TY - JOUR
T1 - Assimilation of Web-Based Urgent Stroke Evaluation
T2 - A Qualitative Study of Two Networks
AU - Singh, Rajendra
AU - Mathiassen, Lars
AU - Switzer, Jeffrey A.
AU - Adams, Robert J.
AU - Singh, Rajendra
N1 - Funding Information:
Based on purposive sampling [33], we organized this research as an exploratory, qualitative case study of 2 stroke networks in Georgia and South Carolina. Each network includes a hub—a comprehensive stroke center at the Georgia Regents University (GRU) and at the Medical University of South Carolina (MUSC)—and connected spokes (ie, rural hospitals supported by the hub). The two networks use the same technology (Remote Evaluation of Acute isCHemic stroke, REACH), they are of similar size and complexity (17 and 15 spokes, respectively), and they operate in similar contexts (providing services to EDs in rural hospitals in the southeast United States). This design allowed us to conduct cross-case comparisons [33,34] of how hub-related characteristics may influence telestroke assimilation across spokes.
Funding Information:
This research was funded by Genentech.
Publisher Copyright:
© 2014 JMIR Publications Inc. All right reserved.
PY - 2014/1
Y1 - 2014/1
N2 - Background: Stroke is a leading cause of death and serious, long-term disability across the world. Urgent stroke care treatment is time-sensitive and requires a stroke-trained neurologist for clinical diagnosis. Rural areas, where neurologists and stroke specialists are lacking, have a high incidence of stroke-related death and disability. By virtually connecting emergency department physicians in rural hospitals to regional medical centers for consultations, specialized Web-based stroke evaluation systems (telestroke) have helped address the challenge of urgent stroke care in underserved communities. However, many rural hospitals that have deployed telestroke have not fully assimilated this technology. Objective: The objective of this study was to explore potential sources of variations in the utilization of a Web-based telestroke system for urgent stroke evaluation and propose a telestroke assimilation model to improve stroke care performance. Methods: An exploratory, qualitative case study of two telestroke networks, each comprising an academic stroke center (hub) and connected rural hospitals (spokes), was conducted. Data were collected from 50 semistructured interviews with 40 stakeholders, telestroke usage logs from 32 spokes, site visits, published papers, and reports. Results: The two networks used identical technology (called Remote Evaluation of Acute isCHemic stroke, REACH) and were of similar size and complexity, but showed large variations in telestroke assimilation across spokes. Several observed hub- A nd spoke-related characteristics can explain these variations. The hub-related characteristics included telestroke institutionalization into stroke care, resources for the telestroke program, ongoing support for stroke readiness of spokes, telestroke performance monitoring, and continuous telestroke process improvement. The spoke-related characteristics included managerial telestroke championship, stroke center certification, dedicated telestroke coordinator, stroke committee of key stakeholders, local neurological expertise, and continuous telestroke process improvement. Conclusions: Rural hospitals can improve their stroke readiness with use of telestroke systems. However, they need to integrate the technology into their stroke delivery processes. A telestroke assimilation model may improve stroke care performance.
AB - Background: Stroke is a leading cause of death and serious, long-term disability across the world. Urgent stroke care treatment is time-sensitive and requires a stroke-trained neurologist for clinical diagnosis. Rural areas, where neurologists and stroke specialists are lacking, have a high incidence of stroke-related death and disability. By virtually connecting emergency department physicians in rural hospitals to regional medical centers for consultations, specialized Web-based stroke evaluation systems (telestroke) have helped address the challenge of urgent stroke care in underserved communities. However, many rural hospitals that have deployed telestroke have not fully assimilated this technology. Objective: The objective of this study was to explore potential sources of variations in the utilization of a Web-based telestroke system for urgent stroke evaluation and propose a telestroke assimilation model to improve stroke care performance. Methods: An exploratory, qualitative case study of two telestroke networks, each comprising an academic stroke center (hub) and connected rural hospitals (spokes), was conducted. Data were collected from 50 semistructured interviews with 40 stakeholders, telestroke usage logs from 32 spokes, site visits, published papers, and reports. Results: The two networks used identical technology (called Remote Evaluation of Acute isCHemic stroke, REACH) and were of similar size and complexity, but showed large variations in telestroke assimilation across spokes. Several observed hub- A nd spoke-related characteristics can explain these variations. The hub-related characteristics included telestroke institutionalization into stroke care, resources for the telestroke program, ongoing support for stroke readiness of spokes, telestroke performance monitoring, and continuous telestroke process improvement. The spoke-related characteristics included managerial telestroke championship, stroke center certification, dedicated telestroke coordinator, stroke committee of key stakeholders, local neurological expertise, and continuous telestroke process improvement. Conclusions: Rural hospitals can improve their stroke readiness with use of telestroke systems. However, they need to integrate the technology into their stroke delivery processes. A telestroke assimilation model may improve stroke care performance.
KW - Case study
KW - Information technology assimilation
KW - Stroke
KW - Telemedicine
KW - Telestroke
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U2 - 10.2196/medinform.3028
DO - 10.2196/medinform.3028
M3 - Article
AN - SCOPUS:84975510173
SN - 2291-9694
VL - 2
JO - JMIR Medical Informatics
JF - JMIR Medical Informatics
IS - 1
M1 - e6
ER -