Hull College of Business, Augusta State University, Augusta, Georgia 30904, USA.
Telemed J E Health. 2012 Apr;18(3):225-9. doi: 10.1089/tmj.2011.0141. Epub 2012 Feb 22.
To explore the relationship between state primary stroke center (PSC) designation policy implementation and access to optimal stroke care for residents of rural areas.
Primary data were collected during the period September 2008-August 2009. Following content analysis of state PSC policies, four case study states were selected for fieldwork, in part for state rural healthcare access challenges. Variables included the barriers and facilitators to PSC designation policy implementation. More than 100 semistructured stakeholder interviews were conducted by teams of researchers. Large-group meetings were also observed. Interview summaries were reviewed by stakeholders for accuracy and completeness.
The consistent finding in all study states was that PSC designation and state policy implementation in rural areas are unlikely for a variety of reasons, including lack of financial resources for telemedicine, difficulty maintaining neurology coverage, and emergency departments unable to administer thrombolytics. Findings indicate recognition by states about the need for stroke-care public policy specific to telemedicine in rural areas.
Although state PSC designation policies raise awareness of rural issues, designation policy alone cannot overcome the obstacle of rural access to optimal stroke care. States must be technology-ready, and providers need to embrace e-health and telemedicine to ensure coordination of care for stroke victims in rural areas. More important is that state policy makers should provide rules and regulations to encourage PSC hospitals to use telemedicine and "proxy credentialing" to support their affiliated rural facilities.
探讨州立初级卒中中心（PSC）指定政策实施与农村居民获得最佳卒中治疗之间的关系。
主要数据收集于 2008 年 9 月至 2009 年 8 月期间。在对州 PSC 政策进行内容分析后，选择了四个案例研究州进行实地考察，部分原因是这些州在农村医疗保健方面存在挑战。研究变量包括 PSC 指定政策实施的障碍和促进因素。研究团队对 100 多名利益相关者进行了半结构化访谈，并观察了大型团体会议。采访摘要由利益相关者进行准确性和完整性审查。
所有研究州的一致发现是，由于缺乏远程医疗的财政资源、维持神经病学覆盖的困难以及急诊科无法使用溶栓药物等多种原因，PSC 指定和州政策在农村地区的实施不太可能。研究结果表明，各州认识到需要制定针对农村地区远程医疗的卒中治疗公共政策。
尽管州 PSC 指定政策提高了对农村问题的认识，但指定政策本身并不能克服农村地区获得最佳卒中治疗的障碍。各州必须具备技术准备，并且提供者需要接受电子健康和远程医疗，以确保农村地区卒中患者的治疗协调。更重要的是，州政策制定者应制定规则和条例，鼓励 PSC 医院使用远程医疗和“代理认证”来支持其附属的农村设施。
