Expansion of telestroke services improves quality of care provided in super rural areas

Donglan Zhang, Guijing Wang, Weiming Zhu, Janani R. Thapa, Jeffrey A. Switzer, David C. Hess, Matthew L. Smith, Matthew D. Ritchey

Research output: Contribution to journalArticlepeer-review

19 Scopus citations


Telestroke is a telemedicine intervention that facilitates communication between stroke centers and lower-resourced facilities to optimize acute stroke management. Using administrative claims data, we assessed trends in telestroke use among fee-for-service Medicare beneficiaries with acute ischemic stroke and the association between providing telestroke services and intravenous tissue plasminogen activator (IV tPA) and mechanical thrombectomy use, mortality, and medical expenditures, by urban versus rural county of residence in the period 2008–15. The proportion of ischemic stroke cases receiving telestroke increased from 0.4 to 3.8 per 1,000 cases, with usage highest among younger, male, non-Hispanic white, and patients in rural or super rural areas (super rural is the bottom quartile of rural areas. Compared with patients receiving usual care, those receiving telestroke had greater IV tPA and mechanical thrombectomy use regardless of county type, while those in super rural counties had lower thirty-day all-cause mortality. Despite increased telestroke use, rural patients remained less likely than urban patients to receive IV tPA. The findings suggest that telestroke service expansion efforts have increased, especially in rural and super rural counties, and have improved outcomes.

Original languageEnglish (US)
Pages (from-to)2005-2013
Number of pages9
JournalHealth Affairs
Issue number12
StatePublished - Dec 2018

ASJC Scopus subject areas

  • Health Policy


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