Abstract TP62: Community Readiness Assessment Of Pre-hospital Telestroke Services In The Ambulance

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Background: We are implementing telemedicine in the ambulance to help retain more stroke patients in rural community hospitals and improve thrombolytic treatment times. Our objective was to assess community acceptability of prehospital telestroke services in rural communities on Oahu and identify patient-centered goals. Methods: Data were collected through a mixed method survey on Oahu using a short Likert-scale questionnaire followed by a semi-structured interview. Data were summarized by descriptive and inferential statistics. Comparisons between rural and urban groups were made by chi-square analysis and Wilcoxon rank-sum two-tailed test. Rural communities were defined as those with >45 min drive time to a Comprehensive Stroke Center. Interviews were transcribed, coded, and analyzed using inductive and deductive methods. Results: Responses were collected from 263 Oahu residents (66.0% female; 47.3% age 35-64; 51.0% rural residents) who were representative of the island population (39.3% Asian; 32.4% Native Hawaiian/Pacific Islander; 44.3% White) and 29 interviews were conducted. Most respondents were comfortable using telemedicine in the ambulance (65.1%) and believed that it would improve the emergency care they receive (65.6%). Most respondents would feel more comfortable staying at their local hospital if they have access to a specialist by telemedicine (74.7%). There were no significant differences between rural and urban respondents’ impressions of telemedicine. Compared to urban respondents, rural respondents were less confident in their local hospital being capable of providing high quality medical care (67.4% rural vs 83.0% urban, p < 0.01) or stroke care (65.9% vs 83.9%, p < 0.001) and more likely to believe they would receive better stroke care outside of their local area (53.1% vs 36.0%, p < 0.05). Conclusions: Most respondents support use of prehospital telemedicine. Rural residents were less likely to perceive their local hospital could provide high quality stroke care and had a less favorable impression of using telemedicine to avert EMS bypass of the local hospital. These findings suggest a potential misalignment of the project goal with some patients’ goal to use EMS to bypass rural hospitals for stroke care.