Stroke Care Using a Hub and Spoke Model with Telemedicine

Huddleston, Penny; Zimmermann, Mary

doi:10.1016/j.ccell.2014.08.014

Cited by 11 publications

(4 citation statements)

References 10 publications

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“…In this article, we examined clinician perspectives on scaling up econsult use from a decentralized, local model to a regional hub-andspoke model. While a hub-and-spoke approach has been successfully used and studied in application to telemedicine, 13,14,33 in particular with stroke care, 34,35 the literature on scaling up e-consults to a hub-and-spoke model is lacking. Our work makes an important contribution to the body of research on expanding access to healthcare by harnessing technology.…”

Section: Discussionmentioning

confidence: 99%

Electronic consultations and economies of scale: a qualitative study of clinician perspectives on scaling up e-consult delivery

Anderson

Rinne

Orlander

et al. 2021

Journal of the American Medical Informatics Association

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Objective To explore Veterans Health Administration clinicians’ perspectives on the idea of redesigning electronic consultation (e-consult) delivery in line with a hub-and-spoke (centralized) model. Materials and Methods We conducted a qualitative study in VA New England Healthcare System (VISN 1). Semi-structured phone interviews were conducted with 35 primary care providers and 38 specialty care providers, including 13 clinical leaders, at 6 VISN 1 sites varying in size, specialist availability, and e-consult volume. Interviews included exploration of the hub-and-spoke (centralized) e-consult model as a system redesign option. Qualitative content analysis procedures were applied to identify and describe salient categories. Results Participants saw several potential benefits to scaling up e-consult delivery from a decentralized model to a hub-and-spoke model, including expanded access to specialist expertise and increased timeliness of e-consult responses. Concerns included differences in resource availability and management styles between sites, anticipated disruption to working relationships, lack of incentives for central e-consultants, dedicated staff’s burnout and fatigue, technological challenges, and lack of motivation for change. Discussion Based on a case study from one of the largest integrated healthcare systems in the United States, our work identifies novel concerns and offers insights for healthcare organizations contemplating a scale-up of their e-consult systems. Conclusions Scaling up e-consults in line with the hub-and-spoke model may help pave the way for a centralized and efficient approach to care delivery, but the success of this transformation will depend on healthcare systems’ ability to evaluate and address barriers to leveraging economies of scale for e-consults.

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Section: Discussionmentioning

confidence: 99%

Electronic consultations and economies of scale: a qualitative study of clinician perspectives on scaling up e-consult delivery

Anderson

Rinne

Orlander

et al. 2021

Journal of the American Medical Informatics Association

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“…The success of this approach is evidenced in health-care practice and services. 85,86 Hub role in the FinCH trial…”

Section: Description Of the Hub-and-spoke Approachmentioning

confidence: 99%

A multidomain decision support tool to prevent falls in older people: the FinCH cluster RCT

Logan

Horne

Allen

et al. 2022

Health Technol Assess

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Background Falls in care home residents are common, unpleasant, costly and difficult to prevent. Objectives The objectives were to evaluate the clinical effectiveness and cost-effectiveness of the Guide to Action for falls prevention in Care Homes (GtACH) programme. Design A multicentre, cluster, parallel, 1 : 1 randomised controlled trial with embedded process evaluation and economic evaluation. Care homes were randomised on a 1 : 1 basis to the GtACH programme or usual care using a secure web-based randomisation service. Research assistants, participating residents and staff informants were blind to allocation at recruitment; research assistants were blind to allocation at follow-up. NHS Digital data were extracted blindly. Setting Older people’s care homes from 10 UK sites. Participants Older care home residents. Intervention The GtACH programme, which includes care home staff training, systematic use of a multidomain decision support tool and implementation of falls prevention actions, compared to usual falls prevention care. Outcomes The primary trial outcome was the rate of falls per participating resident occurring during the 90-day period between 91 and 180 days post randomisation. The primary outcome for the cost-effectiveness analysis was the cost per fall averted, and the primary outcome for the cost–utility analysis was the incremental cost per quality adjusted life-year. Secondary outcomes included the rate of falls over days 0–90 and 181–360 post randomisation, activity levels, dependency and fractures. The number of falls per resident was compared between arms using a negative binomial regression model (generalised estimating equation). Results A total of 84 care homes were randomised: 39 to the GtACH arm and 45 to the control arm. A total of 1657 residents consented and provided baseline measures (mean age 85 years, 32% men). GtACH programme training was delivered to 1051 staff (71% of eligible staff) over 146 group sessions. Primary outcome data were available for 630 GtACH participants and 712 control participants. The primary outcome result showed an unadjusted incidence rate ratio of 0.57 (95% CI 0.45 to 0.71; p < 0.01) in favour of the GtACH programme. Falls rates were lower in the GtACH arm in the period 0–90 days. There were no other differences between arms in the secondary outcomes. Care home staff valued the training, systematic strategies and specialist peer support, but the incorporation of the GtACH programme documentation into routine care home practice was limited. No adverse events were recorded. The incremental cost was £20,889.42 per Dementia Specific Quality of Life-based quality-adjusted life-year and £4543.69 per quality-adjusted life-year based on the EuroQol-5 dimensions, five-level version. The mean number of falls was 1.889 (standard deviation 3.662) in the GtACH arm and 2.747 (standard deviation 7.414) in the control arm. Therefore, 0.858 falls were averted. The base-case incremental cost per fall averted was £190.62. Conclusion The GtACH programme significantly reduced the falls rate in the study care homes without restricting residents’ activity levels or increasing their dependency, and was cost-effective at current thresholds in the NHS. Future work Future work should include a broad implementation programme, focusing on scale and sustainability of the GtACH programme. Limitations A key limitation was the fact that care home staff were not blinded, although risk was small because of the UK statutory requirement to record falls in care homes. Trial registration This trial is registered as ISRCTN34353836. Funding This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 26, No. 9. See the NIHR Journals Library website for further project information.

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“…Several studies have also demonstrated improvement in several stroke time metrics, including doorto-CT, door-to-needle, and onset to reperfusion times [11][12][13][14]. Other benefits include similar or improved safety and improved functional outcomes, compared to existing systems of care at spoke hospitals [11][12][13][14].…”

Section: The Role Of Telemedicinementioning

confidence: 99%

Advanced imaging in acute ischemic stroke: an updated guide to the hub-and-spoke hospitals

Sharobeam

Yan

2021

Current Opinion in Neurology

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Purpose of reviewThe purpose of this review is to summarize the role of the hub-and-spoke system in acute stroke care, highlight the role of advanced imaging and discuss emerging concepts and trials relevant to the hub-and-spoke model. Recent findingsThe advent of advanced stroke multimodal imaging has provided increased treatment options for patients, particularly in rural and regional areas. When used in the hub-and-spoke model, advanced imaging can help facilitate and triage transfers, appropriately select patients for acute therapy and treat patients who may otherwise be ineligible based on traditional time metrics. Recent, ongoing trials in this area may lead to an even greater range of patients being eligible for acute reperfusion therapy, including mild strokes and patients with large core infarct volumes.

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Stroke Care Using a Hub and Spoke Model with Telemedicine

Cited by 11 publications

References 10 publications

Electronic consultations and economies of scale: a qualitative study of clinician perspectives on scaling up e-consult delivery

Electronic consultations and economies of scale: a qualitative study of clinician perspectives on scaling up e-consult delivery

A multidomain decision support tool to prevent falls in older people: the FinCH cluster RCT

Advanced imaging in acute ischemic stroke: an updated guide to the hub-and-spoke hospitals

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