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Kaiser Study Shows the Value of Telestroke Care

A telehealth platform launched in Kaiser Permanente's southern California region has helped boost tPA use and improve door-to-treatment times for stroke patients.

By Eric Wicklund

- One of the nation’s largest health networks is adding to the literature supporting the life-saving aspects of a telestroke program.

California-based Kaiser Permanente has released the results of a study, involving more than 2,500 patients diagnosed with acute ischemic stroke, that shows an almost 75 percent increase in timely use of a clot-dissolving drug following a telehealth consult with a specialist. In addition, patients receiving a telehealth consult were given a diagnostic imaging test 12 minutes sooner, and the drug was administered 11 minutes sooner – reducing the door-to-needle time to less than an hour.

“Our findings add to the existing body of evidence supporting the value of telestroke programs for improving tPA [tissue plasminogen activator] administration rates among ischemic stroke patients at hospitals which may have limited resources or access to neurological expertise,” Adam L. Sharp, MD, a researcher at Kaiser Permanente’s Southern California Department of Research & Evaluation and lead author of the study, said in a press release.

According to the researchers, previous studies of the southern California-based 14-hospital network had shown wide ranges of tPA use, leading executives to launch a telestroke program connecting the two tertiary care medical centers with in-house neurology departments and the 12 community medical centers with no on-site services.

The platform – one of the most highly used telehealth services in the country these days – enables small and rural healthcare providers to collaborate by real-time video with specialists and share diagnostic images of the patient’s brain. If a neurologist can view those images and examine a patient through the video portal, and then prescribe tPA within one hour of the onset of stroke symptoms, the patient’s recovery chances increase dramatically.

The study, conducted between July 2013 and January 2015, saw 2,657 patients treated in the health system for acute ischemic stroke, with tPA administration jumping from 6.3 percent to almost 11 percent. In addition, while eight out of the 10 community medical centers were less likely to administer tPA prior to using the telestroke platform, nine of those hospitals “were at least as likely to administer tPA to ischemic stroke patients as that highest-volume stroke center” once the platform was used, according to the study, published in The Permanente Journal.

The research team did note some limitations to the study, including that telestroke was used in only 24 percent of all stroke interventions during that time period – whether that’s because the patients were beyond the point where telestroke would have helped, or clinicians weren’t interested in using the platform, is uncertain. The study did not analyze clinician satisfaction with the platform, nor did it determine if tPA use improved clinical outcomes.

Still, the study did see a slight decrease in bleeding complications following treatment, and it noted reductions in reduced door-to-imaging time [56 minutes to 44 minutes] and door-to-needle time [66 minutes to 55 minutes].

“These findings have important implications for future delivery of stroke care,” the researchers concluded. “Particularly in hospitals with limited local resources and/or limited access to neurologic expertise, telestroke is an important tool to aid in the evaluation and treatment of potential stroke. We specifically found that unwarranted hospital variability in stroke care could be eliminated through a standardized telestroke program. Additionally, telestroke may aid in triage and transfer decisions and in identifying patients potentially eligible for endovascular intervention or patients who might otherwise benefit from transfer to a stroke center.”

Dig Deeper:

JAMA Report Shows Effectiveness of Mobile Telestroke Services

Stroke Prevention Study to Focus on mHealth Monitoring


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