Recommendations for the Implementation of Telemedicine Within Stroke Systems of Care

Schwamm, Lee H.; Audebert, Heinrich J.; Amarenco, Pierre; Chumbler, Neale R.; Frankel, Michael; George, Mary G.; Gorelick, Philip B.; Horton, Katie; Kaste, Markku; Lackland, Daniel T.; Levine, Steven R.; Meyer, Brett C.; Meyers, Philip M.; Patterson, Victor; Stranne, Steven K.; White, Christopher J.

doi:10.1161/strokeaha.109.192361

Cited by 274 publications

(152 citation statements)

References 81 publications

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“…13 Development of our Telestroke protocol was guided by the NINDS study 5 as well as the recommendations of the American Stroke Association. 14 In contrast to many hospital-based systems, our unique mobile system increased flexibility for the remote neurologist, as it enabled access to the videoconferencing system via laptop at any site and bypassed the travel time to the hub hospital. Any concerns regarding the accuracy of mobile Telestroke assessment has been refuted in prior studies, including the STRokE DOC study, which showed a strong correlation between bedside and remote assessment of NIHSS using a site-independent system.…”

Section: Discussionmentioning

confidence: 99%

Rural Victorian Telestroke project

Nagao

Koschel

Haines

et al. 2012

Internal Medicine Journal

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Section: Discussionmentioning

confidence: 99%

Rural Victorian Telestroke project

Nagao

Koschel

Haines

et al. 2012

Internal Medicine Journal

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“…The timely availability of providers' cognitive skills at the bedside has been illustrated by "tele-stroke" models that allow the rapid sharing of patient exams, clinical data, imaging data, and collaborative diagnostic and therapeutic interventions within a critical time window. 34,35 Models of virtual care have expanded to include trauma, pediatrics, behavioral health, and high-risk obstetrics. Other high-priority and high-frequency conditions such as headache; chest pain; abdominal pain; and urological, otolaryngological, surgical, orthopedic, and pulmonary complaints remain unaddressed.…”

Section: Next Stepsmentioning

confidence: 99%

Creating Integrated Networks Of Emergency Care: From Vision To Value

Martínez

Carr

2013

Health Affairs

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Emergency care is an essential component of the care delivery system in the United States, but it received little attention during the debates about health care reform. As a result, US emergency care remains outdated and fragmented. We provide an overview of efforts to regionalize emergency care in the United States, and we both identify challenges to change and recommend next steps in five domains: people, quality and processes, technology, finances, and jurisdictional politics. We offer a commonsense approach to increasing the value of emergency care delivery by developing regionalized integrated networks of emergency care that take advantage of emerging changes in the health system and are designed to meet time-sensitive patient needs. E mergency care is a crucial component of the health care delivery system in the United States, managing a disproportionately large portion of acute care and acute exacerbations of chronic conditions, and half of all hospital admissions.1,2 With health reform, the importance of emergency care seems destined to increase. The major focus of the Affordable Care Act is on expanding coverage to the uninsured and developing new models of care, with an emphasis on primary care and medical homes-settings that are both limited in their hours of availability and likely to refer 80 percent of their patients with acute and complex conditions to the emergency department (ED) for needed care. 2The existing emergency care system evolved in response to the public's need for access to acute care.3 With an increasing number of patients seeking such care, an aging population, an increased incidence of chronic diseases, physician and staff shortages, and a geographic maldistribution of health care resources, the US emergency care system is at an inflection point. The continuum of emergency care (including prehospital care, the ED, and the hospital-based subspecialists who support the emergency care capabilities of hospitals) must be transformed to provide greater public value-that is, highquality care at lower costs than those of current approaches to emergency care delivery.The ED was once thought of as a resource of last resort for the critically sick and dying. Today, however, it represents-for both patients and their providers-the first option for timely acute care. Only 7-10 percent of all ED visits are for nonurgent visits. 4 The vast majority of ED visits are emergent, urgent, or semi-urgent and require time-sensitive evaluation or intervention (Exhibit 1). The most common conditions among patients visiting the ED include chest pain, asthma, abdominal pain, headache, fever, upper respiratory tract infections, sprains, fractures, and wounds. The development of new models of care coordination, such as patient-centered medical homes and accountable care organizations; the increasing availability of electronic clinical information and enabling technologies, such as telemedicine and remote monitoring; and the shift toward incentives to increase value all provide opportunities to redesig...

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“…When the appropriate technology is available, these services may also provide unique opportunities for interprofessional discussions about patients' decisions, and help to maintain informational and management continuity of care. Telehealth services strive to ensure that continuity of care is maintained despite limited provider-patient and provider-provider face-to-face contact (Schwamm et al, 2009;Vitacca et al, 2010).…”

Section: Practical Challenges: Geography and Timementioning

confidence: 99%

Interprofessional education about patient decision support in specialty care

Politi

Pieterse

Truant

et al. 2011

Journal of Interprofessional Care

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Specialty care involves services provided by health care professionals in order to treat a specific health issue or disease. In contrast to primary health care -a system with the goal of providing continuous, coordinated, and comprehensive care -specialty care often involves intermittent episodes of care focused around a specific condition. In addition, it often includes multiple providers who may play autonomous or complementary roles in patient care delivery.Each provider from each specialty discipline has a unique area of expertise that is important in supporting a patient's care. Interprofessional care involves multiple professionals from different disciplines collaborating to provide an integrated and comprehensive approach to patient care. In order for patients to experience continuity of care across these multiple providers, often located across various settings, providers need to communicate, trust one another, and maintain a shared sense of responsibility to their patients. In this article, we describe the challenges inherent in the interprofessional provision of patient decision support in specialty care settings. We then propose ways to engage in interprofessional decision support in specialty care settings. Finally, we discuss promising approaches to teaching an interprofessional approach to decision support to specialty-care health care professionals and institutions. Additional evaluation and empirical research is required before further recommendations can be made about educational preparation for interprofessional approaches to patient decision support in specialty care settings.Key Words: specialty care, patient involvement, decision support, interprofessional education Abstract Word Count: 223

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Recommendations for the Implementation of Telemedicine Within Stroke Systems of Care

Cited by 274 publications

References 81 publications

Rural Victorian Telestroke project

Rural Victorian Telestroke project

Creating Integrated Networks Of Emergency Care: From Vision To Value

Interprofessional education about patient decision support in specialty care

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