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Published Online: 13 September 2009

The State of Emergency Stroke Resources and Care in Rural Arizona: A Platform for Telemedicine

Publication: TELEMEDICINE and e-HEALTH
Volume 15, Issue Number 7

Abstract

A rural–urban disparity exists in acute stroke management practices in Arizona. A proposed solution is a statewide acute stroke care plan centered on stroke telemedicine. Our purpose was to evaluate the emergency stroke resources available at and care provided by remote Arizona hospitals and to formulate a 5-year stroke telemedicine plan for Arizona rural residents. We used the Arizona Hospital and Healthcare Association Web site to identify all eligible institutions. Consenting personnel were mailed the survey on behalf of the Arizona Department of Health Services. To construct the 5-year telemedicine plan, we used survey data as well as our previously designed stroke telemedicine research trial. We estimated the resources, the geographic coverage, and the operating costs. Thirty-five hospitals met survey eligibility criteria; however, 24/35 (69%) hospitals completed the survey. Only one hospital had neurologists on call 24/7. Hospitals thrombolysed 2%–4% of all stroke patients annually. Ninety percent of the hospitals were interested in participating in a statewide telemedicine initiative. The stroke telemedicine plan divided Arizona into two regions, each with a one-hub to three-spoke ratio. The budget was estimated to be U.S. $8,141,217.10 for 5 years. Remote communities of Arizona were underserviced with regard to the availability of neurologists and the delivery of emergency stroke care. The majority of the remote emergency departments were interested in participating as spoke sites in a statewide stroke telemedicine initiative. Telemedicine may be an effective method to provide expert care to stroke patients located in rural areas.

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cover image Telemedicine and e-Health
TELEMEDICINE and e-HEALTH
Volume 15Issue Number 7September 2009
Pages: 691 - 699
PubMed: 19694588

History

Published online: 13 September 2009
Published in print: September 2009
Published ahead of print: 20 August 2009

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Madeline L. Miley
Departments of Neurology, Emergency Medicine, and Information Technology, Mayo Clinic Arizona, Phoenix, Arizona. Department of Neuroscience, Loyola University, Chicago, Illinois.
Bart M. Demaerschalk
Departments of Neurology, Emergency Medicine, and Information Technology, Mayo Clinic Arizona, Phoenix, Arizona.
Nicole L. Olmstead
Bureau of Emergency Medical Services & Trauma System, Arizona Heart Disease and Stroke Prevention Program, Bureau of Tobacco and Chronic Disease, Arizona Department of Health Services, Phoenix, Arizona.
Terri-Ellen J. Kiernan
Departments of Neurology, Emergency Medicine, and Information Technology, Mayo Clinic Arizona, Phoenix, Arizona.
Doren A. Corday
Departments of Neurology, Emergency Medicine, and Information Technology, Mayo Clinic Arizona, Phoenix, Arizona.
Vatsal Chikani
Bureau of Emergency Medical Services & Trauma System, Arizona Heart Disease and Stroke Prevention Program, Bureau of Tobacco and Chronic Disease, Arizona Department of Health Services, Phoenix, Arizona.
Bentley J. Bobrow
Departments of Neurology, Emergency Medicine, and Information Technology, Mayo Clinic Arizona, Phoenix, Arizona. Bureau of Emergency Medical Services & Trauma System, Arizona Heart Disease and Stroke Prevention Program, Bureau of Tobacco and Chronic Disease, Arizona Department of Health Services, Phoenix, Arizona.

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