Clinical trial NCT03724110: Telestroke for Comprehensive Transient Ischemic Attack Care in Acute Stroke Ready Hospitals
Official title: Telestroke for Comprehensive Transient Ischemic Attack Care in Acute Stroke Ready Hospitals
Study type: OBSERVATIONAL
Overall status: COMPLETED
Conditions: Transient Ischemic Attack
Keywords: Telestroke
Telemedicine
Secondary stroke prevention
Lead sponsor: University of Minnesota
Sponsor class: OTHER
First posted: 2018-10-30
Enrollment: 300
Sex: ALL
Minimum age (years): 18
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Observational model: COHORT
Time perspective: PROSPECTIVE
Sampling method: PROBABILITY_SAMPLE
Study population: All patients admitted with a primary diagnosis of transient ischemic attack at a participating ASRH two years before and one year after implementation of the telestroke inpatient service.

Brief summary: TELECAST-TIA is a prospective single-center study evaluating guideline-based transient ischemic attack (TIA) treatment at an Acute Stroke Ready Hospital (ASRH) pre- and post-initiation of a specialist telestroke inpatient rounding service. TELECAST-TIA will study the following clinical endpoints: diagnostic stroke evaluation, secondary stroke prevention, health screening and evaluation, stroke education, inpatient complications, and stroke recurrence rates. Additional relevant non-clinical data will include patient and provider satisfaction scores, transfer patterns, and a cost analysis.

Detailed description: Telestroke is a validated intervention that improves the triage and emergent treatment of acute stroke, specifically related to the use of intravenous thrombolysis. Effective urgent stroke evaluation and secondary stroke prevention is also essential to decrease the risk of recurrent stroke, however, there have been no studies to date examining the use of telestroke to improve delivery of non-emergent inpatient stroke care per American Heart Association (AHA) guidelines.

Currently, access to stroke specialist expertise is limited resulting in significant disparities in stroke care. Previous publications have identified that patients in rural areas may receive sub-optimal stroke care that does not follow accepted guideline recommendations. Telestroke is a cost-effective mechanism to deliver specialist stroke care to hospitals that do not have in-person stroke consultation available. The aim of TELECAST-TIA is to determine whether specialist telestroke inpatient rounding improves guideline-based TIA treatment when compared to non-specialist transient ischemic attack treatment.

The primary outcome of TELECAST-TIA is a composite score of 3 categories: diagnostic stroke evaluation, secondary stroke prevention, and stroke education. Individual components of the primary outcome were principally derived from AHA stroke guidelines. Additional outcome measures include individual analyses of the components of the primary outcome as well as the complication rate, stroke recurrence rate, transfer rate, patient and provider satisfaction levels, and a cost-analysis. All outcomes will be assessed at 1 year post-implementation, with data accruement starting after a 3-month lead in phase.

Eligibility criteria: Inclusion Criteria:

* Age 18 and above
* Patients with the primary diagnosis of transient ischemic attack evaluated at the Fairview Ridges Hospital emergency room
* Clinical diagnosis of transient ischemic attack by the treating stroke neurology service

Exclusion Criteria:

* Patients less than 18 years old
* Patients who leave the hospital against medical advice
* Patients who are felt to have an alternative diagnosis

Primary outcomes:
measure: Composite score of TIA treatment (%)
timeFrame: 1 year after implementation of the inpatient telestroke service
Secondary outcomes:
measure: Diagnostic TIA Evaluation
timeFrame: 1 year after implementation of the inpatient telestroke service
measure: Secondary Stroke Prevention
timeFrame: 1 year after implementation of the inpatient telestroke service
measure: Stroke Education
timeFrame: 1 year after implementation of the inpatient telestroke service
measure: Composite Stroke Recurrence
timeFrame: Measured at 3 months and at 1 year after discharge
Other outcomes:
measure: Admission rate
timeFrame: 1 year after implementation of the inpatient telestroke service
measure: Patient demographics
timeFrame: 1 year after implementation of the inpatient telestroke service
measure: Cost analysis
timeFrame: 1 year after implementation of the inpatient telestroke service
measure: Hospital length of stay
timeFrame: 1 year after implementation of the inpatient telestroke service
measure: Inpatient Telestroke Feasibility: Physician and Provider patient care time
timeFrame: 1 year after implementation of the inpatient telestroke service
measure: Inpatient Telestroke Feasibility: Time from admission to consultation
timeFrame: 1 year after implementation of the inpatient telestroke service
measure: Composite score of fundamental TIA treatment at non-telestroke ASRHs (%)
timeFrame: 1 year after implementation of the inpatient telestroke service
measure: Composite score of fundamental TIA treatment at the CSC hub site (%)
timeFrame: 1 year after implementation of the inpatient telestroke service
measure: Physician, Patient, Nursing satisfaction with Telestroke Rounding
timeFrame: 1 year
Locations:
city: Burnsville
country: United States
facility: Fairview Ridges Hospital
state: Minnesota
city: Grand Rapids
country: United States
facility: Grand Itasca Clinic and Hospital
state: Minnesota
city: Hibbing
country: United States
facility: Fairview Range Medical Center
state: Minnesota
city: Princeton
country: United States
facility: Fairview Northland Medical Center
state: Minnesota
city: Wyoming
country: United States
facility: Fairview Lakes Medical Center
state: Minnesota
Study officials:
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