Department of Neurology and Neurosurgery, Federal University of São Paulo, São Paulo, Brazil.
Stroke. 2012 Aug;43(8):2078-85. doi: 10.1161/STROKEAHA.111.645861. Epub 2012 Jun 14.
Little is known about adoption or success of telestroke networks outside of published or federally funded programs. Under contract to the Health Resource Services Administration, we conducted an environmental scan of telestroke programs in the United States.
An analyst contacted all potential programs identified in comprehensive online searches, interviewed respondents, and collected response data about structural and functional components of currently operating telestroke programs.
Among 97 potential programs contacted, 56 programs had confirmed telestroke activity, and 38 programs (68%) from 27 states participated. Hospital and community characteristics of nonparticipating programs were similar to those of participating ones. The top 3 clinical needs met by the telestroke were emergency department consultation (100%), patient triage (83.8%), and inpatient teleconsultation (46.0%). Telestroke programs were in operation a median of 2.44 years (interquartile range, 1.36-3.44 years); 94.6% used 2-way, real-time interactive video plus imaging, but only 44% used dedicated telemedicine consultation software. The mean number of spokes per hub increased significantly from 2007 to 2008 to 2009 (3.78 versus 7.60; P<0.05), and >80% of spoke sites were rural or small hospitals. Reimbursement was absent for >40% of sites. Sites rated inability to obtain physician licensure (27.77%), lack of program funds (27.77%), and lack of reimbursement (19.44%) as the most important barriers to program growth.
Telestroke is a widespread and growing practice model. Important barriers to expansion amenable to change relate to organizational, technical, and educational domains and external economic and regulatory forces.
除了已发表或联邦资助的项目外，人们对远程卒中网络的采用或成功知之甚少。根据健康资源服务管理局的合同，我们对美国的远程卒中项目进行了环境扫描。
一名分析师联系了在全面在线搜索中确定的所有潜在项目，对受访者进行了采访，并收集了有关当前运营的远程卒中项目结构和功能组件的数据。
在联系的 97 个潜在项目中，有 56 个项目有确认的远程卒中活动，来自 27 个州的 38 个项目（68%）参与了调查。未参与项目的医院和社区特征与参与项目的类似。远程卒中满足的前 3 个临床需求是急诊咨询（100%）、患者分诊（83.8%）和住院远程咨询（46.0%）。远程卒中项目的平均运行时间为 2.44 年（中位数，1.36-3.44 年）；94.6%使用双向实时互动视频加成像，但只有 44%使用专用远程医疗咨询软件。2007 年至 2008 年至 2009 年，每个集线器的平均分支数量显著增加（3.78 比 7.60；P<0.05），超过 80%的分支站点是农村或小医院。超过 40%的站点没有报销。站点将无法获得医师执照（27.77%）、缺乏项目资金（27.77%）和缺乏报销（19.44%）评为项目增长的最重要障碍。
远程卒中是一种广泛且不断发展的实践模式。可改变的扩展的重要障碍与组织、技术和教育领域以及外部经济和监管力量有关。
