Skip to main content

Currently Skimming:

8 Current Evidence Base
Pages 61-74

The Chapter Skim interface presents what we've algorithmically identified as the most significant single chunk of text within every page in the chapter.
Select key terms on the right to highlight them within pages of the chapter.


From page 61...
... At the top are systematic reviews and meta-analyses. Under that are best evidence, evidence guidelines, and evidence summaries, which can only appear as the body of evidence evolves because scientifically sound studies are needed to create these kinds of standards.
From page 62...
... Although the RCT is the gold standard and there should be more of these, other viable alternatives are being used in traditional medicine as well, so there is no reason why these other study designs should not be used and have the same impact in telemedicine as occurs in the rest of medical care.
From page 63...
... Typically, the groups differ in only one parameter-for telemedicine this would be the use of the technology versus traditional care. Eligibility and outcome assessments are usually standardized.
From page 64...
... These studies typically describe rare events, early trends, or unusual manifestations or responses. Case studies are especially useful because they are the stories that are used when trying to educate and influence policy makers.
From page 65...
... He determined that 108 of the trials were favorable toward the telemedicine intervention and 38 trials showed no statistical difference between the telemedicine intervention and traditional care. So this metaanalysis showed that in 99 percent of the studies, telemedicine interventions were as good as or better than traditional approaches to care.
From page 66...
... In fact, American Heart Association guidelines support bypassing hospitals that do not have the resources to treat acute stroke when transporting a patient in whom acute ischemic stroke is suspected. Telestroke is an early and sustainable application of telehealth for stroke care, particularly acute stroke care.
From page 67...
... However, stroke experts are in short supply, and are needed 24 hours per day, 7 days per week, which is expensive. Easy access via telehealth to regional stroke centers means lower 1A health professional shortage area includes any of the following that the Secretary determines has a shortage of health professional(s)
From page 68...
... Disruptive Innovation: Disruptive Value Network Increases in public reporting and requirements for meaningful use create incentives for hospitals to gain expertise in stroke care. Participation in a telestroke network enables hospitals to access highly experienced stroke experts from a comprehensive center at a reasonable cost.
From page 69...
... Less than half of hub hospitals had a dedicated telemedicine software package; many were using their own electronic medical record, dictating into the spoke hospital's record, or using paper only. Respondents noted that barriers to growing the telestroke program include the lack of infrastructure funds, inability to obtain physician licensure, and lack of physician reimbursement.
From page 70...
... 70 THE ROLE OF TELEHEALTH · providing federal grants to help ensure access to care anywhere that patients are neurologically underserved; · simplifying the main administrative processes related to licensure, credentialing, and billing, which are frequently different in each state; · requiring that federal and third-party reimbursements for telestroke services are at rates equivalent to in-person acute stroke care; · removing requirements for physical proximity to the patient from current critical care billing code regulations; · encouraging the use of telestroke within a state-based, system of care model or integrated delivery networks rather than a geo graphically disconnected, one-off transactional model; and · requiring participation of telestroke sites in national quality im provement programs, including measurement and reporting their outcomes. In terms of further research or inquiry: · determine the most effective models of telestroke care delivery; · explore whether the models can be applied effectively to other disease conditions; · determine if disparities in access to digital broadband services mir ror disparities in health care access; and · provide funding to measure the actual costs of telestroke versus conventional stroke care (i.e., clinical effectiveness research)
From page 71...
... Krupinski disagreed with the participant in part, stating that telehealth will be used for PCMHs in rural areas because the cost is dropping dramatically. Schwamm added that hospitals were willing to purchase telestroke services because policy was actually moving ahead of the business model, viewing the availability of stroke care as a health care rights issue.
From page 72...
... For example, she said, a clear comparison is someone coming into the door of a stroke center versus someone coming to the door of a non-stroke center. She added that the participant's question directly related to the recommendation for more naturalistic settings, noting that many studies are now mixing interventions -- that is, it is not "nothing" versus the intervention but instead, different degrees of telemedicine (e.g., telephone alone versus telephone with video versus telemedicine with supplemental nurse visitation)
From page 73...
... Act of 20092 and the ACA might motivate the adoption of telehealth. Schwamm stated that the contingencies, costs, and efficiencies associated with the HITECH Act created incentives for his own organization to adopt a single, unified medical record on the platform of an integrated delivery system.
From page 74...
... to determine how to provide patients with trusted sources of information. Krupinski agreed, noting that the ATA works closely with many patient advocacy groups, especially when they speak to policy makers about the advantages of telehealth.


This material may be derived from roughly machine-read images, and so is provided only to facilitate research.
More information on Chapter Skim is available.