Abstract TP055: ICAS-Related Stroke: Remote Tele-Based Care Matches or Exceeds In-Person Best Practice Adherence

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Background: Remote tele-based stroke evaluation and treatment programs are a promising option for underserved populations. Implementation and adherence to guideline-based best practices among these programs remains relatively unexplored. We aimed to characterize adherence to best practices in intracranial atherosclerotic stenosis (ICAS)-related stroke management between in-person versus post-acute telestroke, both managed by comprehensive stroke center (CSC) providers. Methods: We performed a retrospective cohort review, identifying patients with ICAS-related stroke across the MHealth Fairview system. The system comprises 9 hospitals, including 2 CSCs with in-person stroke team coverage and 7 hospitals with remote tele-based coverage. Adherence to best practices was determined using four primary outcome measures including rates of permissive hypertension within the first 48 hours of hospitalization, high-intensity statin prescription, time to initiation of antiplatelet medication(s), and appropriate antithrombotic therapy following stroke. Statistical tests included Pearson’s Chi-squared and Fisher’s exact tests (categorical outcomes) or Wilcoxin rank sum test (continuous outcomes). Results: Among 112 patients, 79 were evaluated and treated by in-person CSC providers. The remaining 33 were evaluated and treated remotely by the same CSC provider group. Demographic characteristics and neuroimaging findings were similar between inpatient versus tele-based study participants (Table 1). Adherence to best practices was similar between in-person versus tele-based coverage including rates of permissive hypertension (63.3% vs 56.3%, p=0.52) and appropriate antithrombotic treatment (96% vs 97%, p=1.00). When compared to patients at in-person sites, patients at telestroke sites were significantly more likely to receive high intensity statin (84.8% vs 51.9%, p=0.002). Patients at in-person sites had a significantly longer time from presentation to time of first aspirin dose (median 6.75 hours [IQR 3-19] vs 4.0 hours [2.25-7.25], p=0.047) and to first clopidogrel dose (10 hours [IQR 4-27] vs 4.5 hours [IQR 2.25-12.75], p=0.02) when compared to tele-based sites. Conclusions: Guideline appropriate care was provided at similar or better rates at sites with tele-based rounding versus in-person rounding. While promising, continued evaluation of adherence to best practices within tele-based care settings remains crucial to ensure sustainable success of similar programs.

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