Department of Neurology, University of Alabama at Birmingham (M. Lyerly).
Stroke. 2021 Jan;52(1):253-259. doi: 10.1161/STROKEAHA.120.029993. Epub 2020 Nov 23.
Telestroke has been demonstrated to be a cost-effective means to expand access to care and improve outcomes in stroke; however, information on patient perceptions of this system of care delivery are limited. This study seeks to examine patient feedback of a national telestroke system within the Veterans Health Administration.
Patients who received a telestroke consultation were eligible for a phone interview 2 weeks later, including questions about technology quality, telepresence, and telestroke provider communication. Satisfaction scores ranged from 1 to 7 (higher=more satisfied) and for analyses were dichotomized as 6 to 7 indicating high satisfaction versus <6. Patient variables including stroke severity (measured by the National Institutes of Health Stroke Scale) were obtained from study records. Generalized estimating equation models were used to determine what factors were associated with patient satisfaction.
Over 18 months, 186 interviews were completed, and 142 (76%) reported high satisfaction with telestroke. Patients with more severe stroke were less likely to recall the consultation. Factors significantly associated with patient satisfaction were higher ratings of the technology (<0.0001), telepresence (<0.0001), provider communication ratings (<0.0001), and overall Veterans Affairs satisfaction (=0.02). In the multivariate model, telepresence (odds ratio, 3.10 [95% CI, 1.81-5.31]) and provider ratings (odds ratio, 2.37 [95% CI, 1.20-4.68]) were independently associated with satisfaction. Veterans who were satisfied were more likely to recommend the technology (<0.0001).
Provider qualities, including telepresence and provider ratings, were associated with overall Veteran satisfaction with the telestroke consultation. Technology quality may be necessary but not sufficient to impact patient experience. Training providers to improve telepresence could improve patient experience with telestroke consultation.
远程卒中已被证明是一种扩大获得医疗服务机会和改善卒中预后的经济有效的手段；然而，有关患者对这种医疗服务提供系统的看法的信息有限。本研究旨在检查退伍军人事务部（VA）全国远程卒中系统的患者反馈。
接受远程卒中咨询的患者有资格在 2 周后接受电话采访，包括有关技术质量、远程呈现和远程卒中提供者沟通的问题。满意度评分范围为 1 到 7（分数越高表示越满意），分析时将 6 到 7 分为高满意度，<6 分为低满意度。患者变量包括卒中严重程度（通过 NIHSS 量表测量），从研究记录中获得。使用广义估计方程模型确定与患者满意度相关的因素。
在 18 个月的时间里，完成了 186 次访谈，其中 142 次（76%）报告对远程卒中非常满意。卒中更严重的患者不太可能回忆起咨询。与患者满意度显著相关的因素包括更高的技术评分（<0.0001）、远程呈现评分（<0.0001）、提供者沟通评分（<0.0001）和整体 VA 满意度（=0.02）。在多变量模型中，远程呈现（优势比，3.10[95%置信区间，1.81-5.31]）和提供者评分（优势比，2.37[95%置信区间，1.20-4.68]）与满意度独立相关。对技术满意的退伍军人更有可能推荐该技术（<0.0001）。
提供者素质，包括远程呈现和提供者评分，与退伍军人对远程卒中咨询的总体满意度相关。技术质量可能是必要的，但不足以影响患者的体验。培训提供者提高远程呈现能力可以改善患者对远程卒中咨询的体验。
