Journal article
Telemedicine Is Associated with Faster Diagnostic Imaging in Stroke Patients: A Cohort Study
Telemedicine journal and e-health, Vol.25(2), pp.93-100
02/01/2019
DOI: 10.1089/tmj.2018.0013
PMID: 29958087
Abstract
Background:
Meeting time goals for patients with time-sensitive conditions can be challenging in rural emergency departments (EDs), and adopting policies is critical. ED-based telemedicine has been proposed to improve quality and timeliness of care in rural EDs.
Introduction:
The objective of this study was to test the hypothesis that diagnostic testing in telemedicine-supplemented ED care for patients with myocardial infarction (MI) and stroke would be faster than nontelemedicine care in rural EDs.
Materials and Methods:
This observational cohort study included all ED patients with MI or stroke in 19 rural critical access hospitals served by a single real-time contract-based telemedicine provider in the upper Midwest (2007–2015). The primary outcome for the MI cohort was time-to-
electrocardiogram (EKG)
and for the stroke cohort was time-to-head computed tomography (CT) interpretation. To measure the relationship between telemedicine and timeliness parameters, generalized estimating equations models were used, clustering on presenting hospital.
Results:
Of participating ED visits, 756 were included in the MI cohort (29% used telemedicine) and 140 were included in the stroke cohort (30% used telemedicine). Time-to-EKG did not differ when telemedicine was used (1% faster, 95% confidence interval [CI] −4% to 7%), or after telemedicine was implemented (4% faster, 95% CI −3% to 10%). Head CT interpretation was faster for telemedicine cases (15% faster, 95% CI 4–26%). No differences were observed in time to reperfusion therapy.
Conclusions:
Telemedicine implementation was associated with more timely head CT interpretation for rural patients with stroke, but no difference in early MI care. Future work will focus on the specific manner in which telemedicine changes ED care processes and ongoing professional education.
Details
- Title: Subtitle
- Telemedicine Is Associated with Faster Diagnostic Imaging in Stroke Patients: A Cohort Study
- Creators
- Nicholas M Mohr - 3Department of Epidemiology, University of Iowa College of Public Health, Iowa City, IowaTracy Young - 4Injury Prevention Research Center, University of Iowa College of Public Health, Iowa City, IowaKarisa K Harland - 1Department of Emergency Medicine, University of Iowa Carver College of Medicine, Iowa City, IowaBrian Skow - 5Avera eCARE, Sioux Falls, South DakotaAmy Wittrock - 5Avera eCARE, Sioux Falls, South DakotaAmanda Bell - 5Avera eCARE, Sioux Falls, South DakotaMarcia M Ward - 6Department of Health Management and Policy, University of Iowa College of Public Health, Iowa City, Iowa
- Resource Type
- Journal article
- Publication Details
- Telemedicine journal and e-health, Vol.25(2), pp.93-100
- DOI
- 10.1089/tmj.2018.0013
- PMID
- 29958087
- NLM abbreviation
- Telemed J E Health
- ISSN
- 1530-5627
- eISSN
- 1556-3669
- Publisher
- Mary Ann Liebert, Inc., publishers
- Language
- English
- Date published
- 02/01/2019
- Academic Unit
- Remote care & Telehealth Research Center; Occupational and Environmental Health; Health Management and Policy; Epidemiology; Emergency Medicine; Center for Social Science Innovation; Anesthesia; Injury Prevention Research Center; Public Policy Center (Archive); Law Faculty
- Record Identifier
- 9984024517102771
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