Impact of the Veteran Health Administration National Telestroke Program’s Telestroke Consult Service on Inpatient Ischemic Stroke Quality Metrics
Brian Stamm1, Qing Tang2, Joanne Daggy2, Laura Myers4, Samantha Calcatera4, Katrina Spontak4, Jason Larson4, Lisa Nobel3, William Musser5, Lisa Hermann5, Teresa Damush4, Linda Williams4
1Neurology, Lieutenant Colonel Charles S. Kettles VA Medical Center; University of Michigan, 2Biostatistics and Health Data Science, 3Neurology, Indiana University School of Medicine, 4Richard L. Roudebush VA Medical Center, 5VA National Telestroke Program, Palo Alto VA Medical Center
Objective:
We sought to determine the impact of receiving an acute or subacute telestroke consult from the Veteran Health Administration (VHA) National Telestroke Program (NTSP) on accepted measures of inpatient quality of care.
Background:
In 2018, the VHA launched the NTSP acute telestroke consult service, increasing access to acute stroke expertise in rural and under-resourced facilities and decreasing interhospital transfers. In 2022, the VHA implemented a subacute consult service to improve inpatient stroke workup and management. It is unknown whether telestroke consult services are associated with improved inpatient quality of stroke care.
Design/Methods:
This was a retrospective cohort study of patients discharged from a VHA facility with diagnosis of ischemic stroke from 10/1/2021 through 6/30/2024. Outcomes included four discharge quality indicators: 1) medium/high potency statin, 2) antithrombotic medication, 3) carotid imaging performed prior to discharge, 4) anticoagulation for atrial fibrillation. Logistic regression with generalized estimating equations was employed to examine the association of receiving an NTSP consult (acute or subacute vs none) and the odds of passing each quality indicator among those eligible, adjusted for age and NIHSS. The model for carotid imaging was further adjusted using inverse probability weighting.
Results:
From 22 VHA NTSP facilities (11 that implemented the subacute consult and 11 that did not), 1082 Veterans had an ischemic stroke diagnosis. The mean NIHSS score was 3.2 (SD 4.0), and 28% of stroke admissions had no NIHSS recorded. NIHSS missingness was lower among those with receipt of an NTSP consult (5%) versus no consult (38%; P<.001). Receipt of acute or subacute NTSP consult was associated with higher odds of receiving carotid artery imaging prior to discharge (aOR 3.24, 95%CI 1.74-6.03, P <.001).
Conclusions:
Receiving an NTSP consult was associated with higher quality of inpatient stroke care, with higher NIHSS documentation and odds of receiving carotid artery imaging.
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