Trial reportThe Permanente journal2016
Safe and Effective Implementation of Telestroke in a US Community Hospital Setting.
Trial report in The Permanente journal, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 12 papers.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
12 citing papers in PubMed, 20 citations in OpenAlex.
- Cost-utility tele-stroke in adults with acute ischemic stroke. A systematic review.Public health in practice (Oxford, England) · 2025Review
- Real-time video analysis allows the identification of large vessel occlusion in patients with suspected stroke: feasibility trial of a "telestroke" pathway in Northwestern Switzerland.Frontiers in neurology · 2023Article
- Telemedicine across the continuum of neonatal-perinatal care.Seminars in fetal & neonatal medicine · 2022Review
- Emergency Departments' Uptake of Telehealth for Stroke Versus Pediatric Care: Observational Study.Journal of medical Internet research · 2022Observational
- Telehealth in emergency medicine: A consensus conference to map the intersection of telehealth and emergency medicine.Academic emergency medicine : official journal of the Society for Academic Emergency Medicine · 2021Article
- National Trends in Telestroke Utilization in a US Commercial Platform Prior to the COVID-19 Pandemic.Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association · 2021Article
- Association of Hospital Telestroke Adoption With Changes in Initial Hospital Presentation and Transfers Among Patients With Stroke and Transient Ischemic Attacks.JAMA network open · 2021Article
- Factors associated with emergency department adoption of telemedicine: 2014 to 2018.Journal of the American College of Emergency Physicians open · 2020Article
- Trends in Telestroke Care Delivery: A 15-Year Experience of an Academic Hub and Its Network of Spokes.Circulation. Cardiovascular quality and outcomes · 2020Article
- Impact of Statewide Telestroke Network on Acute Stroke Treatment in Hawai'i.Hawai'i journal of health & social welfare · 2019Article
- Frequent Hub-Spoke Contact Is Associated with Improved Spoke Hospital Performance: Results from the Massachusetts General Hospital Telestroke Network.Telemedicine journal and e-health : the official journal of the American Telemedicine Association · 2018Article
- Impact of "Stroke Code"-Rapid Response Team: An Attempt to Improve Intravenous Thrombolysis Rate and to Shorten Door-to-Needle Time in Acute Ischemic Stroke.Indian journal of critical care medicine : peer-reviewed, official publication of Indian Society of Critical Care Medicine · 2018Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
8 authors at 5 institutions in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
contextThere is substantial hospital-level variation in use of tissue plasminogen activator (tPA) for treatment of acute ischemic stroke. Telestroke services can bring neurologic expertise to hospitals with fewer resources.
objectiveTo determine whether implementation of a telestroke intervention in a large integrated health system would lead to increased tPA utilization and would change rates of hemorrhagic complications.
designA stepped-wedge cluster randomized trial of 11 community hospitals connected to 2 tertiary care centers via telestroke, implemented at each hospital incrementally during a 1-year period. We examined pre- and postimplementation data from July 2013 through January 2015. A 2-level mixed-effects logistic regression model accounted for the staggered rollout.
main outcome measuresReceipt of tPA. Secondary outcome was the rate of significant hemorrhagic complications.
resultsOf the 2657 patients, demographic and clinical characteristics were similar in pre- and postintervention cohorts. Utilization of tPA increased from 6.3% before the intervention to 10.9% after the intervention, without a significant change in complication rates. Postintervention patients were more likely to receive tPA than were preintervention patients (odds ratio = 2.0; 95% confidence interval = 1.2-3.4). Before implementation, 8 of the 10 community hospitals were significantly less likely to administer tPA than the highest-volume tertiary care center; however, after implementation, 9 of the 10 were at least as likely to administer tPA as the highest-volume center.
conclusionTelestroke implementation in a regional integrated health system was safe and effective. Community hospitals' rates of tPA utilization quickly increased and were similar to the largest-volume tertiary care center.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.