A Rural Stroke Network without Telemedicine (P03.016)

Abstract

Objective: Is a stroke network without video telemedicine feasible? Background Stroke networks typically have telemedecine at their core to extend stroke call coverage to needy hospitals. However, because telemedicine equipment is expensive it may widen stroke care disparities. An alternative is a network based on relationship-building, education of local providers, and quality improvement initiatives. Design/Methods: A stroke neurologist was assigned to create a network. Telemedicine was deemed too costly for most referring hospitals. With a core mission to serve disadvantaged populations, we focused on inexpensive educational lectures to local providers, nurse training, care protocols, community awareness campaigns, and local quality monitoring initiatives. Membership is at fair market value with a contract that details mutual responsibilities. Results: To date, several hospitals in Appalachian and Central Kentucky have joined, and several more are asking. Stroke referrals from affiliates have increased with network involvement. Because of network success, additional internal resources have been allocated and we are partnering with a large private health care provider to grow the network. Expanded network initiatives include a stroke registry that may capture 7000 subjects yearly. Conclusions: A stroke network without telemedicine is feasible. Community hospitals do not necessarily want or need telemedicine, and this technological advantage may widen stroke care disparities. Because we are indiscriminate in acquiring affiliates, we may be narrowing disparities in access to stroke care. This will be studied through the network registry. Our network may have spill-over effects to improve vascular health in general for our population. This also deserves further study. Our rate-limiting step for signing affiliates has been allocation of internal resources such as network personnel time. We are hiring additional personnel, allocating more neurologist director time to network activities, and partnering with a large private health care provider. Protected stroke neurology director time has been vital. We are poised for further network growth. Disclosure: Dr. Dobbs has nothing to disclose. Dr. Bellamy has nothing to disclose.