nuttall Eakin
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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English S, Barrett KM, Freeman WD, Demaerschalk BM, Dumitrascu O. Improving the Telemedicine Evaluation of Patients With Acute Vision Loss: A Call to Eyes. Neurology 2022; 99:381-386. [PMID: 35764399 DOI: 10.1212/wnl.0000000000200969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 05/26/2022] [Indexed: 11/15/2022] Open
Abstract
Acute vision loss related to cerebral or retinal ischemia is a time-sensitive emergency with potential treatment options including intravenous or intraarterial thrombolysis and mechanical thrombectomy. However, patients either present in delayed fashion or present to an emergency department that lacks the subspecialty expertise to recognize and treat these conditions in a timely fashion. Moreover, healthcare systems in the United States are becoming increasingly reliant on telestroke and teleneurology services for acute neurologic care, making accurate diagnosis of acute vision loss even more challenging due to critical limitations to the remote video evaluation, including the inability to perform routine ophthalmoscopy. The COVID-19 pandemic has led to a greater reliance on telemedicine services and helped to accelerate the development of novel tools and care pathways to improve remote ophthalmologic evaluation, but these tools have yet to be adapted for use in the remote evaluation of acute vision loss. Permanent vision loss can be disabling for patients and efforts must be made to increase and improve early diagnosis and management. Herein, the authors outline the importance of improving acute ophthalmologic diagnosis, outline key limitations and barriers to the current video-based teleneurology assessments, highlight opportunities to leverage new tools to enhance the remote assessment of vision loss, and propose new avenues to improve access to emergent ophthalmology subspeciality.
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Affiliation(s)
- Stephen English
- Department of Neurology, Mayo Clinic College of Medicine and Science, Jacksonville, Florida
| | - Kevin M Barrett
- Department of Neurology, Mayo Clinic College of Medicine and Science, Jacksonville, Florida
| | - William D Freeman
- Departments of Neurology and Critical Care Medicine, Mayo Clinic College of Medicine and Science, Jacksonville, Florida
| | - Bart M Demaerschalk
- Department of Neurology and Center for Digital Health, Mayo Clinic College of Medicine and Science, Phoenix, Arizona
| | - Oana Dumitrascu
- Departments of Neurology and Ophthalmology, Mayo Clinic College of Medicine and Science, Phoenix, Arizona
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Cruz MJ, Nieblas-Bedolla E, Young CC, Feroze AH, Williams JR, Ellenbogen RG, Levitt MR. United States Medicolegal Progress and Innovation in Telemedicine in the Age of COVID-19: A Primer for Neurosurgeons. Neurosurgery 2021; 89:364-371. [PMID: 34133724 PMCID: PMC8344865 DOI: 10.1093/neuros/nyab185] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 04/03/2021] [Indexed: 01/14/2023] Open
Abstract
Telemedicine has received increased attention in recent years as a potential solution to expand clinical capability and patient access to care in many fields, including neurosurgery. Although patient and physician attitudes are rapidly shifting toward greater telemedicine use in light of the COVID-19 pandemic, there remains uncertainty about telemedicine's regulatory future. Despite growing evidence of telemedicine's utility, there remain a number of significant medicolegal barriers to its mass adoption and wider implementation. Herein, we examine recent progress in state and federal regulations in the United States governing telemedicine's implementation in quality of care, finance and billing, privacy and confidentiality, risk and liability, and geography and interstate licensure, with special attention to how these concern teleneurosurgical practice. We also review contemporary topics germane to the future of teleneurosurgery, including the continued expansion of reciprocity in interstate licensure, expanded coverage for homecare services for chronic conditions, expansion of Center for Medicare and Medicaid Services reimbursements, and protections of store-and-forward technologies. Additionally, we discuss recent successes in teleneurosurgery, stroke care, and rehabilitation as models for teleneurosurgical best practices. As telemedicine technology continues to mature and its expanse grows, neurosurgeons' familiarity with its benefits, limitations, and controversies will best allow for its successful adoption in our field to maximize patient care and outcomes.
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Affiliation(s)
- Michael J Cruz
- School of Medicine, University of Washington, Seattle, Washington, USA
| | | | - Christopher C Young
- Department of Neurological Surgery, University of Washington, Seattle, Washington, USA
| | - Abdullah H Feroze
- Department of Neurological Surgery, University of Washington, Seattle, Washington, USA
| | - John R Williams
- Department of Neurological Surgery, University of Washington, Seattle, Washington, USA
| | - Richard G Ellenbogen
- Department of Neurological Surgery, University of Washington, Seattle, Washington, USA
- Stroke and Applied Neurosciences Center, University of Washington, Seattle, Washington, USA
| | - Michael R Levitt
- Department of Neurological Surgery, University of Washington, Seattle, Washington, USA
- Stroke and Applied Neurosciences Center, University of Washington, Seattle, Washington, USA
- Department of Radiology, University of Washington, Seattle, Washington, USA
- Department of Mechanical Engineering, University of Washington, Seattle, Washington, USA
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Guidetti S, Gustavsson M, Tham K, Andersson M, Fors U, Ytterberg C. F@ce: a team-based, person-centred intervention for rehabilitation after stroke supported by information and communication technology - a feasibility study. BMC Neurol 2020; 20:387. [PMID: 33096984 PMCID: PMC7583214 DOI: 10.1186/s12883-020-01968-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Accepted: 10/16/2020] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Globally, there is a growing use of Information and Communication Technology (ICT), including mobile phones, tablets and computers, which are being integrated into people's daily activities. An ICT-based intervention called F@ce was developed in order to provide a structure for the process in stroke rehabilitation and facilitate change by integrating a global problem-solving strategy using SMS alerts. The aim of the study was to evaluate the feasibility of i) F@ce within in-patient and primary care rehabilitation after stroke, ii) the study design and outcome measures used, and iii) the fidelity, adherence and acceptability of the intervention. METHODS Three teams comprising occupational therapists and physiotherapists who work in neurological rehabilitation participated in a preparatory workshop on F@ce and then enrolled 10 persons with stroke to participate in the intervention. Goals were set using the Canadian Occupational Performance Measure (COPM) and the participants with stroke rated their performance and satisfaction with the activities associated with the three goals every day for 8 weeks. Data were collected at inclusion, at four and 8 weeks, using the COPM, Stroke Impact Scale, Frenchay Activities Index, Life Satisfaction Checklist, Self-Efficacy Scale, Hospital Anxiety and Depression Scale, Fatigue Severity Scale, follow-up survey, daily ratings on the web platform and logbooks. RESULTS All of the participants showed increased scores in the primary outcome (COPM) and a clinically meaningful improvement of ≥2 points was found in four participants regarding performance and in six participants regarding satisfaction. Overall fidelity to the components of F@ce was good. The response rates to the F@ce web platform were 44-100% (mean 78%). All of the participants stated that F@ce had supported their rehabilitation. CONCLUSION The results indicate that the most beneficial part of F@ce was the person-centred, goal-setting process and SMS alerts. All participants were satisfied with F@ce and highlighted the benefits of receiving daily alerts about their goals. This encouraged them to be more active. The only downside mentioned was that they felt under an obligation to practice, although this was described as "a positive obligation".
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Affiliation(s)
- Susanne Guidetti
- Division of Occupational Therapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
| | - Martha Gustavsson
- Division of Occupational Therapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
| | - Kerstin Tham
- Faculty of Health and Society, Malmö University, Malmö, Sweden
| | - Magnus Andersson
- Department of Clinical Neuroscience, Karolinska Institutet, Solna, Sweden
| | - Uno Fors
- Department of Computer and Systems Sciences (DSV), Stockholm University, Stockholm, Sweden
| | - Charlotte Ytterberg
- Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
- Function Area Occupational Therapy & Physiotherapy, Karolinska University Hospital, Stockholm, Sweden
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Young NP, Burkholder DB, Philpot LM, McKie PM, Ebbert JO. Synchronous neurology–primary care collaboration in a medical home. Neurol Clin Pract 2020; 10:388-395. [DOI: 10.1212/cpj.0000000000000754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2019] [Accepted: 08/30/2019] [Indexed: 11/15/2022]
Abstract
BackgroundSynchronous collaboration as defined by a simultaneous encounter between primary care providers (PCPs), patients, and neurologists may improve access to neurologic expertise, care value, and satisfaction of PCPs and patients. We examined a series of synchronous collaborations and report outcomes, PCP satisfaction, downstream utilization, and illustrative case examples.MethodsWithin an outpatient collaborative primary care–neurology care model, we implemented synchronous video consultations from a central hub to satellite clinics while increasing availability of synchronous telephone and face-to-face collaboration. PCP experience was assessed by a postcollaboration survey. Individual cases were summarized. Clinical and utilization outcomes were assessed by a neurologist immediately after and by follow-up chart review.ResultsA total of 58 total synchronous collaborations were performed: 30 by telephone (52%), 18 face to face (31%), and 10 by video (17%) over 27 clinic half-days. The most frequent outcomes as assessed by the neurologist were reassurance of the PCP (23/58; 40%) and patient (22/59; 38%), and the neurologist changed the treatment plan (23/58; 40%). A subsequent face-to-face consultation was completed in 15% (6/58) of patients initially assessed by telephone or video. Test utilization was avoided in 40% (23/58). Unintended utilization occurred 9% (5/58). Most PCPs were very satisfied with the ease of access, quality of care, and reported high likelihood of subsequent use. PCPs perceived similar or less time spent during synchronous vs asynchronous collaboration and neurologist usually altered the testing (87.8%) and treatment plan (95.2%).ConclusionsSynchronous collaboration between neurologists and PCPs may improve timely access to neurologic expertise, downstream utilization, and PCP satisfaction.
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Kiwanuka F, Nanyonga RC, Sak-Dankosky N, Muwanguzi PA, Kvist T. Nursing leadership styles and their impact on intensive care unit quality measures: An integrative review. J Nurs Manag 2020; 29:133-142. [PMID: 32881169 DOI: 10.1111/jonm.13151] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 08/24/2020] [Accepted: 08/25/2020] [Indexed: 12/01/2022]
Abstract
AIM To examine the impact of nursing leadership styles on intensive care unit quality measures. BACKGROUND Evidence on the impact of leadership styles has direct implications for building and strengthening leadership behaviours that foster quality nursing care in intensive care units. EVALUATION An integrative review approach was adopted. Databases including the Cumulative Index of Nursing and Allied Health Literature, PubMed, Scopus, ProQuest, Google Scholar and the Cochrane Library were searched. KEY ISSUES(S) Out of 253 identified studies, seven were included in the review. Leadership styles in intensive care units include transformational, considerate, exemplary, trusted and absentee leadership. Active nurse leaders who share a common vision, and advocate for their staff are perceived as more effective than those who exhibit absentee characteristics. Structural measures influenced by leadership styles include productivity and morale of nursing staff. Outcome measures such as staff outcomes (intent to stay, job satisfaction), medication errors and periventricular/intraventricular haemorrhage in neonatal intensive care units have a positive relational effect with nursing leadership style. CONCLUSIONS The findings highlight the link between nursing leadership styles on structural and outcome measures in intensive care units. The current literature lacks studies highlighting the impact of nursing leadership styles on process measures in intensive care units. IMPLICATIONS FOR NURSING MANAGEMENT Transformational, considerate, exemplary leadership practices, and trusted leadership styles when used by nurse leaders guarantee higher quality of nursing care in intensive care units. Therefore, modern leadership styles need to be supported by health care organisations and education.
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Affiliation(s)
- Frank Kiwanuka
- Department of Nursing Science, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
| | | | | | - Patience A Muwanguzi
- Department of Nursing, School of Health Sciences, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Tarja Kvist
- Department of Nursing Science, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
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Heslin SM, Nappi M, Kelly G, Crawford J, Morley EJ, Lingam V, Henry M, Viccellio P. Rapid creation of an emergency department telehealth program during the COVID-19 pandemic. J Telemed Telecare 2020; 28:207-212. [PMID: 32873137 DOI: 10.1177/1357633x20952632] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Coronavirus disease 2019 (COVID-19) has spread to nearly every continent, with over 2.6 m cases confirmed worldwide. Emergency departments care for a significant number of patients who are under investigation for COVID-19 or are COVID-19-positive. When patients present in the emergency department, there is an increased risk of spreading the virus to other patients and staff. We designed an emergency department telehealth program for patients physically in the emergency department, to reduce exposure and conserve personal protective equipment. While traditional telehealth is designed to be patient-specific and device-independent, our emergency department telehealth program was device-specific and patient-independent. In this article, we describe how we rapidly implemented our emergency department telehealth program, used for 880 min of contact time and 523 patient encounters in a 30-day period, which decreased exposure to COVID-19 and conserved personal protective equipment. We share our challenges, successes and recommendations for designing an emergency department telehealth program, building the technological aspects, and deploying telehealth devices in the emergency department environment. Our recommendations can be adopted by other emergency departments to create and run their own emergency department telehealth initiatives.
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Affiliation(s)
| | | | | | | | | | | | - Mark Henry
- Emergency Medicine, Stony Brook Hospital, USA
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Yang L, Brown-Johnson CG, Miller-Kuhlmann R, Kling SMR, Saliba-Gustafsson EA, Shaw JG, Gold CA, Winget M. Accelerated launch of video visits in ambulatory neurology during COVID-19: Key lessons from the Stanford experience. Neurology 2020; 95:305-311. [PMID: 32611634 DOI: 10.1212/wnl.0000000000010015] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 05/28/2020] [Indexed: 12/12/2022] Open
Abstract
The SARS-CoV-2 (COVID-19) pandemic has rapidly moved telemedicine from discretionary to necessary. Here, we describe how the Stanford Neurology Department (1) rapidly adapted to the COVID-19 pandemic, resulting in over 1,000 video visits within 4 weeks, and (2) accelerated an existing quality improvement plan of a tiered roll out of video visits for ambulatory neurology to a full-scale roll out. Key issues we encountered and addressed were related to equipment/software, provider engagement, workflow/triage, and training. On reflection, the key drivers of our success were provider engagement and dedicated support from a physician champion, who plays a critical role understanding stakeholder needs. Before COVID-19, physician interest in telemedicine was mixed. However, in response to county and state stay-at-home orders related to COVID-19, physician engagement changed completely; all providers wanted to convert a majority of visits to video visits as quickly as possible. Rapid deployment of neurology video visits across all its subspecialties is feasible. Our experience and lessons learned can facilitate broader utilization, acceptance, and normalization of video visits for neurology patients in the present as well as the much anticipated postpandemic era.
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Affiliation(s)
- Laurice Yang
- From the Department of Neurology & Neurological Sciences (L.Y., R.M.-K., C.A.G.), Stanford University School of Medicine; and Evaluation Sciences Unit (C.G.B.-J., S.M.R.K., E.A.S.-G., J.G.S., M.W.), Stanford University School of MedicineCA.
| | - Cati G Brown-Johnson
- From the Department of Neurology & Neurological Sciences (L.Y., R.M.-K., C.A.G.), Stanford University School of Medicine; and Evaluation Sciences Unit (C.G.B.-J., S.M.R.K., E.A.S.-G., J.G.S., M.W.), Stanford University School of MedicineCA
| | - Rebecca Miller-Kuhlmann
- From the Department of Neurology & Neurological Sciences (L.Y., R.M.-K., C.A.G.), Stanford University School of Medicine; and Evaluation Sciences Unit (C.G.B.-J., S.M.R.K., E.A.S.-G., J.G.S., M.W.), Stanford University School of MedicineCA
| | - Samantha M R Kling
- From the Department of Neurology & Neurological Sciences (L.Y., R.M.-K., C.A.G.), Stanford University School of Medicine; and Evaluation Sciences Unit (C.G.B.-J., S.M.R.K., E.A.S.-G., J.G.S., M.W.), Stanford University School of MedicineCA
| | - Erika A Saliba-Gustafsson
- From the Department of Neurology & Neurological Sciences (L.Y., R.M.-K., C.A.G.), Stanford University School of Medicine; and Evaluation Sciences Unit (C.G.B.-J., S.M.R.K., E.A.S.-G., J.G.S., M.W.), Stanford University School of MedicineCA
| | - Jonathan G Shaw
- From the Department of Neurology & Neurological Sciences (L.Y., R.M.-K., C.A.G.), Stanford University School of Medicine; and Evaluation Sciences Unit (C.G.B.-J., S.M.R.K., E.A.S.-G., J.G.S., M.W.), Stanford University School of MedicineCA
| | - Carl A Gold
- From the Department of Neurology & Neurological Sciences (L.Y., R.M.-K., C.A.G.), Stanford University School of Medicine; and Evaluation Sciences Unit (C.G.B.-J., S.M.R.K., E.A.S.-G., J.G.S., M.W.), Stanford University School of MedicineCA
| | - Marcy Winget
- From the Department of Neurology & Neurological Sciences (L.Y., R.M.-K., C.A.G.), Stanford University School of Medicine; and Evaluation Sciences Unit (C.G.B.-J., S.M.R.K., E.A.S.-G., J.G.S., M.W.), Stanford University School of MedicineCA
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14
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Sacchetti DC, Gupta A, Chung CD, Chatterjee A, Zhang Y, Navi BB, Segal AZ, Kamel H. Vascular Neurologists' Involvement in the Care of Medicare Patients With Ischemic Stroke. Neurohospitalist 2020; 10:181-187. [PMID: 32549941 PMCID: PMC7271626 DOI: 10.1177/1941874420902951] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2024] Open
Abstract
BACKGROUND AND PURPOSE We sought to determine the proportion of patients with ischemic stroke evaluated by vascular neurologists in the United States. METHODS Using 2009 to 2015 claims from a 5% nationally representative sample of Medicare beneficiaries, we identified patients ≥65 years of age who were hospitalized for ischemic stroke. We ascertained the proportion of patients evaluated during the hospitalization or within 90 days of discharge by nonvascular and vascular neurologists. We assessed the relationship between county-level socioeconomic status and the likelihood of neurologist evaluation and between neurologist evaluation and diagnostic testing. RESULTS Among 66 989 patients with ischemic stroke, 37 820 (56.5%) were evaluated by a nonvascular neurologist and 11 700 (17.5%) by a board-certified vascular neurologist. Across increasing quartiles of county socioeconomic advantage, the proportion of patients evaluated by a vascular neurologist was 12.2%, 16.5%, 19.8%, and 23.0%. Relative to evaluation by a nonvascular neurologist, evaluation by a vascular neurologist was associated with a higher likelihood of postdischarge heart rhythm monitoring (odds ratio [OR], 1.8; 95% confidence interval [CI], 1.6-1.9), echocardiography (OR, 1.4; 95% CI, 1.3-1.4), cervical vessel imaging (OR, 1.3; 95% CI, 1.2-1.3), and intracranial vessel imaging (OR, 2.1; 95% CI, 2.0-2.2). CONCLUSIONS In a nationally representative cohort of Medicare beneficiaries, we found that about three quarters of patients with ischemic stroke were evaluated by a neurologist, and about one-sixth were evaluated by a vascular neurologist. Patients who were evaluated by a vascular neurologist were significantly more likely to undergo diagnostic testing.
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Affiliation(s)
- Daniel C. Sacchetti
- Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute, New York, NY, USA
- Department of Neurology, Weill Cornell Medical College, New York, NY, USA
| | - Ajay Gupta
- Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute, New York, NY, USA
- Department of Radiology, Weill Cornell Medical College, New York, NY, USA
| | - Caroline D. Chung
- Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute, New York, NY, USA
| | - Abhinaba Chatterjee
- Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute, New York, NY, USA
| | - Yi Zhang
- Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute, New York, NY, USA
- Department of Neurology, Weill Cornell Medical College, New York, NY, USA
| | - Babak B. Navi
- Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute, New York, NY, USA
- Department of Neurology, Weill Cornell Medical College, New York, NY, USA
| | - Alan Z. Segal
- Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute, New York, NY, USA
- Department of Neurology, Weill Cornell Medical College, New York, NY, USA
| | - Hooman Kamel
- Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute, New York, NY, USA
- Department of Neurology, Weill Cornell Medical College, New York, NY, USA
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15
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Ellis MJ, Russell K. The Potential of Telemedicine to Improve Pediatric Concussion Care in Rural and Remote Communities in Canada. Front Neurol 2019; 10:840. [PMID: 31428043 PMCID: PMC6688625 DOI: 10.3389/fneur.2019.00840] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Accepted: 07/19/2019] [Indexed: 12/15/2022] Open
Abstract
Concussion is a form of mild traumatic brain injury that affects thousands of Canadian children and adolescents annually. Despite national efforts to harmonize the recognition and management of pediatric concussion in Canada, timely access to primary and specialized care following this injury remains a challenge for many patients especially those who live in rural and remote communities. To address similar challenges facing patients with stroke and other neurological disorders, physicians have begun to leverage advances in telemedicine to improve the delivery of specialized neurological care to those living in medically underserved regions. Preliminary studies suggest that telemedicine may be a safe and cost-effective approach to assist in the medical care of select patients with acute concussion and persistent post-concussion symptoms. Here we provide an overview of telemedicine, teleneurology, the principles of concussion assessment and management, as well as the current state of concussion care in Canada. Utilizing preliminary evidence from studies of telemedicine in concussion and experience from comprehensive systems of care for stroke, we outline steps that must be taken to evaluate the potential of telemedicine-based concussion networks to improve the care of pediatric concussion patients living in underserved rural and remote communities in Canada.
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Affiliation(s)
- Michael J Ellis
- Department of Surgery, University of Manitoba, Winnipeg, MB, Canada.,Pediatrics and Child Health, University of Manitoba, Winnipeg, MB, Canada.,Section of Neurosurgery, University of Manitoba, Winnipeg, MB, Canada.,Children's Hospital Research Institute of Manitoba, Winnipeg, MB, Canada.,Pan Am Concussion Program, Winnipeg, MB, Canada
| | - Kelly Russell
- Pediatrics and Child Health, University of Manitoba, Winnipeg, MB, Canada.,Children's Hospital Research Institute of Manitoba, Winnipeg, MB, Canada
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16
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Chirra M, Marsili L, Wattley L, Sokol LL, Keeling E, Maule S, Sobrero G, Artusi CA, Romagnolo A, Zibetti M, Lopiano L, Espay AJ, Obeidat AZ, Merola A. Telemedicine in Neurological Disorders: Opportunities and Challenges. Telemed J E Health 2019; 25:541-550. [PMID: 30136898 PMCID: PMC6664824 DOI: 10.1089/tmj.2018.0101] [Citation(s) in RCA: 80] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Revised: 06/28/2018] [Accepted: 06/29/2018] [Indexed: 12/23/2022] Open
Abstract
Introduction: Telemedicine represents an emerging model for the assessment and management of various neurological disorders. Methods: We sought to discuss opportunities and challenges for the integration of telemedicine in the management of common and uncommon neurological disorders by reviewing and appraising studies that evaluate telemedicine as a means to facilitate the access to care, deliver highly specialized visits, diagnostic consultations, rehabilitation, and remote monitoring of neurological disorders. Results: Opportunities for telemedicine in neurological disorders include the replacement of or complement to in-office evaluations, decreased time between follow-up visits, reduction in disparities in access to healthcare, and promotion of education and training through interactions between primary care physicians and tertiary referral centers. Critical challenges include the integration of the systems for data monitoring with an easy-to-use, secure, and cost-effective platform that is both widely adopted by patients and healthcare systems and embraced by international scientific societies. Conclusions: Multiple applications may spawn from a model based on digitalized healthcare services. Integrated efforts from multiple stakeholders will be required to develop an interoperable software platform capable of providing not only a holistic approach to care but also one that reduces disparities in the access to care.
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Affiliation(s)
- Martina Chirra
- Division of Hematology-Oncology, Department of Internal Medicine, University of Cincinnati, Cincinnati, Ohio
- Department of Oncology, Medical Oncology Unit, University of Siena, Siena, Italy
| | - Luca Marsili
- Department of Neurology and Rehabilitation Medicine, Gardner Family Center for Parkinson's Disease and Movement Disorders, University of Cincinnati, Cincinnati, Ohio
| | - Linsdey Wattley
- College of Medicine, University of Cincinnati, Cincinnati, Ohio
| | - Leonard L. Sokol
- Department of Neurology and Rehabilitation Medicine, Gardner Family Center for Parkinson's Disease and Movement Disorders, University of Cincinnati, Cincinnati, Ohio
- College of Medicine, University of Cincinnati, Cincinnati, Ohio
| | - Elizabeth Keeling
- Department of Neurology and Rehabilitation Medicine, Gardner Family Center for Parkinson's Disease and Movement Disorders, University of Cincinnati, Cincinnati, Ohio
| | - Simona Maule
- Autonomic Unit, Department of Medical Sciences, Città della Salute e della Scienza Hospital, Torino, Italy
| | - Gabriele Sobrero
- Autonomic Unit, Department of Medical Sciences, Città della Salute e della Scienza Hospital, Torino, Italy
| | - Carlo Alberto Artusi
- Department of Neuroscience Rita Levi Montalcini, University of Turin, Torin, Italy
| | - Alberto Romagnolo
- Department of Neuroscience Rita Levi Montalcini, University of Turin, Torin, Italy
| | - Maurizio Zibetti
- Department of Neuroscience Rita Levi Montalcini, University of Turin, Torin, Italy
| | - Leonardo Lopiano
- Department of Neuroscience Rita Levi Montalcini, University of Turin, Torin, Italy
| | - Alberto J. Espay
- Department of Neurology and Rehabilitation Medicine, Gardner Family Center for Parkinson's Disease and Movement Disorders, University of Cincinnati, Cincinnati, Ohio
| | - Ahmed Z. Obeidat
- Department of Neurology and Rehabilitation Medicine, The Waddell Center for Multiple Sclerosis, University of Cincinnati, Cincinnati, Ohio
| | - Aristide Merola
- Department of Neurology and Rehabilitation Medicine, Gardner Family Center for Parkinson's Disease and Movement Disorders, University of Cincinnati, Cincinnati, Ohio
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17
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Acceptability and Attitude towards a Mobile-Based Home Exercise Program among Stroke Survivors and Caregivers: A Cross-Sectional Study. Int J Telemed Appl 2019; 2019:5903106. [PMID: 31186627 PMCID: PMC6521373 DOI: 10.1155/2019/5903106] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2018] [Revised: 03/11/2019] [Accepted: 04/01/2019] [Indexed: 12/03/2022] Open
Abstract
Background Stroke is a leading cause of disability and requires continued care after hospital discharge. Mobile-based interventions are suitable to reduce the cost of stroke rehabilitation and facilitate self-management among stroke survivors. However, before attempting to use mobile-based home exercise program, it is crucial to recognize the readiness of stroke survivors and their caregivers to opt for such interventions. Objective To assess the acceptability and attitude towards a mobile-based home exercise program among stroke survivors and their primary caregivers. Methods A cross-sectional study was conducted among 102 participants to understand their attitude and acceptability towards mobile-based home exercise program. A validated 10-item questionnaire was adapted for the study. The questions which assessed the attitude were rated on a three-point Likert scale, with three denoting agree and one denoting disagree. The acceptability was assessed by their willingness to opt for a mobile-based home program services. A Chi-square analysis and cross-tabulation were performed to test differences between caregivers and patients. A logistic regression was performed to determine the effects of age, gender, and mobile phone on acceptability. Results Ninety-two percent of caregivers and 90% of patients showed willingness to opt for mobile-based intervention. Majority of the participants showed a positive attitude towards this mode of treatment. There was no difference in the attitude noted among caregivers and patients (p>0.05) towards mobile-based intervention. Conclusion The stroke survivors and caregivers welcomed the concept of mobile-based home exercise program even in a low-resource settings, but further studies to understand treatment and cost-effectiveness of this technology among the stroke survivors would lead to better implementation.
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18
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Brecthel L, Gainey J, Penwell A, Nathaniel TI. Predictors of thrombolysis in the telestroke and non telestroke settings for hypertensive acute ischemic stroke patients. BMC Neurol 2018; 18:215. [PMID: 30577762 PMCID: PMC6302528 DOI: 10.1186/s12883-018-1204-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Accepted: 11/26/2018] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND In acute ischemic stroke patients, telestroke technology provides sustainable approaches to improve the use of thrombolysis therapy. How this is achieved as it relates to inclusion or exclusion of clinical risk factors for thrombolysis is not fully understood. We investigated this in a population of hypertensive stroke patients. METHODS Structured data from a regional stroke registry that contained telestroke and non telestroke patients with a primary diagnosis of acute ischemic stroke with history of hypertension were collected between January 2014 and June 2016. Clinical risk factors associated with inclusion or exclusion for recombinant tissue plasminogen activator (rtPA) in the telestroke and non telestroke were identified using multiple regression analysis. Associations between variables and rtPA in the regression models were determined using variance inflation factors while the fitness of each model was determined using the ROC curve to predict the power of each logistic regression model. RESULTS The non telestroke admitted more patients (62% vs 38%), when compared with the telestroke. Although the telestroke admitted fewer patients, it excluded 11% and administered thrombolysis therapy to 89% of stroke patients with hypertension. In the non telestroke group, adjusted odd ratios showed significant associations of NIH stroke scale score (OR = 1.059, 95% CI, 1.025-1.093, P < 0.001) and coronary artery disease (OR = 2.003, 95% CI, 1.16-3.457, P = 0.013) with inclusion, while increasing age (OR = 0.979, 95% CI, 0.961-0.996, P = 0.017), higher INR (OR = 0.146, 95% CI, 0.032-0.665, P = 0.013), history of previous stroke (OR = 0.39, 95% CI, 0.223-0.68, P = 0.001), and renal insufficiency (OR = 0.153, 95% CI, 0.046-0.508, P = 0.002) were associated with rtPA exclusion. In the telestroke, only direct admission to the telestroke was associated with rtPA administration, (OR = 4.083, 95% CI, 1.322-12.611, P = 0.014). CONCLUSION The direct admission of hypertensive stroke patients to the telestroke network was the only factor associated with inclusion for thrombolysis therapy even after adjustment for baseline variables. The telestroke technology provides less restrictive criteria for clinical risk factors associated with the inclusion of hypertensive stroke patients for thrombolysis.
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Affiliation(s)
- Leanne Brecthel
- University of South Carolina, School of Medicine-Greenville, Greenville, SC, 29605, USA
| | - Jordan Gainey
- University of South Carolina, School of Medicine-Greenville, Greenville, SC, 29605, USA
| | - Alexandria Penwell
- University of South Carolina, School of Medicine-Greenville, Greenville, SC, 29605, USA
| | - Thomas I Nathaniel
- University of South Carolina, School of Medicine-Greenville, Greenville, SC, 29605, USA.
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19
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Van de Winckel A, Carey JR, Bisson TA, Hauschildt EC, Streib CD, Durfee WK. Home-based transcranial direct current stimulation plus tracking training therapy in people with stroke: an open-label feasibility study. J Neuroeng Rehabil 2018; 15:83. [PMID: 30227864 PMCID: PMC6145321 DOI: 10.1186/s12984-018-0427-2] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Accepted: 09/11/2018] [Indexed: 11/17/2022] Open
Abstract
Background Transcranial direct current stimulation (tDCS) is an effective neuromodulation adjunct to repetitive motor training in promoting motor recovery post-stroke. Finger tracking training is motor training whereby people with stroke use the impaired index finger to trace waveform-shaped lines on a monitor. Our aims were to assess the feasibility and safety of a telerehabilitation program consisting of tDCS and finger tracking training through questionnaires on ease of use, adverse symptoms, and quantitative assessments of motor function and cognition. We believe this telerehabilitation program will be safe and feasible, and may reduce patient and clinic costs. Methods Six participants with hemiplegia post-stroke [mean (SD) age was 61 (10) years; 3 women; mean (SD) time post-stroke was 5.5 (6.5) years] received five 20-min tDCS sessions and finger tracking training provided through telecommunication. Safety measurements included the Digit Span Forward Test for memory, a survey of symptoms, and the Box and Block test for motor function. We assessed feasibility by adherence to treatment and by a questionnaire on ease of equipment use. We reported descriptive statistics on all outcome measures. Results Participants completed all treatment sessions with no adverse events. Also, 83.33% of participants found the set-up easy, and all were comfortable with the devices. There was 100% adherence to the sessions and all recommended telerehabilitation. Conclusions tDCS with finger tracking training delivered through telerehabilitation was safe, feasible, and has the potential to be a cost-effective home-based therapy for post-stroke motor rehabilitation. Trial registration NCT02460809 (ClinicalTrials.gov).
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Affiliation(s)
- Ann Van de Winckel
- Division of Physical Therapy; Division of Rehabilitation Science, University of Minnesota, 420 Delaware Street SE (MMC388), Minneapolis, MN, 55455, USA.
| | - James R Carey
- Division of Physical Therapy; Division of Rehabilitation Science, University of Minnesota, 420 Delaware Street SE (MMC388), Minneapolis, MN, 55455, USA
| | - Teresa A Bisson
- Division of Physical Therapy, University of Minnesota, Minneapolis, MN, 55455, USA
| | - Elsa C Hauschildt
- Department of Mechanical Engineering, University of Minnesota, Minneapolis, MN, 55455, USA
| | | | - William K Durfee
- Department of Mechanical Engineering, University of Minnesota, Minneapolis, MN, 55455, USA
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20
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Riou-Comte N, Mione G, Humbertjean L, Brunner A, Vezain A, Lavandier K, Marchal S, Bracard S, Debouverie M, Richard S. Implementation and Evaluation of an Economic Model for Telestroke: Experience from Virtuall, France. Front Neurol 2017; 8:613. [PMID: 29209268 PMCID: PMC5701923 DOI: 10.3389/fneur.2017.00613] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Accepted: 11/03/2017] [Indexed: 01/07/2023] Open
Abstract
Background Telestroke is recognized as a safe and time-efficient way of treating stroke patients. However, admission centers (spokes) are subject to financial charges which can make them reluctant to join the system. We implemented and assessed an economic model supporting our telestroke system, Virtuall, France, which includes one expert center (hub) and six spokes. Methods The model is based on payment for the expertise provided by the hub, distribution of charges related to telemedicine according to the fees perceived by the spokes, and transfer of patients between the spokes and the hub. We performed a cost–benefit analysis for all patients included in Virtuall from January 2014 to December 2015 to assess the economic balance in each center. Results 321 patients were prospectively included in the study. Application of the economic model resulted in overall financial balance with funding of a dedicated medical service in the hub, and reduced costs directly related to telestroke by an average of 10% in the spokes. The conditions generating the highest costs for the spokes were: a patient returning from the hub for re-hospitalization (mean cost of $1,995/patient); management of patients treated by intravenous thrombolysis without transfer to the hub (mean cost of $2,075/patient). The most favorable financial condition for the spokes remained simple transfer of patients to the hub and no return (mean cost of $329/patient). Conclusion We describe an economic model which can be applied to any telestroke system to ensure the optimal balance between hub and spoke centers.
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Affiliation(s)
- Nolwenn Riou-Comte
- Department of Neurology, Stroke Unit, University Hospital of Nancy, Nancy, France
| | - Gioia Mione
- Department of Neurology, Stroke Unit, University Hospital of Nancy, Nancy, France
| | - Lisa Humbertjean
- Department of Neurology, Stroke Unit, University Hospital of Nancy, Nancy, France
| | | | | | | | | | - Serge Bracard
- Department of Neuroradiology, University Hospital of Nancy, Nancy, France
| | - Marc Debouverie
- Department of Neurology, Stroke Unit, University Hospital of Nancy, Nancy, France
| | - Sébastien Richard
- Department of Neurology, Stroke Unit, University Hospital of Nancy, Nancy, France.,Centre d'Investigation Clinique Plurithématique CIC-P 1433, INSERM U1116, University Hospital of Nancy, Vandoeuvre-lès-Nancy, France
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