Abstract 265: TeleStroke: Expanding Access and Coordination of Care from Acute Stroke to Follow-up

Abstract

Background: The University of Utah Medical Center (UUMC) serves a wide geographical area, encompassing 10% of the continental US landmass. Stroke patients are often transported from remote facilities for specialty care. The UUMC Telestroke Center routinely provides acute care, but has only rarely been used for outpatient follow-up. The objective of this study was to develop a novel pathway for follow-up care after inpatient admissions for acute ischemic stroke (AIS) utilizing the existing telestroke infrastructure, with the goals of improving quality outcomes, reducing patient costs, and increasing access to care. Methods: Utilizing LEAN methodology, the existing care model was process-mapped to assess for potential areas of improvement. Over one month in 2013, a convenience sample of 27 inpatients admitted with AIS were surveyed to assess for potential barriers associated with travel to appointments, as well as for attitudes towards utilizing tele-health technologies for follow-up care. We analyzed primary residence patient zip-codes to determine which communities might be optimal for tele-health follow-up visits. Results: Ten patients (37%) lived ≤50 miles from UUMC; 7 (26%) 51-100 miles; 8 (30%)101-500 miles; and 2 (7.4%) > 500 miles away. Patients estimated the costs associated with a visit (excluding appointment fees) as: $0-9 (3.8%), $10-100 (42.3%), $101-500 (38.5%), $501-1000 (11.5%), and >$1000 (3.8%). Twenty-two patients (88%) said they would be interested in a tele-followup visit if it were closer to home and/or reduced travel time, and 59% of respondents said they would actually prefer this option to an in-office visit. Due to these results, an ideal community clinic partner was identified based upon geographic patient demographics, existing tele-health infrastructure, university-based scheduling, shared billing and meaningful-use software, and an expressed interest in collaboration. Follow-up tele-visits will link a stroke specialist physician at UUMC with a patient at the community clinic via 2-way audio-video telehealth equipment. A medical assistant with additional training in the neurologic exam will help facilitate the visit. Clinic training and coordination has already occurred, and a go-live date is anticipated for late February 2014. Discussion: A proof-of-concept health care model has been established at UUMC to provide tele-health follow-up after AIS admission to reduce significant barriers to follow-up care. Outcome metrics will include patient satisfaction, stroke and all cause readmission rates, medication compliance, and outpatient follow-up rates. Beyond increasing access to care, we hope that utilizing remote sites for follow-up will increase communication and coordination with primary care providers at these sites, in essence building a remote care “neighborhood” for our patients and optimizing care after discharge.