Telestroke Across the Continuum of Care: Lessons from the COVID-19 Pandemic

Amy K Guzik; Sheryl Martin-Schild; Prasanna Tadi; Sherita N Chapman; Sami Al Kasab; Sharyl R Martini; Brett C Meyer; Bart M Demaerschalk; Marcella A Wozniak; Andrew M Southerland

doi:10.1016/j.jstrokecerebrovasdis.2021.105802

Telestroke Across the Continuum of Care: Lessons from the COVID-19 Pandemic

J Stroke Cerebrovasc Dis. 2021 Jul;30(7):105802. doi: 10.1016/j.jstrokecerebrovasdis.2021.105802. Epub 2021 Apr 8.

Authors

Affiliations

¹ Department of Neurology, Wake Forest University, Winston-Salem, NC, USA. Electronic address: [email protected].
² Department of Neurology, Touro Infirmary and New Orleans East Hospital, New Orleans, LA, USA.
³ Department of Neurology, Creighton University, Omaha, NE, USA.
⁴ Department of Neurology, University of Virginia, Charlottesville, VA, USA.
⁵ Department of Neurology, Medical University of South Carolina, Charleston, SC, USA.
⁶ Department of Neurology, Michael E. DeBakey VA Medical Center and Baylor College of Medicine, Houston, TX, USA.
⁷ Department of Neurosciences, University of California San Diego, San Diego, CA, USA.
⁸ Department of Neurology, Center for Connected Care, and Center for Digital Health, Mayo Clinic College of Medicine and Science, Phoenix, AZ, USA.
⁹ Department of Neurology, University of Maryland School of Medicine, Baltimore, MD, USA.
¹⁰ Department of Neurology, University of Virginia, Charlottesville, VA, USA; Department of Public Health Sciences, University of Virginia, Charlottesville, VA, USA.

PMID: 33866272
PMCID: PMC9760114
DOI: 10.1016/j.jstrokecerebrovasdis.2021.105802

Abstract

While use of telemedicine to guide emergent treatment of ischemic stroke is well established, the COVID-19 pandemic motivated the rapid expansion of care via telemedicine to provide consistent care while reducing patient and provider exposure and preserving personal protective equipment. Temporary changes in re-imbursement, inclusion of home office and patient home environments, and increased access to telehealth technologies by patients, health care staff and health care facilities were key to provide an environment for creative and consistent high-quality stroke care. The continuum of care via telestroke has broadened to include prehospital, inter-facility and intra-facility hospital-based services, stroke telerehabilitation, and ambulatory telestroke. However, disparities in technology access remain a challenge. Preservation of reimbursement and the reduction of regulatory burden that was initiated during the public health emergency will be necessary to maintain expanded patient access to the full complement of telestroke services. Here we outline many of these initiatives and discuss potential opportunities for optimal use of technology in stroke care through and beyond the pandemic.

Keywords: COVID-19 (4), Pandemic (5); Coronavirus (7); SARS CoV-2 (6); Stroke (8); Stroke care (9); Stroke delivery (10); Telemedicine (2); Teleneurology (3); Telestroke (1).

MeSH terms

COVID-19*
Continuity of Patient Care* / economics
Delivery of Health Care, Integrated* / economics
Fee-for-Service Plans
Health Care Costs
Healthcare Disparities
Humans
Insurance, Health, Reimbursement
Ischemic Stroke / diagnosis
Ischemic Stroke / economics
Ischemic Stroke / therapy*
Occupational Health
Outcome and Process Assessment, Health Care* / economics
Patient Safety
Telemedicine* / economics