Stroke Telemedicine for Arizona Rural Residents, the Legacy Telestroke Study.

Autor:	Demaerschalk BM; Department of Neurology, Mayo Clinic College of Medicine and Science, Phoenix, Arizona, USA.; Center for Connected Care, Mayo Clinic and Center for Digital Health, Mayo Clinic, Rochester, Minnesota, USA., Aguilar MI; Neuro Hospitalist and Stroke Program, Penrose/St Francis, Centura Health, Colroado Springs, Colorado, USA., Ingall TJ; Department of Neurology, Mayo Clinic College of Medicine and Science, Phoenix, Arizona, USA., Dodick DW; Department of Neurology, Mayo Clinic College of Medicine and Science, Phoenix, Arizona, USA., Vargas BB; Department of Neurology and Neurotherapeutics at University of Texas Southwestern, Dallas, Texas, USA., Channer DD; Department of Neurology, Mayo Clinic College of Medicine and Science, Phoenix, Arizona, USA.; Center for Connected Care, Mayo Clinic and Center for Digital Health, Mayo Clinic, Rochester, Minnesota, USA., Boyd EL; Department of Research, Mayo Clinic, Phoenix, Arizona, USA., Kiernan TEJ; Comprehensive Stroke Program, St. Anthony's Hospital, Lakewood, Colorado, USA., Fitz-Patrick DG; Department of Research, Mayo Clinic, Phoenix, Arizona, USA., Collins JG; Department of Neurology, Mayo Clinic College of Medicine and Science, Phoenix, Arizona, USA., Hentz JG; Department of Biostatistics, Mayo Clinic, Phoenix, Arizona, USA., Noble BN; Department of Pharmacy Practice, Oregon State University College of Pharmacy, Corvallis, Oregon, USA., Wu Q; School of Public Health and Nevada Institute of Personalized Medicine at the University of Nevada, Las Vegas, Nevada, USA., Brazdys K; Clinical Research Practice, Los Angeles, California, USA., Bobrow BJ; Department of Emergency Medicine, McGovern Medical School at UTHealth, Houston, Texas, USA.
Jazyk:	angličtina
Zdroj:	Telemedicine reports [Telemed Rep] 2022 Mar 14; Vol. 3 (1), pp. 67-78. Date of Electronic Publication: 2022 Mar 14 (Print Publication: 2022).
DOI:	10.1089/tmr.2022.0002
Abstrakt:	Background: Efficacy of telemedicine for stroke was first established by the Stroke Team Remote Evaluation Using a Digital Observation Camera (STRokE DOC) trials in California and Arizona. Following these randomized controlled trials, the Stroke Telemedicine for Arizona Rural Residents (STARR) network was the first telestroke network to be established in Arizona. It consisted of a 7 spoke 1 hub telestroke system, and it was designed to serve rural, remote, or neurologically underserved communities. Objective: The objective of STARR was to establish a multicenter state-wide telestroke research network to determine the feasibility of prospective collection, recording, and regularly analysis of telestroke patient consultations and care data for the purposes of establishing quality measures, improvement, and benchmarking against other national and international telestroke programs. Methods: The STARR trial was open to enrollment for 29 months from 2008 to 2011. Mayo Clinic Hospital, Phoenix, Arizona served as the hub primary stroke center and its vascular neurologists provided emergency telestroke consultations to seven participating rural, remote, or underserved spoke community hospitals in Arizona. Eligibility criteria for activation of a telestroke alert and study enrollment were established. Consecutive patients exhibiting symptoms and signs of acute stroke within a 12 h window were enrolled, assessed, and treated by telemedicine. The state government sponsor, Arizona Department of Health Services' research grant covered the cost of acquisition, maintenance, and service of the selected telemedicine equipment as well as the professional telestroke services provided. The study deployed multiple telemedicine video cart systems, picture archive and communications systems software, and call management solutions. The STARR protocol was reviewed and approved by Mayo Clinic IRB, which served as the central IRB of record for all the participating hospitals, and the trial was registered at ClinicalTrials.gov. Results: The telestroke hotline was activated 537 times, and ultimately 443 subjects met criteria and consented to participate. The STARR successfully established a multicenter state-wide telestroke research network. The STARR developed a feasible and pragmatic approach to the prospective collection, storage, and analysis of telestroke patient consultations and care data for the purposes of establishing quality measures and tracking improvement. STARR benchmarked well against other national and international telestroke programs. STARR helped set the foundation for multiple regional and state telestroke networks and ultimately evolved into a national telestroke network. Conclusions: Multiple small and rurally located community hospitals and health systems can successfully collaborate with a more centrally located larger hospital center through telemedicine technologies to develop a coordinated approach to the assessment, diagnosis, and emergency treatment of patients manifesting symptoms and signs of an acute stroke syndrome. This model may serve well the needs of patients presenting with other time-sensitive medical emergencies.Clinical Trial Registration number: NCT00829361. Competing Interests: No competing financial interests exist. (© Bart M. Demaerschalk et al., 2022; Published by Mary Ann Liebert, Inc.)
Databáze:	MEDLINE
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