Short Communication
Variation in patterns of telestroke usage during the COVID-19 pandemic

https://doi.org/10.1016/j.jstrokecerebrovasdis.2023.107036Get rights and content

Abstract

Objectives

Early in the pandemic, there was a substantial increase in telestroke uptake among hospitals. The motivations for using telestroke during the pandemic might have been different than for hospitals that adopted telestroke previously. We compared stroke care at hospitals that adopted telestroke prior to the pandemic to care at hospitals that adopted telestroke during the pandemic.

Materials and methods

Stroke episodes and telestroke use were identified in Medicare Fee-for-Service Data. Hospital and episode characteristics were compared between pre-pandemic (Jan. 2019–Mar. 2020) and pandemic (Apr. 2020–Dec. 2020) adopters.

Results

Hospital bed counts, critical access statuses, stroke volumes, clinical operating margins, shares of stroke care via telestroke, and vascular neurology consult rates did not differ significantly between pre-pandemic and pandemic-adopting hospitals. Hospitals that never adopted telestroke during the study period were more likely to be small critical access hospitals with low clinical operating margins.

Conclusions

Compared to hospitals that adopted telestroke before the pandemic, hospitals that adopted telestroke during the pandemic were similar in characteristics and how they used telestroke.

Section snippets

Sample of stroke and transient ischemic attack episodes

Using 100% Medicare Inpatient and Outpatient Standard Analytic Files, we identified all acute ischemic stroke or transient ischemic attack admissions in the US within the traditional fee-for-service Medicare program from January 2018 to December 2021. Admissions included inpatient or outpatient ED / observation stays in any short-term acute care or critical access hospital with a primary diagnosis for stroke / transient ischemic attack (TIA) (International Classification of Diseases, Ninth

Results

Of the 886 hospitals without telestroke as of January 2019, 108 subsequently introduced telestroke and 778 did not. Of the 108 that introduced telestroke, 42 (39%) introduced the service in the 15-month pre-pandemic period and 66 (61%) in the 9-month pandemic period (Fig. 1). Of the 66 hospitals that introduced it in the pandemic period, 38 (58%) hospitals introduced telestroke in three months (April–June of 2020).

Discussion

Contrary to our expectations, in a comparison of hospitals that adopted telestroke pre-pandemic to early-pandemic adopters, we found few differences in hospital characteristics, how telestroke was used, and whether telestroke was maintained for at least a year. We had hypothesized that hospitals that adopted telestroke during the pandemic would use more local neurologists, but we observe no significant differences in use of local neurologists and that average hospital-neurologist distances were

Grant support

Supported by grant R01-NS111952 from the National Institute of Neurological Disorders and Stroke.

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