Telestroke Adoption, Cost, and Quality in Hospitals in North Carolina
There is some evidence to suggest that telestroke services can provide care comparable to in-person services, while keeping patients in their community. However, little is known about how hospital and community characteristics influence telestroke adoption or how telestroke program characteristics influence costs and quality of telestroke services. To address this need, the proposed project will examine hospitals in NC to: 1) identify all hospitals providing telestroke services and characterize the structure (e.g., size, ownership), market (e.g., distance to nearest hospital with stroke services), and community characteristics (e.g., population size, income) of these hospitals using secondary data; 2) compare these structural, market, and community characteristics of hospitals providing telestroke to hospitals that are not providing telestroke; and 3) within a sample of hospitals with telestroke programs, examine associations between telestroke program structural characteristics, process measures (e.g., door-to-needle time), quality measures (e.g., patients with complications), and costs (e.g., capital and operational) using a combination of secondary and primary data.
The project is policy relevant because it will begin to explore hospital, market, and community characteristics associated with telestroke adoption and provide insight into why some telestroke programs are more efficient and effective than others. This knowledge can be used by hospital leaders and policymakers to better understand barriers and facilitators to telestroke adoption and strategies for promoting sustainability. Also, because the project will identify all hospitals in NC offering telestroke, it will support future studies using claims data and/or data from electronic health records to assess cost of care and longer-term patient outcomes.