Comparison of Stroke Outcomes of Hub and Spoke Hospital Treated Patients in Mayo Clinic Telestroke Program.
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Abstract
PURPOSE To examine telemedicine as it applies to acute ischemic stroke care at a spoke hospital and the effect on patient outcomes including the timeliness of response quality of care safety morbidity and mortality when compared to standard hub hospital stroke center care METHODS Retrospective review of prospectively entered quality performance stroke telestroke patient catalog data were completed for 1000 adult patients who presented with an acute ischemic stroke to the Mayo Clinic Hospitals 500 patients or to one of thirteen Mayo Clinic affiliated telestroke spoke hospitals in the regions 500 patients The primary outcome of interest was the percentage of accurate decision making for eligibility of IV alteplase administration assessed by blinded adjudication and the secondary outcomes pertained to complications discharge parameters and standard quality metrics RESULTS There was no difference in the spoke hospital versus hub hospital groups in identifying and making the correct decision regarding which patients were eligible for IV alteplase administration 96 95 confidence interval CI 94 97 versus 97 95 CI 95 98 P 0 32 There was no difference among the groups in proportion receiving IV alteplase sustaining symptomatic intracranial hemorrhage and mortality Patients in the spoke group were less likely to have a favorable outcome at discharge as defined by National Institutes of Health Stroke Scale NIHSS 0 1 or mRS 0 1 or Glasgow Outcome Scale GOS 0 1 21 versus 35 P Under 0 001 were less likely to have venous thromboembolism prophylaxis 46 versus 63 P Under 0 01 were less likely to have received antithrombotic therapy 85 versus 90 P 02 were less likely to be discharged on anticoagulation when indicated 56 versus 64 P 01 and were less likely to be prescribed cholesterol reducing treatment 68 versus 72 P Under 001 The initial acute care hospital length of stay was longer for the spoke hospital group by one day median 4 versus 3 P Under 001 CONCLUSION The key findings were that evidence based stroke thrombolysis eligibility decision making thrombolysis administration and thrombolysis emergency stroke metrics were uniformly excellent for the spoke hospital group when compared to the standard hub hospital group However evidence based stroke hospitalization and discharge metrics were inferior for the spoke hospital group when compared to the standard hub hospital