The status of telestroke in the United States: a survey of currently active stroke telemedicine programs.
OBJECTIVE
Little is known about adoption or success of telestroke networks outside of published or federally funded programs. Under contract to the Health Resource Services Administration, we conducted an environmental scan of telestroke programs in the United States.


METHODS
An analyst contacted all potential programs identified in comprehensive online searches, interviewed respondents, and collected response data about structural and functional components of currently operating telestroke programs.


RESULTS
Among 97 potential programs contacted, 56 programs had confirmed telestroke activity, and 38 programs (68%) from 27 states participated. Hospital and community characteristics of nonparticipating programs were similar to those of participating ones. The top 3 clinical needs met by the telestroke were emergency department consultation (100%), patient triage (83.8%), and inpatient teleconsultation (46.0%). Telestroke programs were in operation a median of 2.44 years (interquartile range, 1.36-3.44 years); 94.6% used 2-way, real-time interactive video plus imaging, but only 44% used dedicated telemedicine consultation software. The mean number of spokes per hub increased significantly from 2007 to 2008 to 2009 (3.78 versus 7.60; P<0.05), and >80% of spoke sites were rural or small hospitals. Reimbursement was absent for >40% of sites. Sites rated inability to obtain physician licensure (27.77%), lack of program funds (27.77%), and lack of reimbursement (19.44%) as the most important barriers to program growth.


CONCLUSIONS
Telestroke is a widespread and growing practice model. Important barriers to expansion amenable to change relate to organizational, technical, and educational domains and external economic and regulatory forces.
Department of Neurology and Neurosurgery, Federal University of São Paulo, São Paulo, Brazil. giselesampaio@hotmail.com
Gisele S
GS
Silva
Shawn
S
Farrell
Emma
E
Shandra
Anand
A
Viswanathan
Lee H
LH
Schwamm
D003199:Computer Systems; D003406:Credentialing; D004282:Documentation; D006761:Hospitals; D006801:Humans; D007348:Insurance, Health / Q000191:economics / Q000639:trends; D008004:Licensure; D009862:Online Systems; D012017:Referral and Consultation; D012051:Reimbursement Mechanisms; D019114:Remote Consultation; D020521:Stroke / Q000175:diagnosis / Q000628:therapy*; D017216:Telemedicine / Q000191:economics / Q000706:statistics & numerical data / Q000639:trends*; D013689:Telephone; D014481:United States; D049269:Videoconferencing