A Department of Veterans Affairs-funded study published in Neurology found that a telestroke program helped prevent unnecessary hospital transfers for patients.  

The research, published in conjunction with the Regenstrief Institute and Indiana University School of Medicine, examined the VHA National Telestroke Program, which provides acute stroke care at facilities without an available neurologist.  

The research team found the chance of being transferred to another facility decreased by 60% after the program’s implementation and increased the likelihood of timely stroke treatment.

"This analysis suggests that telestroke provides additional benefits for both patients and health systems," said senior author Dr. Linda S. Williams, research scientist for the Regenstrief Institute and professor of neurology at Indiana University School of Medicine, in a statement.  

"It increases care efficiency and cost-effectiveness, while further optimizing care for the patient who does not have to endure an unnecessary or even counterproductive transfer to another facility," Williams continued.  

WHY IT MATTERS  

As noted by the authors in the study, telestroke allows a remote specialist to evaluate, diagnose and treat patients presenting with acute stroke – which, in turn, enables improved utilization rates for the thrombolytic drug alteplase, improved access in geographically under-resourced areas and reduced disparities in acute stroke care.  

It also, as the researchers pointed out, can help with appropriate care levels for patients.  

"Some patients may be best served by staying at a community facility, while others warrant transfer to a higher level of care such as a primary or comprehensive stroke center," they observed.  

"By reducing unnecessary transfers, appropriate lower acuity patients may be cared for within their local community with the added benefit of remaining closer to their family and social support," they continued.  

In 2016, the Veterans Health Administration implemented the VA National Telestroke Program, which represents both urban and rural facilities spread out over a diverse geographic landscape. Using a mobile device, a neurologist from a nearby "hub" of physicians across the country is able to evaluate the patients and provide a treatment plan for the on-site staff to carry out.  

"The message is not to aim for an increase or decrease [in] transfers but to match the patient with the correct disposition and level of care based on their needs," said the researchers.  

By August 2021, the program was active in 50 facilities nationwide.  

For this study, researchers examined 3,488 stroke encounters from 3,289 patients at 21 facilities that had joined the NTSP in 2017 or 2018, comparing the "pre-NTSP" period with the post-implementation period.  

On average, they found that the odds of transfer were significantly reduced in nine of the 21 facilities, with only one demonstrating a significant increase.  

"We know that thrombolysis rates increased after NTSP implementation, so some of the increase in transfers may be for appropriate post-thrombolysis care unable to be provided at smaller facilities," they wrote.  

"Ultimately, implementation of the NTSP has enhanced timely disposition of the patient to match their stroke needs while at the same time elevating the care provided at the local facility to minimize the need for unnecessary transfers," read the study.  

THE LARGER TREND

The VA's telehealth programs have been a foundational part of care for years, enabled by bipartisan legislation enabling interstate telemedicine for providers and patients.   

But as with other providers, the COVID-19 pandemic triggered a large uptick in use, with the agency partnering with companies like Apple to ensure continuity of care.  

"I like to say that we met our five-year goals for telehealth in the first month of the pandemic, and we’re not looking back," said Dr. Neil Evans, chief officer for the Office of Connected Care in the Veterans Health Administration, in an interview with Healthcare IT News in March.  

ON THE RECORD  

"The VHA telestroke program facilitates timely assessment of stroke and elevates the level of care at smaller facilities, eliminating the need for many transfers," said Williams in a statement regarding the study.

"This demonstrates another strategy to leverage telehealth in acute care settings while also reducing rural healthcare disparities," she added.

Kat Jercich is senior editor of Healthcare IT News.
Twitter: @kjercich
Email: kjercich@himss.org
Healthcare IT News is a HIMSS Media publication.