I
n 2005, patients who were hospitalized
with an ischemic stroke in Tucson or
Phoenix were 10 times more likely to
receive potentially disability-preventing
or life-saving emergency medical care
than patients treated at hospitals
in rural Arizona.
Today, patients in rural Arizona have at
least as good a chance of receiving the
best possible treatment – a “clot-busting”
drug called TPA (for Tissue Plasminogen
Activator) – compared with some stroke
patients in the state’s two largest cities.
The change came about because of the
Telestroke Program at the Mayo Clinic –
Phoenix.
The two visionary physicians who developed
the program are Bart M. Demaerschalk,
MD, professor of neurology and director of
the telestroke and teleneurology programs
at Mayo Clinic, and Ben Bobrow, MD,
professor of emergency medicine at the
University of Arizona College of Medicine –
Phoenix, and medical director of the Bureau
of Emergency Medicine Services and
Trauma System for the Arizona Department
of Health Services (ADHS).
In 2005, with funding from ADHS, Drs.
Demaerschalk and Bobrow surveyed 37
hospitals outside of Phoenix and Tucson,
and learned that only one had round-theclock neurology coverage. The rest had only
spotty neurology coverage – or none at all.
They also visited established telestroke
programs at the University of California,
San Diego (UCSD), and the University of
Utah, learning how they developed their
services, including how they measured
quality of care.
Their next step, in 2007, was to get Mayo
involved in a UCSD study. Called the
STRokE DOC Trial, it compared telemedicine
consults to telephone consults for patients
admitted to emergency rooms with
symptoms of stroke. STRokE DOC was
funded by the National Institutes of Health,
with ADHS covering the costs of Mayo’s
participation.
In 2009, encouraged by what they were
seeing, Drs. Demaerschalk and Bobrow next
obtained additional ADHS funding for their
own research, a three-year study called
STARR – Stroke Telemedicine for Arizona
Rural Residents. This time, all patients were
managed through telemedicine consults
with Dr. Demaerschalk and other stroke
experts at Mayo.
“We see telemedicine
as an important
opportunity to improve
patient care.”
Bart M. Demaerschalk, MD
With Mayo Clinic – Phoenix as the stroke
telemedicine “hub,” the STARR study
expanded to include Bisbee’s Copper Queen
Community Hospital, followed by other rural
hospitals in Cottonwood, Parker, Flagstaff,
Tuba City, Show Low, Globe, Kingman, Casa
Grande and Yuma, as well as Maricopa
Medical Center in downtown Phoenix. The
study wrapped up in 2012; final data are
being analyzed and a summary manuscript
is being written.
As STARR was nearing completion, Drs.
Demaerschalk and Bobrow began working
with their telestroke colleagues to reach
their ultimate goal – to take Mayo’s
telestroke program from a research
program to a non-profit, sustainable
business.
“It took a year and 25 individuals to
construct the 80-page business plan,”
Dr. Demaerschalk says, “and not a single
community partner was lost in that
transition. I think that reflects the quality
of the program, and the strength of the
relationships that were built in the process.”
In its first two years, Mayo’s telestroke
program evaluated 50 stroke patients. That
number has now grown to 1,500 or more
annually. The quality metrics – including
lives saved and numbers of stroke patients
who avoid permanent disability – are now
as good at the state’s rural hospitals as they
are in Tucson and Phoenix.
“We have also reduced the need for medical
transport,” Dr. Demaerschalk says. “Before
telestroke, 90 percent of rural patients
experiencing stroke were transported by
ground or air ambulance to Tucson or
Phoenix. And now that transport rate has
dropped to well below 30 percent.
“That means patients and their families can
enjoy the community support that otherwise
might be fractured or lost or difficult to
maintain, because of geography and time.”
Doctors, hospitals, and health care insurers
also win, Dr. Demaerschalk says. Doctors,
because they may be reluctant to tackle
emergency stroke care without the support
of a consulting neurologist. Hospitals,
because they can retain their patients and
not lose revenue. Insurers, because their
overall rehabilitation and long-term care
costs are reduced.
Dr. Demaerschalk considers telestroke “one
of the poster children for telemedicine. It’s
better care, it’s convenient, it’s expert care
where it otherwise wouldn’t exist, and with
better outcomes, and it costs less money.
It’s a rare gem.”
27