Assimilation of Web-Based Urgent Stroke Evaluation: A Qualitative Study of Two Networks
BackgroundStroke is a leading cause of death and serious, long-term disability across the world. Urgent stroke care treatment is time-sensitive and requires a stroke-trained neurologist for clinical diagnosis. Rural areas, where neurologists and stroke specialists are lacking, have a high incidence...
| Main Authors: | , , , |
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| Format: | Article |
| Language: | English |
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JMIR Publications
2014-04-01
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| Series: | JMIR Medical Informatics |
| Online Access: | http://medinform.jmir.org/2014/1/e6/ |
| _version_ | 1798014258719490048 |
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| author | Singh, Rajendra Mathiassen, Lars Switzer, Jeffrey A Adams, Robert J |
| author_facet | Singh, Rajendra Mathiassen, Lars Switzer, Jeffrey A Adams, Robert J |
| author_sort | Singh, Rajendra |
| collection | DOAJ |
| description | BackgroundStroke is a leading cause of death and serious, long-term disability across the world. Urgent stroke care treatment is time-sensitive and requires a stroke-trained neurologist for clinical diagnosis. Rural areas, where neurologists and stroke specialists are lacking, have a high incidence of stroke-related death and disability. By virtually connecting emergency department physicians in rural hospitals to regional medical centers for consultations, specialized Web-based stroke evaluation systems (telestroke) have helped address the challenge of urgent stroke care in underserved communities. However, many rural hospitals that have deployed telestroke have not fully assimilated this technology.
ObjectiveThe objective of this study was to explore potential sources of variations in the utilization of a Web-based telestroke system for urgent stroke evaluation and propose a telestroke assimilation model to improve stroke care performance.
MethodsAn exploratory, qualitative case study of two telestroke networks, each comprising an academic stroke center (hub) and connected rural hospitals (spokes), was conducted. Data were collected from 50 semistructured interviews with 40 stakeholders, telestroke usage logs from 32 spokes, site visits, published papers, and reports.
ResultsThe two networks used identical technology (called Remote Evaluation of Acute isCHemic stroke, REACH) and were of similar size and complexity, but showed large variations in telestroke assimilation across spokes. Several observed hub- and spoke-related characteristics can explain these variations. The hub-related characteristics included telestroke institutionalization into stroke care, resources for the telestroke program, ongoing support for stroke readiness of spokes, telestroke performance monitoring, and continuous telestroke process improvement. The spoke-related characteristics included managerial telestroke championship, stroke center certification, dedicated telestroke coordinator, stroke committee of key stakeholders, local neurological expertise, and continuous telestroke process improvement.
ConclusionsRural hospitals can improve their stroke readiness with use of telestroke systems. However, they need to integrate the technology into their stroke delivery processes. A telestroke assimilation model may improve stroke care performance. |
| first_indexed | 2024-04-11T15:15:48Z |
| format | Article |
| id | doaj.art-39ae4934ef174a928d38f2fb59a2bb70 |
| institution | Directory Open Access Journal |
| issn | 2291-9694 |
| language | English |
| last_indexed | 2024-04-11T15:15:48Z |
| publishDate | 2014-04-01 |
| publisher | JMIR Publications |
| record_format | Article |
| series | JMIR Medical Informatics |
| spelling | doaj.art-39ae4934ef174a928d38f2fb59a2bb702022-12-22T04:16:30ZengJMIR PublicationsJMIR Medical Informatics2291-96942014-04-0121e610.2196/medinform.3028Assimilation of Web-Based Urgent Stroke Evaluation: A Qualitative Study of Two NetworksSingh, RajendraMathiassen, LarsSwitzer, Jeffrey AAdams, Robert JBackgroundStroke is a leading cause of death and serious, long-term disability across the world. Urgent stroke care treatment is time-sensitive and requires a stroke-trained neurologist for clinical diagnosis. Rural areas, where neurologists and stroke specialists are lacking, have a high incidence of stroke-related death and disability. By virtually connecting emergency department physicians in rural hospitals to regional medical centers for consultations, specialized Web-based stroke evaluation systems (telestroke) have helped address the challenge of urgent stroke care in underserved communities. However, many rural hospitals that have deployed telestroke have not fully assimilated this technology. ObjectiveThe objective of this study was to explore potential sources of variations in the utilization of a Web-based telestroke system for urgent stroke evaluation and propose a telestroke assimilation model to improve stroke care performance. MethodsAn exploratory, qualitative case study of two telestroke networks, each comprising an academic stroke center (hub) and connected rural hospitals (spokes), was conducted. Data were collected from 50 semistructured interviews with 40 stakeholders, telestroke usage logs from 32 spokes, site visits, published papers, and reports. ResultsThe two networks used identical technology (called Remote Evaluation of Acute isCHemic stroke, REACH) and were of similar size and complexity, but showed large variations in telestroke assimilation across spokes. Several observed hub- and spoke-related characteristics can explain these variations. The hub-related characteristics included telestroke institutionalization into stroke care, resources for the telestroke program, ongoing support for stroke readiness of spokes, telestroke performance monitoring, and continuous telestroke process improvement. The spoke-related characteristics included managerial telestroke championship, stroke center certification, dedicated telestroke coordinator, stroke committee of key stakeholders, local neurological expertise, and continuous telestroke process improvement. ConclusionsRural hospitals can improve their stroke readiness with use of telestroke systems. However, they need to integrate the technology into their stroke delivery processes. A telestroke assimilation model may improve stroke care performance.http://medinform.jmir.org/2014/1/e6/ |
| spellingShingle | Singh, Rajendra Mathiassen, Lars Switzer, Jeffrey A Adams, Robert J Assimilation of Web-Based Urgent Stroke Evaluation: A Qualitative Study of Two Networks JMIR Medical Informatics |
| title | Assimilation of Web-Based Urgent Stroke Evaluation: A Qualitative Study of Two Networks |
| title_full | Assimilation of Web-Based Urgent Stroke Evaluation: A Qualitative Study of Two Networks |
| title_fullStr | Assimilation of Web-Based Urgent Stroke Evaluation: A Qualitative Study of Two Networks |
| title_full_unstemmed | Assimilation of Web-Based Urgent Stroke Evaluation: A Qualitative Study of Two Networks |
| title_short | Assimilation of Web-Based Urgent Stroke Evaluation: A Qualitative Study of Two Networks |
| title_sort | assimilation of web based urgent stroke evaluation a qualitative study of two networks |
| url | http://medinform.jmir.org/2014/1/e6/ |
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