Quality monitoring in telestroke networks: real-world insights from survey response data and literature review.

Background and aims: The objective of telestroke services is to enhance the quality of stroke care delivered to remote locations. The American Heart Association/ American Stroke Association (AHA/ASA) and the European Stroke Organization (ESO) have issued recommendations for quality monitoring in telestroke. To provide real-world insights, our study analyzed data on quality monitoring practices among telestroke networks. Methodology: This is a secondary analysis of a global telestroke survey previously conducted by our group. The focus of the current analysis was on reported quality metrics. We also reviewed articles from our prior systematic review (SR) of the literature on telestroke networks to extract quality metrics from published data and compared these with those reported in survey responses. Results: Eighty-eight of 254 networks responded to the survey. The SR analyzed 92 studies describing 64 acute telestroke networks across 17 countries. Quality monitoring was performed in 64 of 88 surveyed networks (72%), and it was described in all networks identified in the published literature. The most frequently reported performance indicator across both data sources was thrombolysis rate (93% in survey, 87% in SR). Other recommended indicators were reported less frequently in both the survey and the SR, with recanalization rate reported as 54% vs. 35%, discharge NIHSS as 65% vs. 1%, and in-hospital mortality as 78% vs. 31%, respectively. Conclusion: Our study is the first real-world insight into the state of quality monitoring in telestroke, both from peer-reviewed literature and self-reported data. The observed heterogeneity and low uptake of recommended quality indicators highlight the potential need for consensus on a standardized minimal quality monitoring dataset to facilitate feasible quality monitoring and comparison of outcomes across networks.