Objective: To conduct a cost-effectiveness analysis of telestroke-a 2-way, audiovisual technology that links stroke specialists to remote emergency department physicians and their stroke patients-compared to usual care (i.e., remote emergency departments without telestroke consultation or stroke experts). Methods:A decision-analytic model was developed for both 90-day and lifetime horizons. Model inputs were taken from published literature where available and supplemented with western states' telestroke experiences. Costs were gathered using a societal perspective and converted to 2008 US dollars. Quality-adjusted life-years (QALYs) gained were combined with costs to generate incremental cost-effectiveness ratios (ICERs). In the lifetime horizon model, both costs and QALYs were discounted at 3% annually. Both one-way sensitivity analyses and Monte Carlo simulations were performed. Results:In the base case analysis, compared to usual care, telestroke results in an ICER of $108,363/QALY in the 90-day horizon and $2,449/QALY in the lifetime horizon. For the 90-day and lifetime horizons, 37.5% and 99.7% of 10,000 Monte Carlo simulations yielded ICERs Ͻ$50,000/QALY, a ratio commonly considered acceptable in the United States.

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This study analyzes state-level data for 1959-78 to (letermifle whether the rapid growth of teacher unionism during those years was primarily a result or a cause of the public sector bargaining laws adopted during the same period. The author finds, contrary to the view of some scholars, that the enactment of laws requiring public sector employers to bargain with majority representatives of their employees was the single most important cause of the growth in the proportion of teachers covered by union contracts. Although the growth in teacher unionism in turn encouraged the adoption of some new or stronger bargaining laws, this effect was relatively weak. More important predictors of new bargaining laws included the extent of political patronage in a state and the bargaining laws adopted by neighboring states. IN THE past 30 years, millions of publicemployees have either joined unions or forced the transformation of existing public employee associations into unions, and many states have enacted legislation extending the union rights of public employees. Neither of these important developments, however, was anticipated by most industrial relations scholars, and neither has been fully explained, even retrospectively. To assist the search for such an explanation, this study examines the growth of collective bargaining by public school teachers and the enactment of teacher bargaining laws.' Its central focus is what Burton called "the most tantalizing question about the growth of public sector bargaining," namely, how important were changes in bargaining laws as a cause of the growth of bargaining?2 Two conflicting answers have been offered to that question. On the one hand, many teacher union leaders and school board representatives have claimed that bargaining laws were very important. Most of the seventy practitioners interviewed for 'Restricting the focus to a homogeneous group such as teachers effectively holds many variables constant.i'John F. Burton, Jr., "The Extent of Collective Bargaining in the Public Sector," in Benjamin Aaron, Joseph Grodin, and James L. Sterh, eds., Public-Sector Bargaining

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