Telemedicine impact on post-stroke outpatient follow-up in an academic healthcare network during the COVID-19 pandemic

• Authors: Darwish Alabyad, Morehouse School of Medicine; Manet Lemuel-Clarke, Emory University; Marlyn Antwan, Emory University; Laura Henriquez, Emory University; Samir Belagaje, Emory University; Srikant Rangaraju, Emory University; Ashlee Mosley, Emory University; Jacqueline Cabral, Emory University; Teri Walczak, Emory University; Moges Ido, Georgia Department of Public Health; Patricia Hashima, Georgia Department of Public Health; Rana Bayakly, Georgia Department of Public Health; Kathryn Collins, Emory Healthcare; Loretta Sutherly-Bhadsavle, Emory Healthcare; Cynthia Brasher, Emory Healthcare; Elham Danaie, Emory Healthcare; Patricia Victor, Emory Healthcare; Deborah Westover, Emory Healthcare; Mark Webb, Emory Healthcare; Susana Skukalek, Emory University; AM Barrett, Univ Massachusetts; Gregory Esper, Emory University; Fadi Nahab, Emory University
• Journal Title: JOURNAL OF STROKE & CEREBROVASCULAR DISEASES
• Volume: Volume 32, Number 8
• Publisher: ELSEVIER INC | 2023-08-01, Pages 107213-107213
• Type of Work: Article | Final Publisher PDF
• Publisher DOI: http://doi.org/10.1016/j.jstrokecerebrovasdis.2023.107213
• Subjects: Health Sciences, Medicine and Surgery
• Keywords: Science & Technology; Life Sciences & Biomedicine; Neurosciences; Peripheral Vascular Disease; Neurosciences & Neurology; Cardiovascular System & Cardiology

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.