Statewide Model for Stroke Telemedicine Recommended for Arizona - Mayo Clinic study finds disparity in stroke care between rural and urban areas.
A rural-urban disparity exists in Arizona when it comes to expedient delivery of emergency stroke care "and at risk are the more than one-third residents who live outside of metropolitan Phoenix or Tucson.
Some 10,000 Arizonans suffer an acute stroke each year, and those living in Phoenix or Tucson have the advantage of availability to primary stroke centers (PSCs), where they potentially can receive timely medical assessment and treatment.
This is in stark contrast to rural communities, where equivalent access to stroke expertise and resources is generally not available "a condition mirrored nationally. PSCs represent a relatively small proportion of U.S. hospitals in general, and are most often located in urban areas, contributing to the difference.
A Mayo Clinic-led study has examined this disparity and recommended implementation of a five-year "stroke telemedicine plan" for rural Arizona residents.
"The remote communities in Arizona are greatly underserved in terms of the availability of neurologists and the delivery of emergency stroke care," said lead investigator of the study, Bart M. Demaerschalk, M.D., Mayo Clinic neurologist and director of the Stroke Telemedicine for Arizona Rural Residents Network.
The plan, developed jointly by Arizona Department of Health Services and Mayo Clinic in Arizona, divides Arizona into two regions, each with a one-hub to three-spoke ratio. Phoenix PSCs would serve northern Arizona and Tucson PSCs would serve the southern portion. Up to eight Phoenix PSCs would service 26 remote hospital emergency departments and up to three Tucson PSCs would deliver service to nine emergency departments.
It works like this: A call is placed from a remote participating hospital emergency department to one of the on-call "hub" vascular neurologists, who is equipped with a smart phone and a laptop with a webcam. This allows the physician to be located anywhere "while performing a telemedicine consultation and review of brain CT scans with the patient and physicians in the rural emergency room. A diagnosis of stroke is confirmed and appropriate treatment is then recommended, which may include the clot-busting drug, tPA, which can be administered to patients whose symptoms qualify for the powerful medication when a clot blocks blood flow to the brain.
Dr. Demaerschalk noted in his study that although 18 percent of acute stroke patients in metropolitan areas receive Thrombolysis (treatment to dissolve blood clots), the rate in rural Arizona (on par with the national averages) is just 2 to 4 percent.
In the study, 24 of the 35 hospitals in Arizona potentially eligible for the survey participated, and of those, only one had neurologists on call 24/7.
While telemedicine is not new to Arizona, having been in existence since 1996, the services have largely been non-emergency in nature, such a teleradiology, teledermatology and telebehavioral health. Emergency stroke telemedicine is not currently available in those existing areas.
Two of the remote hospitals surveyed for the study "in Kingman and Yuma "previously served as stroke telemedicine spoke centers with the Mayo Clinic Hospital PSC hub in a successful Arizona Department of Health Services-funded clinical trial.
"It is our experience that telemedicine may be an effective method to provide expert care to stroke patients in rural areas," says Dr. Demaerschalk. "Development of a state network model for others to consider is the first step toward fulfilling this mandate." He also notes that the majority of the remote Arizona emergency departments surveyed for the study expressed interest in participating as spoke sites in a statewide stroke telemedicine network initiative, and that business plan development is under way.
The study was published in Telemedicine and e-Health, the official journal of the American Telemedicine Association and the leading international, peer-reviewed journal combining medicine, telecommunications and information technology.
Co-investigators in the study include Madeline L. Miley, B.S. (cand.); Nicole S. Olmstead M.P.H., Terry Ellen Kiernan, M.S.N.; Doren A, Corday, B.S.; Vatsal Chikani, M.P.H. and Bentley J. Bobrow, M.D.