Rural Hospital Dollars Benefit From "Siri"

Telestroke is a cost effective option for rural hospitals

(RxWiki News) Not all hospitals can afford to have stroke experts on hand around the clock. This is particularly true for small or rural medical centers where such a move might not make sense when they see so few stroke patients.

Telestroke, which has been increasing in popularity in recent years, appears to be a cost-effective method for rural hospitals, a new study suggests. It also benefits patients by ensuring they receive treatment sooner and get sent home from the hospital faster.

During a telestroke visit, a neurologist or stroke specialist consults with a stroke patient at a small or rural hospital emergency room through a video conference. The program allows smaller-staffed medical facilities to, in effect, offer 24-hour-a-day specialty stroke care.

"Call 9-1-1 immediately if you notice stroke symptoms."

A stroke occurs when blood flow to part of the brain is blocked. Symptoms include a sudden or severe headache, confusion, clumsiness, loss of balance, weakness or numbness on one side of the body, sight, hearing or taste changes, or trouble speaking or walking. However symptoms can vary depending on the part of the brain affected by the stroke.

Bart Demaerschalk, MD, a neurologist and director of the Mayo Clinic Telestroke Program, noted that previous research has indicated that telestroke programs are cost effective when examining the net cost to society for each year of life gained by stroke survivors.

Yet this marks the first study to find that telestroke programs are cost effective for rural hospitals in terms of operations. The research was meant as a tool to aid hospital administrators in determining whether such a program would be cost effective for their hospital.

"It's a relatively small amount of money, comparatively, telestroke costs a couple thousand dollars more to save quality years of life — so it's a bargain really," said Dr. Demaerschalk.

The addition of new telestroke networks has been slowed in part by the upfront cost of instituting such a program and the lack of a cost analysis to demonstrate the continued costs of a telestroke program.

During the study investigators developed a model to compare cost and effectiveness with and without telestroke over a 5-year period.

They found that if one hospital staffed with stroke experts provided telestroke services to seven other medical centers, an additional 45 patients a year would receive life-saving clot-busting drugs.

Under that model an additional 20 individuals each year also would have received endovascular stroke therapy in which blood clots in the brain are removed through a corkscrew-like device passed through a catheter in the blood vessels. These additional treatments would allow an additional six patients to be sent home from the hospital annually.

A telestroke network was associated with $358,435 in annual cost savings, with each smaller rural medical center projected to save $109,080. The hospital providing the stroke expert was projected to bring in an additional $405,121 a year. If the cost savings were shared over the projected eight hospitals, each would save $44,804 a year by utilizing telestroke.

"If the costs associated with the technology are reduced or if reimbursement opportunities increase we will recognize that this treatment method may, in fact, save even more money," Dr. Demaerschalk said.

"The upfront costs associated with setting up the telestroke technology and managing the network organization are quickly offset by the financial gains that result from a higher proportion of patients receiving clot-busting drugs and the reduced stroke-related disability and subsequent reduced need for rehabilitation, nursing home care and assistance at home."

The research was funded by Genentech, Inc., a biotechnology corporation now owned by drug company Roche Holding AG.

The study was recently published in Circulation: Cardiovascular Quality and Outcomes, an American Heart Association journal.

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Review Date: 
December 5, 2012