Abstract Details

Title Impact of the Veteran Health Administration National Telestroke Program’s Telestroke Consult Service on Inpatient Ischemic Stroke Quality Metrics

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) P1 - Poster Session 1 (11:45 AM-12:45 PM)

Poster/Presentation
Number 13-009

Objective

We sought to determine the impact of receiving an acute or subacute telestroke consult from the Veteran Health Administration (VHA) National Telestroke Program (NTSP) on accepted measures of inpatient quality of care.

Background In 2018, the VHA launched the NTSP acute telestroke consult service, increasing access to acute stroke expertise in rural and under-resourced facilities and decreasing interhospital transfers. In 2022, the VHA implemented a subacute consult service to improve inpatient stroke workup and management. It is unknown whether telestroke consult services are associated with improved inpatient quality of stroke care.

Design/Methods This was a retrospective cohort study of patients discharged from a VHA facility with diagnosis of ischemic stroke from 10/1/2021 through 6/30/2024. Outcomes included four discharge quality indicators: 1) medium/high potency statin, 2) antithrombotic medication, 3) carotid imaging performed prior to discharge, 4) anticoagulation for atrial fibrillation. Logistic regression with generalized estimating equations was employed to examine the association of receiving an NTSP consult (acute or subacute vs none) and the odds of passing each quality indicator among those eligible, adjusted for age and NIHSS. The model for carotid imaging was further adjusted using inverse probability weighting.

Results

From 22 VHA NTSP facilities (11 that implemented the subacute consult and 11 that did not), 1082 Veterans had an ischemic stroke diagnosis. The mean NIHSS score was 3.2 (SD 4.0), and 28% of stroke admissions had no NIHSS recorded. NIHSS missingness was lower among those with receipt of an NTSP consult (5%) versus no consult (38%; P<.001). Receipt of acute or subacute NTSP consult was associated with higher odds of receiving carotid artery imaging prior to discharge (aOR 3.24, 95%CI 1.74-6.03, P <.001).

Conclusions Receiving an NTSP consult was associated with higher quality of inpatient stroke care, with higher NIHSS documentation and odds of receiving carotid artery imaging.

Authors/Disclosures
Brian Stamm, MD PRESENTER	Dr. Stamm has received personal compensation in the range of $10,000-$49,999 for serving as a Physician with Veterans Health Administration.
Qing Tang, MS	Ms. Tang has nothing to disclose.
Joanne Daggy	Joanne Daggy has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for NIH. The institution of Joanne Daggy has received research support from NIH.
Laura Myers	The institution of Laura Myers has received research support from VA.
Samantha Calcatera, PhD	Dr. Calcatera has nothing to disclose.
Katrina Spontak, MS	Ms. Spontak has nothing to disclose.
Jason Larson, Researcher	Mr. Larson has nothing to disclose.
Lisa Nobel (UMass Neurology)	Ms. Nobel has nothing to disclose.
William S. Musser, MD	Dr. Musser has nothing to disclose.
Lisa D. Hermann, MD (Vanderbilt University Medical Center)	Dr. Hermann has nothing to disclose.
Teresa M. Damush, PhD	The institution of Dr. Damush has received research support from Veterans Health Administration. The institution of Dr. Damush has received research support from National Cancer Institute. The institution of Dr. Damush has received research support from PCORI.
Linda S. Williams, MD, FAAN (Roudebush VAMC)	The institution of Dr. Williams has received research support from VA HSR&D.

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