Abstract MP27: Telestroke Capacity and Outcomes for Patients With Stroke

Abstract

Background: Telestroke is increasingly used by hospitals, but there has been limited research on its impact on treatment and outcomes. Methods: Using a 100% sample of traditional Medicare beneficiaries over a 10-year period, we compared the care patterns and outcomes of acute ischemic stroke admissions that first presented to hospitals with telestroke capacity to matched admissions in control hospitals without telestroke capacity. Matching was based on sociodemographic and clinical characteristics, hospital characteristics, and month and year of admission. Our primary outcomes were receipt of reperfusion treatment through thrombolysis with alteplase or thrombectomy, mortality at 30 days from admission, spending through 90 days from admission, and functional status as measured by days spent in community living after discharge. Results: Over the period January 2008 through June 2017, there were 87,338 ischemic stroke admissions cared for at 643 telestroke hospitals of which 76,636 (88%) were matched to an admission at a control hospital. Compared to control admissions, admissions that started in telestroke hospitals had higher rates of reperfusion treatment (6.76% and 5.98%; difference 0.78, 95% CI 0.54 to 1.03, p<.001) and lower mortality (mortality 30 days from admission was 13.12% vs 13.62%; difference 0.50, 95% CI 0.17 to 0.83, p=.003). There were no differences in functional status and spending. Increases in reperfusion treatment were largest in the lowest-volume hospitals, among rural residents, and patients age 85 years and older. Conclusions: Patients with ischemic stroke treated at hospitals with telestroke capacity were more likely to receive reperfusion treatment and had lower 30-day mortality.