Telestroke for Comprehensive Transient Ischemic Attack Care in Acute Stroke Ready Hospitals (TELECAST-TIA)

October 16, 2023 updated by: University of Minnesota
TELECAST-TIA is a prospective single-center study evaluating guideline-based transient ischemic attack (TIA) treatment at an Acute Stroke Ready Hospital (ASRH) pre- and post-initiation of a specialist telestroke inpatient rounding service. TELECAST-TIA will study the following clinical endpoints: diagnostic stroke evaluation, secondary stroke prevention, health screening and evaluation, stroke education, inpatient complications, and stroke recurrence rates. Additional relevant non-clinical data will include patient and provider satisfaction scores, transfer patterns, and a cost analysis.

Study Overview

Status

Completed

Conditions

Intervention / Treatment

Detailed Description

Telestroke is a validated intervention that improves the triage and emergent treatment of acute stroke, specifically related to the use of intravenous thrombolysis. Effective urgent stroke evaluation and secondary stroke prevention is also essential to decrease the risk of recurrent stroke, however, there have been no studies to date examining the use of telestroke to improve delivery of non-emergent inpatient stroke care per American Heart Association (AHA) guidelines.

Currently, access to stroke specialist expertise is limited resulting in significant disparities in stroke care. Previous publications have identified that patients in rural areas may receive sub-optimal stroke care that does not follow accepted guideline recommendations. Telestroke is a cost-effective mechanism to deliver specialist stroke care to hospitals that do not have in-person stroke consultation available. The aim of TELECAST-TIA is to determine whether specialist telestroke inpatient rounding improves guideline-based TIA treatment when compared to non-specialist transient ischemic attack treatment.

The primary outcome of TELECAST-TIA is a composite score of 3 categories: diagnostic stroke evaluation, secondary stroke prevention, and stroke education. Individual components of the primary outcome were principally derived from AHA stroke guidelines. Additional outcome measures include individual analyses of the components of the primary outcome as well as the complication rate, stroke recurrence rate, transfer rate, patient and provider satisfaction levels, and a cost-analysis. All outcomes will be assessed at 1 year post-implementation, with data accruement starting after a 3-month lead in phase.

Study Type

Observational

Enrollment (Actual)

300

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Locations

  • United States
    • Minnesota
      • Burnsville, Minnesota, United States, 55337
        • Fairview Ridges Hospital
      • Grand Rapids, Minnesota, United States, 55744
        • Grand Itasca Clinic and Hospital
      • Hibbing, Minnesota, United States, 55746
        • Fairview Range Medical Center
      • Princeton, Minnesota, United States, 55371
        • Fairview Northland Medical Center
      • Wyoming, Minnesota, United States, 55092
        • Fairview Lakes Medical Center

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

14 years and older (Adult, Older Adult)

Accepts Healthy Volunteers

No

Sampling Method

Probability Sample

Study Population

All patients admitted with a primary diagnosis of transient ischemic attack at a participating ASRH two years before and one year after implementation of the telestroke inpatient service.

Description

Inclusion Criteria:

  • Age 18 and above
  • Patients with the primary diagnosis of transient ischemic attack evaluated at the Fairview Ridges Hospital emergency room
  • Clinical diagnosis of transient ischemic attack by the treating stroke neurology service

Exclusion Criteria:

  • Patients less than 18 years old
  • Patients who leave the hospital against medical advice
  • Patients who are felt to have an alternative diagnosis

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Observational Models: Cohort
  • Time Perspectives: Prospective

Cohorts and Interventions

Group / Cohort
Intervention / Treatment
Pre-Telestroke
Retrospective collection of defined metrics for all TIA patients admitted to the participating ASRH 2 years prior to implementation of an inpatient telestroke service.
Post-Telestroke
Prospective collection of defined metrics for all TIA patients admitted to the participating ASRH after implementation of an inpatient telestroke service.
Other: Telestroke
Telestroke is an audiovisual communication network that allows for coordination of stroke care from a distant 'hub' site (the telestroke provider location) to an originating 'spoke' site (patient location) in a HIPAA compliant fashion. In TELECAST-TIA, inpatient telestroke rounding will be used to oversee the urgent diagnostic TIA evaluation, secondary stroke prevention, and stroke education in patients admitted with TIA.
Other Names:
  • Telemedicine

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Composite score of TIA treatment (%)
Time Frame: 1 year after implementation of the inpatient telestroke service

A 19-item global assessment of fundamental TIA treatment primarily informed by AHA guidelines/GWTG criteria, represented in 3 categories:

  • Diagnostic evaluation (10 items): neurologist evaluation, LDL, HgA1c, head CT, brain MRI, intracranial vascular imaging, cervical vascular imaging, EKG, telemetry, and outpatient prolonged cardiac monitoring.
  • Secondary prevention (6 items): antiplatelet, anticoagulation, statin, antihypertensives, diabetes management, and carotid revascularization.
  • Stroke education (3 items): tobacco cessation counseling, exercise/lifestyle counseling, and signs of stroke.

An item is not scored when not indicated clinically (for example tobacco cessation in a non-smoker), therefore the composite scores will be reported and analyzed as percentages.
1 year after implementation of the inpatient telestroke service

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Diagnostic TIA Evaluation
Time Frame: 1 year after implementation of the inpatient telestroke service

A 10-item global assessment of diagnostic TIA evaluation as well as individual analysis of each item.

Diagnostic evaluation (10 items): neurologist evaluation, LDL, HgA1c, head CT, brain MRI, intracranial vascular imaging, cervical vascular imaging, EKG, telemetry, and outpatient prolonged cardiac monitoring.

An item is not scored when not indicated clinically (for example prolonged cardiac monitoring in a patient with known Afib or an MRI in a patient with an MRI incompatible pacemaker), therefore the composite scores will be reported and analyzed as percentages.
1 year after implementation of the inpatient telestroke service
Secondary Stroke Prevention
Time Frame: 1 year after implementation of the inpatient telestroke service

A 6-item global assessment of secondary stroke prevention as well as individual analysis of each item.

Secondary stroke prevention (6 items): antiplatelet, anticoagulation, statin, antihypertensives, diabetes management, and carotid revascularization.

An item is not scored when not indicated clinically (for example deferring antiplatelet agents if a patient requires anticoagulation), therefore the composite scores will be reported and analyzed as percentages.
1 year after implementation of the inpatient telestroke service
Stroke Education
Time Frame: 1 year after implementation of the inpatient telestroke service

A 3-item global assessment of stroke education as well as individual analysis of each item.

Stroke education (3 items): tobacco cessation counseling, exercise/lifestyle counseling, and signs of stroke.

An item is not scored when not indicated clinically (for example tobacco cessation in a non-smoker), therefore the composite scores will be reported and analyzed as percentages.
1 year after implementation of the inpatient telestroke service
Composite Stroke Recurrence
Time Frame: Measured at 3 months and at 1 year after discharge
The composite rate of recurrent TIA, ischemic, or hemorrhagic stroke at 3 months and one year post-stroke admission.
Measured at 3 months and at 1 year after discharge

Other Outcome Measures

Outcome Measure
Measure Description
Time Frame
Admission rate
Time Frame: 1 year after implementation of the inpatient telestroke service
Rate of admission versus discharge from the ED.
1 year after implementation of the inpatient telestroke service
Patient demographics
Time Frame: 1 year after implementation of the inpatient telestroke service
Patient demographics of the TIA service will be assessed.
1 year after implementation of the inpatient telestroke service
Cost analysis
Time Frame: 1 year after implementation of the inpatient telestroke service
A cost analysis incorporating the referring 'spoke' hospital and the central 'hub' hospital will be performed. Data collected will include hospital cost of admission, hospital admission reimbursement, transfer costs, and operational costs.
1 year after implementation of the inpatient telestroke service
Hospital length of stay
Time Frame: 1 year after implementation of the inpatient telestroke service
The number of days of hospitalization for patients admitted with a primary diagnosis of TIA.
1 year after implementation of the inpatient telestroke service
Inpatient Telestroke Feasibility: Physician and Provider patient care time
Time Frame: 1 year after implementation of the inpatient telestroke service
Total screen telestroke screen time will be assessed. This will be defined by the time that the telestroke patient visitation connection was made until it was terminated and also by the amount of time billed by the physician.
1 year after implementation of the inpatient telestroke service
Inpatient Telestroke Feasibility: Time from admission to consultation
Time Frame: 1 year after implementation of the inpatient telestroke service
Time from both admission and consult order placement until consultation
1 year after implementation of the inpatient telestroke service
Composite score of fundamental TIA treatment at non-telestroke ASRHs (%)
Time Frame: 1 year after implementation of the inpatient telestroke service

A 19-item assessment of fundamental TIA treatment (see primary outcome) at ASRHs within the same stroke network that do not have an inpatient telestroke service. These scores will serve as temporal controls for the primary outcome.

An item is not scored if it is not indicated clinically (for example tobacco cessation in a non-smoker), therefore the composite scores will be reported and analyzed as percentages.
1 year after implementation of the inpatient telestroke service
Composite score of fundamental TIA treatment at the CSC hub site (%)
Time Frame: 1 year after implementation of the inpatient telestroke service

A 19-item assessment of fundamental TIA treatment (see primary outcome) at the CSC hub site. This data will serve to compare the delivery of TIA treatment via telestroke vs. TIA treatment delivered in person at the hub site.

An item is not scored if it is not indicated clinically (for example tobacco cessation in a non-smoker), therefore the composite scores will be reported and analyzed as percentages.
1 year after implementation of the inpatient telestroke service
Physician, Patient, Nursing satisfaction with Telestroke Rounding
Time Frame: 1 year
Surveys will assess local physician, nursing, and patient satisfaction with the virtual telestroke service. Assessed items will include perceptions of convenience/inconvenience, quality of care provided, and satisfaction with the service relative to an in-person consulting service and/or transfer to a comprehensive stroke center for in-person consultation.
1 year

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

University of Minnesota

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

General Publications

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Actual)

October 2, 2018

Primary Completion (Actual)

July 2, 2019

Study Completion (Actual)

July 2, 2022

Study Registration Dates

First Submitted

September 28, 2018

First Submitted That Met QC Criteria

October 28, 2018

First Posted (Actual)

October 30, 2018

Study Record Updates

Last Update Posted (Actual)

October 18, 2023

Last Update Submitted That Met QC Criteria

October 16, 2023

Last Verified

October 1, 2023

More Information

Terms related to this study

Keywords

Additional Relevant MeSH Terms

Other Study ID Numbers

  • NEUR-2017-26226-TIA

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

NO

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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