Arizona Telemedicine May 2014 - Page 31

I n 2005, patients who were hospitalized with an ischemic stroke in Tucson or Phoenix were 10 times more likely to receive potentially disability-preventing or life-saving emergency medical care than patients treated at hospitals in rural Arizona. Today, patients in rural Arizona have at least as good a chance of receiving the best possible treatment – a “clot-busting” drug called TPA (for Tissue Plasminogen Activator) – compared with some stroke patients in the state’s two largest cities. The change came about because of the Telestroke Program at the Mayo Clinic – Phoenix. The two visionary physicians who developed the program are Bart M. Demaerschalk, MD, professor of neurology and director of the telestroke and teleneurology programs at Mayo Clinic, and Ben Bobrow, MD, professor of emergency medicine at the University of Arizona College of Medicine – Phoenix, and medical director of the Bureau of Emergency Medicine Services and Trauma System for the Arizona Department of Health Services (ADHS). In 2005, with funding from ADHS, Drs. Demaerschalk and Bobrow surveyed 37 hospitals outside of Phoenix and Tucson, and learned that only one had round-theclock neurology coverage. The rest had only spotty neurology coverage – or none at all. They also visited established telestroke programs at the University of California, San Diego (UCSD), and the University of Utah, learning how they developed their services, including how they measured quality of care. Their next step, in 2007, was to get Mayo involved in a UCSD study. Called the STRokE DOC Trial, it compared telemedicine consults to telephone consults for patients admitted to emergency rooms with symptoms of stroke. STRokE DOC was funded by the National Institutes of Health, with ADHS covering the costs of Mayo’s participation. In 2009, encouraged by what they were seeing, Drs. Demaerschalk and Bobrow next obtained additional ADHS funding for their own research, a three-year study called STARR – Stroke Telemedicine for Arizona Rural Residents. This time, all patients were managed through telemedicine consults with Dr. Demaerschalk and other stroke experts at Mayo. “We see telemedicine as an important opportunity to improve patient care.” Bart M. Demaerschalk, MD With Mayo Clinic – Phoenix as the stroke telemedicine “hub,” the STARR study expanded to include Bisbee’s Copper Queen Community Hospital, followed by other rural hospitals in Cottonwood, Parker, Flagstaff, Tuba City, Show Low, Globe, Kingman, Casa Grande and Yuma, as well as Maricopa Medical Center in downtown Phoenix. The study wrapped up in 2012; final data are being analyzed and a summary manuscript is being written. As STARR was nearing completion, Drs. Demaerschalk and Bobrow began working with their telestroke colleagues to reach their ultimate goal – to take Mayo’s telestroke program from a research program to a non-profit, sustainable business. “It took a year and 25 individuals to construct the 80-page business plan,” Dr. Demaerschalk says, “and not a single community partner was lost in that transition. I think that reflects the quality of the program, and the strength of the relationships that were built in the process.” In its first two years, Mayo’s telestroke program evaluated 50 stroke patients. That number has now grown to 1,500 or more annually. The quality metrics – including lives saved and numbers of stroke patients who avoid permanent disability – are now as good at the state’s rural hospitals as they are in Tucson and Phoenix. “We have also reduced the need for medical transport,” Dr. Demaerschalk says. “Before telestroke, 90 percent of rural patients experiencing stroke were transported by ground or air ambulance to Tucson or Phoenix. And now that transport rate has dropped to well below 30 percent. “That means patients and their families can enjoy the community support that otherwise might be fractured or lost or difficult to maintain, because of geography and time.” Doctors, hospitals, and health care insurers also win, Dr. Demaerschalk says. Doctors, because they may be reluctant to tackle emergency stroke care without the support of a consulting neurologist. Hospitals, because they can retain their patients and not lose revenue. Insurers, because their overall rehabilitation and long-term care costs are reduced. Dr. Demaerschalk considers telestroke “one of the poster children for telemedicine. It’s better care, it’s convenient, it’s expert care where it otherwise wouldn’t exist, and with better outcomes, and it costs less money. It’s a rare gem.” 27