Telehealth for Heart Attack and Stroke in Rural Hospitals
The primary purpose of this project is to examine telehealth for heart attack and stroke in national samples of hospitals by reviewing trends and factors in adoption of these telehealth services and implementation strategies across levels of rurality. This project involves two parts: 1) using existing data sets to compare telehealth adoption trends for heart attack and stroke among urban and hospitals within the rural continuum and will examine whether factors found in our previous North Carolina study—for example, delivery system affiliation, Critical Access Hospital status, and presence of other telehealth services—are important nationally for understanding adoption; and 2) collecting survey data to focus specifically on telestroke in rural hospitals across the U.S.
The survey will enable characterization of telestroke care processes (e.g., hub-and-spoke/third-party vendor, processes for transferring patients) and implementation strategies (e.g., stroke champions, redefining roles), informed by the American Telemedicine Association's telestroke guidelines and will examine how the guidelines are operationalized and whether level of rurality and health system affiliation are associated with differences in operationalization of the guidelines. Secondary data analysis will use 2010-2015 data from Dorenfest Database, American Hospital Association annual survey, Healthcare Cost Report Information System, and population characteristics from the Centers of Disease Control and Prevention's WONDER database. Analyses will examine trends between urban and rural hospitals as well as between categories of rural hospitals. The datasets including important community-level variables and hospital-level variables. Zip codes and RUCA codes will be used to classify rural hospitals for the sample. Using a list of rural hospital closures since, hospitals that provided telehealth for heart attack and/or stroke but have since closed will be identified. Secondary data will be complemented with a brief survey of rural hospitals specifically about telestroke services. Targeted respondents will be hospital stroke coordinators. The survey will capture data about telestroke infrastructure, processes, and implementation strategies.