Study: Telehealth could be 'cost-effective strategy'
While it is widely believed that telehealth strategies can improve patient outcomes by enabling providers’ instant access to specialized clinical knowledge, concerns over telehealth costs remain. An analysis of available data suggested those concerns lack substance, according to research published online Dec. 4 by Circulation: Cardiovascular Quality and Outcomes.
Providers treating acute ischemic stroke patients with assistance from specialists via telehealth networks are more likely to administer evidence-based treatments, such as intravenous thrombolysis and endovascular revascularization therapies when appropriate, according to lead author Jeffrey A. Switzer, DO, an assistant professor at the Medical College of Georgia in Augusta, and his colleages. The benefits of remote referrals, along with modern communication technologies, have led to increased utilization of telehealth, but “telestroke networks are associated with significant upfront costs, and the absence of cost-effectiveness data has hindered further dissemination.”
To determine the cost-effectiveness from the perspectives of a hub hospital, spoke hospitals and an entire network, researchers developed a model to compare five-year costs with and without a telestroke network based on data retrieved from networks implemented by Georgia Health Sciences University in Augusta and the Mayo Clinic in Rochester, Minn.
Based on the results, they estimated that a telestroke network consisting of a single hub hospital and seven spoke hospitals seeing a total of 1,112 acute ischemic stroke patients per year could achieve total cost savings of $358,435 annually.
The model also estimated that each year in a telestroke network 114 fewer acute ischemic stroke patients would be admitted to the hub hospital, about 16 more would be admitted to each spoke hospital, 45 more patients would receive intravenous thrombolysis, 20 more would receive endovascular stroke therapy and six more patients would be discharged to home. While cost savings accrued only to spoke hospitals with hub hospitals bearing the financial burden in the model, sharing arrangements could distribute savings equitably. Additionally, cost-effectiveness increased with additional spoke hospitals in the model.
The majority of cost savings were the result of fewer patient transfers from the hub hospital to spoke hospitals in the model. However, while limiting transfers to achieve cost savings seems like a sound objective in the abstract, “in reality, transfers between hospitals occur for multiple reasons, reflecting patients’ health needs, available resources and the expertise of hospitals,” wrote Switzer et al. “Small, rural hospitals often lack neurologists, interventionalists, neurosurgeons and intensivists, and may be incapable of managing complex stroke cases.”
Other study limitations included an assumption that spoke hospitals possessed resources to treat more patients and a limited dataset to work with. However, Switzer et al concluded that “telestroke networks can be a cost-effective strategy and should be considered by decision makers to improve the quality of stroke care.”