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Telehealth for Acute Stroke Management (Telestroke): Systematic Review of Analytic Studies

Technology
Any modality of telehealth (synchronous or asynchronous) that enables communication between a patient and health care providers, or among health care providers, for the purposes of assessing, treating, or rehabilitating stroke patients.

Issue
There is uncertainty about how telestroke programs can be optimally delivered. There have been several original studies evaluating telestroke services, but no systematic effort summarizing them.

Methods and Results
This systematic review was based on a search of five bibliographic databases completed in mid-December 2006, and a scan of relevant reference lists. It included 22 studies with original data on telestroke modalities assessing health outcomes, cost-effectiveness, patient and provider satisfaction, or process of care, published in English in a peer-review journal. Two independent teams of reviewers screened all articles and extracted data by consensus.

The environmental scan, which identified 15 organizations (two in Canada) providing telestroke services, was based on the articles included in the systematic review, as well as a review of 400 hits from Google.

Implications for Decision Making

  • Telestroke improves access to therapy. Telestroke improves access to thrombolysis treatment, which may in turn reduce mortality and serious morbidity post-stroke. A high level of patient satisfaction has been documented with this service.
  • Uncertainty remains regarding cost-effectiveness and safety. Conclusions regarding the economic impact and potential harm from telestroke services compared with face-to-face care could not be drawn from the available evidence.
  • Opportunities for further understanding exist. The lack of standardized reporting of resources and outcomes precludes comparisons among programs and the determination of best practices. The creation of two programs in Canada opens the door to collaborative efforts that could lead to standardized evaluation frameworks, economies of scale for knowledge transfer, and a better understanding of the safety and resource implications of the services that the two programs offer.

This summary is based on a comprehensive health technology assessment available from CADTH’s web site (www.cadth.ca): Deshpande A, Khoja S, McKibbon A, Rizo C, Jadad AR. Telehealth for acute stroke management (telestroke): systematic review of analytic studies and environmental scan of relevant initiatives.