Stroke Telemedicine for Arizona Rural Residents Trial
Stroke Telemedicine for Arizona Rural Residents Trial
The STARR network registry consists of a 4 spoke 1 hub system. Which will consist of
 prospective collection, recording, and regular analysis of telestroke patient consultation
 and care data for the purpose of quality measure assessment and improvement and benchmarking
 against other national and international telestroke programs.
Background:

 Acute stroke resources and care are deficient in Arizona's rural communities. Stroke
 telemedicine is a proven modality for overcoming the deficiency. Stroke telemedicine allows a
 telephonic consultation and/or two-way audio video consultation between a stroke neurologist
 and a stroke patient at a remotely located emergency department. University of California San
 Diego Stroke Center has completed an NIH funded randomized controlled trial, STRokE DOC,
 comparing telephonic consultations to video consultations. In that trial, video telemedicine
 consultations resulted in more accurate decision making compared with telephone
 consultations. The video telemedicine consultative modality provides the rural stroke patient
 with the opportunity to receive expert stroke care, interpretation of neuroimaging,
 determination of appropriate acute therapy, and recommendations regarding need for transfer
 to a higher level of care. Mayo Clinic Arizona is currently completing a state funded
 feasibility trial, STRokE DOC Arizona (06-005731), as a preliminary step toward establishing
 a state wide stroke telemedicine network, STARR. The STARR network plan should include the
 prospective collection, recording, and regular analysis of telestroke patient consultation
 data for the purpose of quality measure assessment and improvement.

 Objective:

 The objective of this research is to establish a system for the prospective collection,
 recording, and regular analysis of telestroke patient consultation and care data for the
 purpose of quality measure assessment and improvement and benchmarking against other national
 and international telestroke programs.

 Methods:

 The STARR network consists of a primary stroke center hub (Mayo Clinic Hospital) that serves
 multiple spoke hospitals in remote and rural regions of the state (e.g. Kingman and Yuma
 Regional Medical Centers, La Paz Regional Hospital and Copper Queen Community Hospital). Mayo
 Clinic vascular neurologists, who have licenses and privileges to practice teleneurology at
 spoke hospitals in the state, participate in a 24/7 Mayo Clinic telestroke hotline. When an
 acute stroke patient presents to a STARR network participating spoke hospital emergency
 department, a stroke alert is activated and the hotline is phoned. An on-call vascular
 neurologist receives the pager notification and communicates with the referring emergency
 physician. The telestroke consultation will begin by telephone and will be supplemented by
 audio-video telemedicine communication and teleradiology. The patient is registered at Mayo
 Clinic and a registration number is generated by the house supervisor. Emergency neurology
 care is rendered. Every participating spoke hospital emergency physician is already a
 sub-investigator in telestroke research and has completed HSRP training and certification.
 The Mayo Clinic IRB has served as the central IRB of record for state funded Mayo Clinic
 telestroke research. The patient or legal designate will be approached by either the spoke
 emergency physician investigator and/or the hub neurologist investigator (via telemedicine
 camera) for consent to proceed with telestroke consultation, and to acquire, store, and
 analyze data concerning the acute stroke care and outcome of the patient. Data sources will
 include the Mayo Clinic electronic transcribed telestroke consultation note, the emergency
 department nursing and physician records, the admission consultation and diagnostic tests
 records, hospital discharge note, and the content of a brief 90 day follow-up phone call by
 the research coordinator to patient and/or family member. The licensed neurologists already
 have authorization to access patient spoke hospital records as part of their clinical
 privileges, but the designated Mayo Clinic research coordinator will have the responsibility
 to extract data from the sources and enter it into the registry. The STARR registry data
 elements will be exactly the same as the established and familiar data elements for the
 STRokE DOC Arizona trial, for the purposes of continuity. Mayo Clinic Arizona research
 biostatistics group will develop the electronic data manager and conduct and report analyses
 monthly to the telestroke research group.
Inclusion Criteria:

 -  Patients presenting to Rural Emergency Department within 12 hours of acute stroke
 symptom onset.

 -  Written informed consent.

 Exclusion Criteria:

 -  Unlikely to complete study through 90-day follow-up.