The STRokE DOC Trial Technique: ‘Video Clip, Drip, and/or Ship’

Meyer, Brett C.; Raman, Rema; Rao, Ramesh; Fellman, R. D.; Beer, Jürg; Werner, J.; Zivin, Justin A.; Lyden, Patrick D.

doi:10.1111/j.1747-4949.2007.00153.x

Cited by 24 publications

(10 citation statements)

References 22 publications

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“…Details of the design and statistical methods for each of the two trials have been published. 9 Common data elements were pooled to assess for correctness of thrombolysis decision-making. Secondary outcomes included rt-PA use rate, 90-day functional outcome, hemorrhage, and data completeness.…”

Section: Methodsmentioning

confidence: 99%

Efficacy of Telemedicine for Stroke: Pooled Analysis of the Stroke Team Remote Evaluation Using a Digital Observation Camera (STRokE DOC) and STRokE DOC Arizona Telestroke Trials

Demaerschalk

Raman

Ernström

et al. 2012

Telemedicine and e-Health

132

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Background and Purpose: Telemedicine can disseminate vascular neurology expertise and optimize recombinant tissue plasminogen activator (rt-PA) use for acute ischemic stroke in rural underserved communities. The purpose of this study was to prospectively assess whether telemedicine or telephone was superior for decision-making. Methods: The study design is a pooled analysis of two identically designed randomized controlled trials conducted in a multistate hub and spoke telestroke network setting with acute stroke syndrome patients, comparing telemedicine versus telephone-only consultations. From each trial, common data elements were pooled to assess, principally, for correctness of thrombolysis decision-making. Secondary outcomes included rt-PA use rate, 90-day functional outcome, post-thrombolysis intracranial hemorrhage, and data completeness. Results: Two hundred seventy-six pooled patients were evaluated. Correct thrombolysis eligibility decisions were made more often with telemedicine (96% telemedicine, 83% telephone; odds ratio [OR] 4.2; 95% confidence interval [CI] 1.69-10.46; p = 0.002). Intravenous rt-PA usage was 26% (29% telemedicine, 24% telephone; OR 1.27; 95% CI 0.71-2.25; p = 0.41). Ninety-day outcomes were not different for Barthel Index, modified Rankin Scale, or mortality. There was no difference in post-thrombolysis intracranial hemorrhage (8% telemedicine, 6% telephone; p > 0.999). Conclusions: This pooled analysis supports the hypothesis that stroke telemedicine consultations, compared with telephone-only, result in more accurate decision-making. Together with high rt-PA utilization rate, low post-rt-PA intracranial hemorrhage rate, and acceptable patient outcome, the results confirm that telemedicine is a viable consultative tool for acute stroke. The replication of the hub and spoke network infrastructure supports the generalizability of telemedicine when used in broader settings.

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Section: Methodsmentioning

confidence: 99%

Efficacy of Telemedicine for Stroke: Pooled Analysis of the Stroke Team Remote Evaluation Using a Digital Observation Camera (STRokE DOC) and STRokE DOC Arizona Telestroke Trials

Demaerschalk

Raman

Ernström

et al. 2012

Telemedicine and e-Health

132

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“…52 Many of these studies have been in small community hospitals without prior tPA experience or 24/7 neurology coverage. 38,39,[41][42][43][44][45]47,[53][54][55][56] The number of centers using telestroke for acute stroke care, including recommendations regarding thrombolysis, is growing. Feasibility has been established using primarily uncontrolled case series from single or multiple sites.…”

Section: Feasibility and Reliability Of Remote Assessment Of Neuroimamentioning

confidence: 99%

“…The originating sites (ie, clinical setting where the patient is physically located) include (1) a remote Maryland facility using ISDN connections and a restructured NIHSS-telestroke (23 telemedicine cases), 38 (2) an isolated Massachusetts island hospital (24 telemedicine cases), 39 (3) 12 German community hospitals within an ISDN network (1123 cases), 40 (4) 2 Texas community hospitals using a fiberoptic network (328 cases), 41 (5) 8 rural Georgia hospitals using a cell phone or regular telephone service for audio and a 1-way videoconferencing system (75 patients 42 and 194 patients 43 ), and (6) 4 California community hospitals using HQ-VTC. 44 Assessing NIHSS reliability during remote acute telestroke consultations is problematic because acute telestroke consults are generally performed when local neurological evaluations are unavailable. Without concurrent NIHSS-bedside examinations, interrater reliability cannot be directly assessed.…”

Section: Acute Stroke Setting Including Thrombolytic Evaluationmentioning

confidence: 99%

“…The recently reported STRokE DOC trial (design described previously 44 ) compared decision making in acute stroke patients for thrombolytic eligibility using HQ-VTC with review of computed tomography (CT) images versus telephone consultation alone. It demonstrated that the accuracy of decision making by stroke neurologists via telestroke and assisted by the local referring physician is superior to that via telephone for patients with acute ischemic stroke when assessing their suitability for treatment with thrombolytics.…”

Section: Acute Stroke Setting Including Thrombolytic Evaluationmentioning

confidence: 99%

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A Review of the Evidence for the Use of Telemedicine Within Stroke Systems of Care

Schwamm¹,

Holloway²,

Amarenco³

et al. 2009

Stroke

404

162

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Abstract-The aim of this new statement is to provide a comprehensive and evidence-based review of the scientific data evaluating the use of telemedicine for stroke care delivery and to provide consensus recommendations based on the available evidence. The evidence is organized and presented within the context of the American Heart Association's Stroke Systems of Care framework and is classified according to the joint American Heart Association/American College of Cardiology Foundation and supplementary American Heart Association Stroke Council methods of classifying the level of certainty and the class of evidence. Evidence-based recommendations are included for the use of telemedicine in general neurological assessment and primary prevention of stroke; notification and response of emergency medical services; acute stroke treatment, including the hyperacute and emergency department phases; hospital-based subacute stroke treatment and secondary prevention; and rehabilitation.

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“…17 This multidirectional collaboration would be safer and more efficient, cost-effective, and patient-centered than historic unidirectional transfer models. 21 Delivering care at the system level requires that the quality of care be measured at that level. Health care quality focuses primarily on providers and hospitals.…”

Section: Reinventing Emergency Care: Regionalization 20mentioning

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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The STRokE DOC Trial Technique: ‘Video Clip, Drip, and/or Ship’

Cited by 24 publications

References 22 publications

Efficacy of Telemedicine for Stroke: Pooled Analysis of the Stroke Team Remote Evaluation Using a Digital Observation Camera (STRokE DOC) and STRokE DOC Arizona Telestroke Trials

Efficacy of Telemedicine for Stroke: Pooled Analysis of the Stroke Team Remote Evaluation Using a Digital Observation Camera (STRokE DOC) and STRokE DOC Arizona Telestroke Trials

A Review of the Evidence for the Use of Telemedicine Within Stroke Systems of Care

Creating Integrated Networks Of Emergency Care: From Vision To Value

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