Description of problem In 2016 the Centers for Disease Control and Prevention CDC in 2016 stroke was the fifth leading cause of death in the United States US Stroke is a leading cause of long term disability in adults Approximately 795 000 people in the U S suffer from a stroke each year Roger et al 2012 In 2017 the estimated cost of stroke care including health care services pharmacological therapy and days missed from work totaled over 34 billion CDC gov stroke When treatment is received within the first few hours of a stroke research has demonstrated that patients have a 30 reduction in disability and mortality According to the 2016 Rural Health Information Hub 53 9 of Mississippians reside in a rural area most without adequate access to a neurologist trained in acute stroke care In 2017 a national study comparing emergency medicine service EMS response times in rural versus urban areas found that rural areas experienced significantly slower EMS times Rural area response times were found to be more than double the time noted in urban areas at 26 minutes and 14 minutes respectively Additionally 22 of people in the rural U S are within a 30 minute drive to a facility staffed with a neurologist Albright et al 2010 When studying the time it takes EMS to respond to a rural location in conjunction with the time spent transporting the patient to a facility equipped to treat stroke on average one hour has already elapsed NEJM
Telemedicine allows a neurologist to perform a prompt patient examination from a remote location and evaluate eligibility of time sensitive acute stroke treatment Significance of problem According to the American Heart Association more than 7 million Americans carry a diagnosis of stroke Annual cost to the U S healthcare system for stroke exceeded 38 billion in 2009 Kulscar Gilchrist George 2014 According to the Mississippi Department of Health a 2014 study showed that Mississippi had the highest stroke related death rate in the nation It is critical that strategies are developed to improve stroke patients quality outcomes and reducing healthcare expenses Stroke has a high socioeconomic impact Welchsler et al 2013 Neurologists with training in acute stroke treatment are most commonly located at facilities in urban areas Telemedicine is a resource that allows rural underserved areas to have neurology expertise and optimize time sensitive treatments Research question hypothesis Telemedicine for stroke will have a positive impact on timely stroke treatment the volume of patients treated and reduce long term disability while remaining cost effective Avitzur 2010 Patients who present to a rural emergency department will be afforded a virtual exam by a neurologist including a review of diagnostic studies past and current medical history via a computerized monitor and an appropriate treatment plan communicated with the on site medical provider Literature Review Technology of Telemedicine Small rural medical centers typically are not staffed with neurologist to examine acute stroke patients This is attributed to several different factors The expense of recruiting and retaining a full time neurologist may not provide a timely return on investment for small centers Telemedicine allows an acute stroke patient to be evaluated by a mobile computerized cart that is located at the patient's bedside
A neurologist is able to operate a live camera on the other side of the connection to visually examine the patient in the same fashion as if the physician were present in person at the bedside The neurologist is able to evaluate the patient's treatment eligibility and communicate immediately with the local staff giving orders regarding treatment of intravenous fibrinolytics Expert in ER Telestroke 2015 This practice promotes efficiency and decreases the loss of millions of brain cells by restoring blood flow and oxygen Quality Results of Telemedicine When fibrinolytics are considered and administered per evidence based protocols stroke patients experience better long term outcomes including reduction in disability and a better rehabilitation experience Zanaty et al 2014 Telemedicine has been documented to raise fibrinolytic administration volumes by over 50 including some centers administering it for the first time Fang Cutler Rosen 2010 Benefits of Telemedicine Cost and Reimbursement Telemedicine isn t a completely new concept Before computerized telemedicine was available emergency physicians would sometimes telephone a neurologist for their medical opinion in an effort to minimize the volume of stroke patients transferred to advanced medical facilities Handschu et al 2014 This contributed to the smaller hospital experiencing higher loss of revenue as well as increased expenses for this patient population Demaerschalk 2011 Telemedicine does require financial investments upfront but if managed appropriate a positive return on investment may be achieved in a relative short time frame According to Miley 2009 the average cost to implement telemedicine specific to acute stroke care is 46 000 Grants or other assistive funding is often available for telemedicine in rural areas Hess Audebert 2013
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