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  • 1
    Online Resource
    Online Resource
    Rural and Urban Differences in Hypertension Management Through Telehealth Before and During the COVID-19 Pandemic Among Commercially Insured Patients
    Oxford University Press (OUP) ; 2023
    In:  American Journal of Hypertension ( 2023-09-29)
    Details
    In: American Journal of Hypertension, Oxford University Press (OUP), ( 2023-09-29)
    Abstract: The COVID-19 pandemic prompted a rapid increase in telehealth use. However, limited evidence exists on how rural and urban residents used telehealth and in-person outpatient services to manage hypertension during the pandemic. Methods This longitudinal study analyzed 701,410 US adults (18–64 years) in the MarketScan Commercial Claims Database, who were continuously enrolled from January 2017 through March 2022. We documented monthly numbers of hypertension-related telehealth and in-person outpatient visits (per 100 individuals), and the proportion of telehealth visits among all hypertension-related outpatient visits, from January 2019 through March 2022. We used Welch’s 2-tail t-test to differentiate monthly estimates by rural-urban status and month-to-month changes. Results From February through April 2020, the monthly number of hypertension-related telehealth visits per 100 individuals increased from 0.01 to 6.05 (P & lt;0.001) for urban residents and from 0.01 to 4.56 (P & lt;0.001) for rural residents. Hypertension-related in-person visits decreased from 20.12 to 8.30 (P & lt;0.001) for urban residents and from 20.48 to 10.15 (P & lt;0.001) for rural residents. The proportion of hypertension-related telehealth visits increased from 0.04% to 42.15% (P & lt;0.001) for urban residents and from 0.06% to 30.98% (P & lt;0.001) for rural residents. From March 2020 to March 2022, the monthly average of the proportions of hypertension-related telehealth visits was higher for urban residents than for rural residents (10.19% vs. 6.96%; P & lt;0.001). Conclusions Data show that rural residents were less likely to use telehealth for hypertension management. Understanding trends in hypertension-related telehealth utilization can highlight disparities in the sustained use of telehealth to advance accessible health care.
    Type of Medium: Online Resource
    ISSN: 0895-7061 , 1941-7225
    URL: Article
    DOI: 10.1093/ajh/hpad093
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2023
    detail.hit.zdb_id: 1479505-X
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  • 2
    Online Resource
    Online Resource
    Table2.docx
    Frontiers Media SA ; 2023
    In:  Frontiers in Health Services Vol. 3 ( 2023-11-30)
    Details
    In: Frontiers in Health Services, Frontiers Media SA, Vol. 3 ( 2023-11-30)
    Abstract: Stroke systems of care (SSOC) promote access to stroke prevention, treatment, and rehabilitation and ensure patients receive evidence-based treatment. Stroke patients living in rural areas have disproportionately less access to emergency medical services (EMS). In the United States, rural counties have a 30% higher stroke mortality rate compared to urban counties. Many states have SSOC laws supported by evidence; however, there are knowledge gaps in how states implement these state laws to strengthen SSOC. Objective This study identifies strategies and potential challenges to implementing state policy interventions that require or encourage evidence-supported pre-hospital interventions for stroke pre-notification, triage and transport, and inter-facility transfer of patients to the most appropriate stroke facility. Design Researchers interviewed representatives engaged in implementing SSOC across six states. Informants ( n = 34) included state public health agency staff and other public health and clinical practitioners. Outcomes This study examined implementation of pre-hospital SSOCs policies in terms of (1) development roles, processes, facilitators, and barriers; (2) implementation partners, challenges, and solutions; (3) EMS system structure, protocols, communication, and supervision; and (4) program improvement, outcomes, and sustainability. Results Challenges included unequal resource allocation and EMS and hospital services coverage, particularly in rural settings, lack of stroke registry usage, insufficient technologies, inconsistent use of standardized tools and protocols, collaboration gaps across SSOC, and lack of EMS stroke training. Strategies included addressing scarce resources, services, and facilities; disseminating, training on, and implementing standardized statewide SSOC protocols and tools; and utilizing SSOC quality and performance improvement systems and approaches. Conclusions This paper identifies several strategies that can be incorporated to enhance the implementation of evidence-based stroke policies to improve access to timely stroke care for all patient populations, particularly those experiencing disparities in rural communities.
    Type of Medium: Online Resource
    ISSN: 2813-0146
    URL: Article
    URL: Article
    URL: Article
    DOI: 10.3389/frhs.2023.1280250
    DOI: 10.3389/frhs.2023.1280250.s001
    DOI: 10.3389/frhs.2023.1280250.s002
    Language: Unknown
    Publisher: Frontiers Media SA
    Publication Date: 2023
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  • 3
    Online Resource
    Online Resource
    Abstract 19: Assessing The Impact Of Stroke Systems Of Care Policies On Stroke-related Outcomes
    Ovid Technologies (Wolters Kluwer Health) ; 2022
    In:  Circulation: Cardiovascular Quality and Outcomes Vol. 15, No. Suppl_1 ( 2022-05)
    Details
    In: Circulation: Cardiovascular Quality and Outcomes, Ovid Technologies (Wolters Kluwer Health), Vol. 15, No. Suppl_1 ( 2022-05)
    Abstract: Introduction: Stroke systems of care (SSOC) laws have been adopted across the US as early as 2002 to improve access to time- sensitive, life-saving treatments and care for stroke patients. However, the impact of these laws on stroke care delivery and patient outcomes remains largely unknown. The study goal was to determine whether the policy interventions are associated with improved stroke outcomes by examining SSOC laws implemented by states. Methods: We developed a policy surveillance dataset of the 50 states and D.C. SSOC laws in effect at any time from 2002-2018. A stakeholder group of federal, state, and local SSOC experts informed the study. Based on an evidence-informed conceptual model, the study linked the policy surveillance dataset with three state-level outcomes: 1) age-adjusted overall stroke mortality rates; 2) percentage of hospitals certified as primary stroke centers (PSC); and 3) percentage of patients who received brain scan results within 45 minutes of arrival at a stroke center. To estimate policy effectiveness, we used Bayesian Additive Regression Trees to predict outcomes as if no policies were in effect and compared them to the actual observed outcomes in each state that put at least one policy into effect. For each modeled outcome, we controlled for state-level contextual factors such as stroke prevalence, percent rural population, non-white population, density of hospital closure, Paul Coverdell National Acute Stroke Program participation, and Medicaid expansion status. Results: Results identified 38 states with at least one SSOC law in effect during the study period. Of these states, 11 states had lower and 3 had higher overall stroke mortality rates than predicted; 9 states had a higher and 4 had a lower proportion of PSCs than predicted; and 12 states had higher and 2 had lower brain scan rates within 45 minutes than predicted. Conclusion: Having one or more SSOC laws in effect is associated with improved stroke outcomes. This information can inform national chronic disease organizations and state decisionmaker efforts to improve SSOC at state and regional levels.
    Type of Medium: Online Resource
    ISSN: 1941-7713 , 1941-7705
    URL: Article
    DOI: 10.1161/circoutcomes.15.suppl_1.19
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2022
    detail.hit.zdb_id: 2453882-6
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