Background: Telestroke services allow under-resourced
hospitals to gain access to stroke specialists to improve
the timeliness and quality of stroke care. However,
limited research is available on how telestroke networks
are developed, implemented, and sustained. Understanding
the process of telestroke network implementation is
critical for developing implementation guidance and for
evaluating determinants of implementation effectiveness.
Objective: This study examines the adoption decision
process and strategies employed during telestroke network
development, implementation, and sustainability.
Research Design: We interviewed representatives from five
telestroke networks in North Carolina. Each network
consisted of a distant site from which stroke
consultation was provided and multiple originating sites
at which the patient presented.
Subjects: The sample included 24 telestroke
representatives (i.e., 5 network representatives and 19
hospital representatives) and 4 hospital representatives
who do not participate in telestroke (i.e., nonadopters).
Measures: The qualitative measures used in this study
were based on Roger's stages of the innovation process in
organizations. Stages included agenda setting and
matching (pre-implementation), restructuring, redefining,
and clarifying (implementation), and routinizing
Results: Distant and originating sites employed various
strategies in the pre-implementation, implementation, and
sustainability stages. Although there are many
commonalities across networks, there are also important
differences, for example in terms of network structure,
quality monitoring, and performance feedback. Some
nonadopter hospitals reported difficulty accessing
information about telestroke, suggesting that some
hospitals are not reached by telestroke network marketing
Conclusions: Identifying and/or tailoring strategies to
support the needs of hospitals in different telestroke
network models should be a priority for future research.