Objective:

To identify advantages and barriers to telestroke network optimization in rural critical access hospitals.

Background:

Utilization rates of acute stroke treatments and clinical outcomes among rural residents continue to lag behind those of their urban counterparts. Although access to specialized care via telestroke among rural populations has been shown to improve acute stroke therapy delivery and reduce patient mortality, optimization of telestroke networks remains understudied.

Design/Methods:

The West Virginia University Rural Tele-Emergency Medicine Initiative (WVU-RTEMI) is a cross-sectional study that conducted qualitative interviews with 20 key stakeholders regarding their experiences with the telestroke service. Participants were designated as either direct providers of telemedicine services (n=11) and/or unit administrators (n=16) at WVU-specific sites (n=12), or rural satellite locations (n=8). A coding system was developed from interaction types, including positive versus negative instances, direct versus indirect telemedicine experience, and positive versus negative potential for future expansion of telemedicine. Transcripts were analyzed using the qualitative mixed methods research software Dedoose. Coded transcripts were reviewed and categorized based on interaction content, differences across participant roles, and observed themes.

Results:

The observed themes were: positive statements about the project objective and outcome, current challenges, and barriers for expansion of telemedicine. Participants were predominantly positive across provider and administrator roles toward implementation of WVU-RTEMI and potential for future expansion. The most prevalent categories were positive statements based on direct experience (98) and expansion of telemedicine (80). There was no significant difference in the number of excerpts from each participant role. Current challenges included anxiety and limitations of video versus in-person, technology availability, and provider training.

Conclusions:

Telemedicine has demonstrated promising results in treating stroke patients from rural communities. The results from this study can assist in directing community-based education for originating rural site providers, guide advocacy, and highlight the need for ongoing system maintenance in established networks.