title: Impact of Telemedicine on Access to Acute Stroke Care in the State of Texas.
abstract: BACKGROUND
  To examine the impact of telemedicine on access to acute stroke care and expertise in the state of Texas.
  
  
  METHODS
  Texas hospitals were surveyed using a standard questionnaire and categorized as: (1) stand-alone Primary Stroke Centers not using telemedicine for acute stroke care, (2) Primary Stroke Centers using telemedicine for acute stroke care, (3) non-Primary Stroke Center hospitals using telemedicine for acute stroke care, or (4) non-Primary Stroke Center hospitals not using telemedicine for acute stroke care. Population data were obtained from the US Census Bureau and the Neilson Claritas Demographic Estimation Program. Access within 60 minutes to a designated facility was calculated at the block group level.
  
  
  RESULTS
  Over 75% of Texans had 60-minute access to a stand-alone Primary Stroke Center. Including Primary Stroke Centers using telemedicine increased access by 6.5%. Adding non- Primary Stroke Centers that use telemedicine for acute stroke care provided 60-minute access for an additional 2% of Texans, leaving 16% of Texans without 60-minute access to acute stroke care. Approximately 62% of Texans had 60-minute access to more than one type of facility that provided acute stroke care.
  
  
  CONCLUSIONS
  The use of telemedicine in the state of Texas brought 60-minute access to >2 million Texans who otherwise would not have had access to acute stroke expertise. Our findings demonstrate that using telemedicine for acute stroke has the ability to provide neurologically underserved areas access to acute stroke care.
authors.affiliation: Stroke Program, Department of Neurology, University of Texas-Houston Memorial Hermann Medical Center, Houston, TX 77030.
authors.forename: Tzu-Ching
authors.initials: TC
authors.lastname: Wu
authors.affiliation: Department of Neurology, School of Medicine, University of Alabama at Birmingham, Birmingham, AL 35294.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Lyerly
authors.affiliation: Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, AL 35294 ; Health Services and Outcomes Research Center for Outcome and Effectiveness Research and Education (COERE),University of Alabama at Birmingham, Birmingham, AL 35294 ; Center of Excellence in Comparative Effectiveness Research for Eliminating Disparities (CERED) Minority Health & Health Disparities Research Center (MHRC),University of Alabama at Birmingham, Birmingham, AL 35294.
authors.forename: Karen C
authors.initials: KC
authors.lastname: Albright
authors.affiliation: Stroke Program, Department of Neurology, University of Texas-Houston Memorial Hermann Medical Center, Houston, TX 77030.
authors.forename: Eric
authors.initials: E
authors.lastname: Ward
authors.affiliation: Stroke Program, Department of Neurology, University of Texas-Houston Memorial Hermann Medical Center, Houston, TX 77030.
authors.forename: Amanda
authors.initials: A
authors.lastname: Hassler
authors.affiliation: Stroke Program, Department of Neurology, University of Texas-Houston Memorial Hermann Medical Center, Houston, TX 77030.
authors.forename: Jessica
authors.initials: J
authors.lastname: Messier
authors.affiliation: Department of Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA 19104.
authors.forename: Catherine
authors.initials: C
authors.lastname: Wolff
authors.affiliation: Department of Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA 19104.
authors.forename: Charles C
authors.initials: CC
authors.lastname: Brannas
authors.affiliation: Stroke Program, Department of Neurology, University of Texas-Houston Memorial Hermann Medical Center, Houston, TX 77030.
authors.forename: Sean I
authors.initials: SI
authors.lastname: Savitz
authors.affiliation: Department of Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA 19104 ; Department of Emergency Medicine, University of Pennsylvania, Philadelphia, PA 19104.
authors.forename: Brendan G
authors.initials: BG
authors.lastname: Carr
keywords: Telemedicine; access to care; ischemic stroke