AcuteCare Telemedicine Blog

Telestroke Is Proving to Be a Saver

Telestroke programs have been proving themselves very effective in bringing critical care to patients in rural areas throughout the country for a few years now and testimonials about patients who have benefitted from advanced, specialized treatment via telemedicine technology are becoming more common place. Receiving advanced stroke care faster is saving lives and resulting in less debilitating recoveries. Telemedicine programs help extend higher quality care to patients living in more rural areas, but some have questioned whether the cost to implement and maintain the technology and services has been thoroughly vetted and considered.

According to a new study by Mayo Clinic researchers, a telestroke program is leading to lower cost. Stroke patients living in rural areas who receive care via a telestroke network see, on average, nearly $1,500 in lower costs over their lifetime compared to stroke patients who do not receive telestroke care, researchers found. The savings are primarily attributed to reduced resource utilization, including nursing home care and inpatient rehabilitation. Researchers also estimate that, compared with no network, a modeled telestroke system consisting of a single hub and seven spoke hospitals may result in the appropriate use of more clot-busting drugs, more catheter based interventional procedures and other stroke therapies, with more stroke patients discharged home independently.

Despite the considerable upfront and maintenance expenses, the entire network of hospitals realizes a greater total cost savings, officials say. “This study shows that a hub-and-spoke telestroke network is not only cost-effective from the societal perspective, but it’s cost-saving,” said neurologist Bart Demaerschalk, MD, director of the Mayo Clinic Telestroke Program, and lead investigator of the study, in a press statement. “We can assess medical services, like telemedicine, in terms of the net costs to society for each year of life gained.”

“The results serve to inform government organizations, insurers, healthcare institutions, practitioners, patients and the general public that an upfront investment in telemedicine and stroke network personnel can be justified in our health system,” added Demaerschalk.

Today there are 10 million people utilizing telemedicine and the number will continue to rise as more state legislatures and medical insurance providers realize the benefits to providing payment and reimbursements for telestroke and telehealth services.

Stroke Care Requires a Change in Behavior

More than 2 million brain cells die each minute during a stroke. Reducing the time from a patient’s arrival in the emergency room to the administration of the clot-busting agent tPA, the so-called “door to needle” time, is paramount. A major obstacle to treatment outside the direct influence of the physician is when individuals with stroke symptoms delay seeking treatment.

The public is not without knowledge of stroke. Multiple websites and sources help people recognize stroke symptoms. These include academic sites such as the Mayo Clinic, commercial sites like WebMD, and government resources from the NINDS (National Institute of Neurological Disorders and Stroke). Public service announcements have been used to improve the awareness of stroke symptoms. More importantly, the time sensitive nature of stroke treatment has been brought to the forefront as a focus since the 1990’s. Education does help; the percent of patients arriving to the ER within 24 hours of stroke onset nearly doubled following a 1992 campaign stressing the need for early treatment.

However, in 1996, following FDA approval of tPA use with a 3 hour time limit, the role of timeliness in stroke treatment became even more crucial. Whereas public awareness of stroke symptoms had improved, education campaigns had not sufficiently decreased the time to respond. Even today, many patients are still missing the benefits of immediate treatment with tPA. Education has achieved its goal, making the risks of stroke and the availability of treatment understood, but changing behavior is not as easy. The public is not unafraid of stroke; people may simply be too afraid of the diagnosis. Delays result from the inability to accept that a stroke is actually occurring. Furthermore, previous unfavorable experiences in receiving care or suboptimal outcomes can influence future behavior.

This concept is supported by data in patients with myocardial infarctions (heart attack) which suggest psychological factors may be at play. The extrapolation of this behavior to stroke is not difficult given the typical presentation of stroke is not painful and often not immediately disabling. Society must reinforce the immediate use of the 911 system and healthcare providers must endeavor to give every stroke event the best possible outcome. Otherwise, patients who “wait and see” if it is really going to become a problem suffer as brain cells die.