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Alabyad D, Lemuel-Clarke M, Antwan M, Henriquez L, Belagaje S, Rangaraju S, Mosley A, Cabral J, Walczak T, Ido M, Hashima P, Bayakly R, Collins K, Sutherly-Bhadsavle L, Brasher C, Danaie E, Victor P, Westover D, Webb M, Skukalek S, Barrett AM, Esper GJ, Nahab F. Telemedicine impact on post-stroke outpatient follow-up in an academic healthcare network during the COVID-19 pandemic. J Stroke Cerebrovasc Dis 2023; 32:107213. [PMID: 37384981 PMCID: PMC10284452 DOI: 10.1016/j.jstrokecerebrovasdis.2023.107213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 06/07/2023] [Accepted: 06/07/2023] [Indexed: 07/01/2023] Open
Abstract
BACKGROUND The expansion of telemedicine associated with the COVID-19 pandemic has influenced outpatient medical care. The objective of our study was to determine the impact of telemedicine on post-acute stroke clinic follow-up. METHODS We retrospectively evaluated the impact of telemedicine in Emory Healthcare, an academic healthcare system of comprehensive and primary stroke centers in Atlanta, Georgia, on post-hospital stroke clinic follow-up. We compared the frequency of 90-day follow-up in a centralized subspecialty stroke clinic among patients hospitalized before the local COVID-19 pandemic (January 1, 2019- February 28, 2020), during (March 1- April 30, 2020) and after telemedicine implementation (May 1- December 31, 2020). A comparison was made across hospitals less than 1 mile, 10 miles, and 25 miles from the stroke clinic. RESULTS Of 1096 ischemic stroke patients discharged home or to a rehab facility during the study period, 342 (31%) had follow-up in the Emory Stroke Clinic (comprehensive stroke center 46%, primary stroke center 10 miles away 18%, primary stroke center 25 miles away 14%). Overall, 90-day follow-up increased from 19% to 41% after telemedicine implementation (p<0.001) with telemedicine appointments amounting for up to 28% of all follow-up visits. In multivariable analysis, factors associated with teleneurology follow-up (vs no follow-up) included discharge from the comprehensive stroke center, thrombectomy treatment, private insurance, private transport to the hospital, NIHSS 0-5 and history of dyslipidemia. CONCLUSIONS Despite telemedicine implementation at an academic healthcare network successfully increasing post-stroke discharge follow-up in a centralized subspecialty stroke clinic, the majority of patients did not complete 90-day follow-up during the COVID-19 pandemic.
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Affiliation(s)
| | | | - Marlyn Antwan
- Department of Neurology, Emory University, Atlanta, GA, United States
| | - Laura Henriquez
- Department of Neurology, Emory University, Atlanta, GA, United States
| | - Samir Belagaje
- Department of Neurology, Emory University, Atlanta, GA, United States
| | - Srikant Rangaraju
- Department of Neurology, Emory University, Atlanta, GA, United States
| | - Ashlee Mosley
- Department of Neurology, Emory University, Atlanta, GA, United States
| | - Jacqueline Cabral
- Department of Neurology, Emory University, Atlanta, GA, United States
| | - Teri Walczak
- Department of Neurology, Emory University, Atlanta, GA, United States
| | - Moges Ido
- Georgia Department of Public Health, Atlanta, GA, United States
| | | | - Rana Bayakly
- Georgia Department of Public Health, Atlanta, GA, United States
| | | | | | | | | | | | | | - Mark Webb
- Emory Healthcare, Atlanta, GA, United States
| | - Susana Skukalek
- Department of Neurosurgery, Emory University, Atlanta, GA, United States
| | - A M Barrett
- Department of Neurology, University of Massachusetts, Worcester, MA, United States
| | - Gregory J Esper
- Department of Neurology, Emory University, Atlanta, GA, United States
| | - Fadi Nahab
- Department of Neurology, Emory University, Atlanta, GA, United States.
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Lemuel-Clarke M, Antwan M, Henriquez L, Belagaje SR, RANGARAJU S, Mosley A, Cabral J, Walczak T, Ido M, Hashima P, Bayakly R, Jaffe J, Sutherly-Bhadsavle L, Brasher C, Danaie EI, Victor P, Westover D, Webb M, Skukalek SL, Barrett AM, Esper GJ, Nahab F. Abstract NS3: Telemedicine Impact On Post-stroke Outpatient Follow-up In An Academic Healthcare Network. Stroke 2022. [DOI: 10.1161/str.53.suppl_1.ns3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction:
The expansion of telemedicine associated with the COVID-19 pandemic has influenced outpatient medical care. The objective of our study was to determine the impact of telemedicine on post-acute stroke clinic follow-up.
Methods:
With this retrospective cohort study, we evaluated the impact of telemedicine in Emory Healthcare, an academic healthcare system of comprehensive (CSC) and primary stroke centers (PSC) in Atlanta, Georgia, on post-hospital stroke clinic follow-up. We compared the frequency of successful post-hospitalization follow-up in a centralized subspecialty stroke clinic among patients hospitalized before the local COVID-19 pandemic (January 1- February 28, 2020), during (March 1- April 30, 2020) and after telemedicine implementation (May 1- December 31, 2020). A comparison was made across network hospitals less than 1 mile (CSC) and 25 miles (PSC25) from the specialty stroke clinic.
Results:
Of the 553 ischemic stroke patients [median age 68 years (IQR 58-79), median NIHSS 4 (IQR 1-8)] discharged home or to a rehab facility during the study period, 241 (43.6%) had follow-up in the Emory Stroke Clinic (CSC=48%, PSC25=23%). Overall, 90-day follow-up increased from 31% before to 48% after telemedicine implementation. Similarly, telemedicine appointments increased from 19% to 72% of the follow-up visits. The increase in follow-up visits was modest among CSC patients, from 41% to 51% (p=0.16), relative to the increase among PSC25 patients (5.3% to 31%, p=0.002).
Conclusions:
Telemedicine implementation at an academic healthcare network successfully increased post-stroke discharge follow-up in a centralized subspecialty stroke clinic for hospitalized patients up to 25 miles from the clinic site. However, more work is required to facilitate follow up in the majority of patients.
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McDavid K, Piedrahita C, Hashima P, Vall EA, Kay C, O'Connor J. Growing Fit: Georgia's model for engaging early care environments in preventing childhood obesity. J Ga Public Health Assoc 2016; 5:266-275. [PMID: 27331199 PMCID: PMC4910621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023] Open
Abstract
BACKGROUND In the United States, one in three children is overweight or obese by their fifth birthday. In Georgia, 35 percent of children are overweight or obese. Contrary to popular belief, children who are overweight or obese are likely to be the same weight status as adults, making early childhood an essential time to address weight status. An estimated 380,000 Georgia children attend early care and education environments, such as licensed child care centers, Head Start, and pre-kindergarten programs, which provide an opportunity to reach large numbers of children, including those at risk for obesity and overweight. METHODS To address this opportunity, the Georgia Department of Public Health, Georgia Shape - the Governor's Initiative to prevent childhood obesity, and HealthMPowers, Inc., created the Growing Fit training and toolkit to assist early childhood educators in creating policy, systems, and environmental changes that support good nutrition and physical activity. This report, the first related to this project, describes the training and its dissemination between January and December 2015. RESULTS A total of 103 early childcare educators from 39 early childcare education centers (22 individual childcare systems) from 19 counties in Georgia were trained. Fifteen systems completed a pre and post-test assessment of their system, demonstrating slight improvements. Training for an additional 125 early childcare education centers is planned for 2016. CONCLUSIONS Lessons learned from the first year of the training include the need for more robust assessment of adoption and implementation of policy, systems, and environmental changes in trained centers.
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Affiliation(s)
| | | | | | | | | | - Jean O'Connor
- Georgia Department of Public Health, Atlanta, GA; Emory University, Atlanta, GA
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