Abstract WP202: Telestroke Adoption: Characteristics of Communities Served, and the Impact on Hospital Transfer Rates

Introduction: Telestroke programs can increase access to stroke expertise for patients with acute ischemic stroke (AIS) and may also enable local admission of AIS patients who previously required transfer. We evaluated the characteristics of communities served by hospitals adopting telestroke over time, and whether adoption was associated with decreased AIS transfer rates for hospitals. Methods: We used data from academic hub-and-spoke telestroke networks to compile a comprehensive dataset of spoke hospitals from seven states (MA, NH, ME, SC, NC, GA, UT) that adopted telestroke from 2010-2024. Hospitals were classified as metropolitan, micropolitan, and small town/rural using Rural-Urban Commuting Area codes. For each hospital, we identified the percentile of median household income and social deprivation index (SDI) for its health service area (HSA). We used fee-for-service Medicare claims data from 2010-2019 to examine changes in AIS transfer rates from two years pre- vs two years post-adoption among hospitals adopting telestroke from 2012-2017. Results: In the seven states, 103 hospitals adopted telestroke from 2010-2024: 47 (46%) in metropolitan areas, 32 (31%) in micropolitan areas and 24 (23%) in small town/rural areas. The median household income percentile of HSAs for hospitals adopting telestroke was 31% overall (25 th -75 th percentile 12%-64%) (Figure 1). The median SDI of HSAs for hospitals adopting telestroke was 54% overall (25 th -75 th percentile 38%-66%) (Figure 2). Among the 67 hospitals adopting telestroke during 2012-2017, the mean change in transfer rate was +0.5%, and hospitals’ change in transfer rate ranged from -20% to +18% (Figure 3). Conclusion: Hospitals adopting telestroke in these academic hub-and-spoke networks were slightly more likely to be in lower-resourced communities. Telestrokes impact on transfer rates varied widely and likely reflects variation in hospitals' resources and AIS patient volume. Overall telestroke adoption was not associated with decreased transfer rates.