Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia; Stroke Division, The Florey Institute of Neuroscience and Mental Health, Melbourne, Victoria, Australia; The University of Melbourne, Melbourne, Victoria, Australia.
Int J Stroke. 2014 Feb;9(2):252-8. doi: 10.1111/ijs.12137. Epub 2013 Oct 22.
Urgent treatment of acute stroke in rural Australia is problematic partly because of limited access to medical specialists. Utilization of telemedicine could improve delivery of acute stroke treatments in rural communities.
The study aims to demonstrate enhanced clinical decision making for use of thrombolysis within 4·5 h of ischemic stroke symptom onset in a rural setting using a telemedicine specialist support model.
A formative program evaluation research design was used. The Victorian Stroke Telemedicine program was developed and will be evaluated over five stages to ensure successful implementation. The phases include: (a) preimplementation phase to establish the Victorian Stroke Telemedicine program including the clinical pathway, data collection tools, and technology processes; (b) pilot clinical application phase to test the pathway in up to 10 patients; (c) modification phase to refine the program; (d) full clinical implementation phase where the program is maintained for one-year; and (e) a sustainability phase to assess project outcomes over five-years. Qualitative (clinician interviews) and quantitative data (patient, clinician, costs, and technology processes) are collected in each phase.
The primary outcome is to achieve a minimum 10% absolute increase in eligible patients treated with thrombolysis. Secondary outcomes are utilization of the telestroke pathway and improvements in processes of stroke care (e.g., time to brain scan). We will report door to telemedicine consultation time, length of telemedicine consultation, clinical utility and acceptability from the perspective of clinicians, and 90-day patient outcomes.
This research will provide evidence for an effective telestroke program for use in regional Australian hospitals.
在澳大利亚农村，由于获得医学专家的机会有限，急性中风的紧急治疗存在问题。远程医疗的应用可以改善农村地区急性中风治疗的效果。
本研究旨在展示一种远程医疗专家支持模式，以增强农村地区在缺血性中风症状发作后 4.5 小时内使用溶栓治疗的临床决策能力。
采用形成性计划评估研究设计。维多利亚中风远程医疗计划已经开发出来，并将分五个阶段进行评估，以确保成功实施。这些阶段包括：(a) 预先实施阶段，包括制定临床路径、数据收集工具和技术流程；(b) 试点临床应用阶段，对多达 10 名患者进行路径测试；(c) 改进阶段，改进方案；(d) 全面临床实施阶段，为期一年；(e) 可持续性阶段，评估项目在五年内的结果。在每个阶段都收集定性数据（临床医生访谈）和定量数据（患者、临床医生、成本和技术流程）。
主要结果是使符合溶栓治疗条件的患者的治疗比例至少增加 10%。次要结果是远程中风途径的利用和中风护理流程的改进（例如，脑部扫描时间）。我们将报告从远程医疗咨询到门的时间、远程医疗咨询的时间长度、从临床医生的角度来看的临床实用性和可接受性，以及 90 天的患者预后。
本研究将为澳大利亚农村地区使用有效的远程中风计划提供证据。
