Next Steps in Improving Telestroke Systems of Care—From Reach to Efficiency

Telestroke is evidence based, cost-effective, and widespread in the modern stroke system of care. [1][2]2][3] Patients presenting to rural and underresourced hospitals can access cerebrovascular expertise for decision-making related to time-sensitive acute reperfusion therapies in the absence of in-person consultants.However, robust assessment of telestroke network performance remains inherently challenging in the distributed hub-and-spoke model of care.Capturing telestroke use and meaningful process and outcome measures across systems of care can be especially difficult. 1We commend Stamm et al 4 for successfully addressing this challenge.The authors performed an analysis of patients with acute ischemic stroke potentially eligible for thrombolysis treated with and without telestroke in the Paul Coverdell Michigan Stroke Registry.Notably, they report a 61% greater adjusted odds of treatment with thrombolysis among patients treated with telestroke but a 44% lower adjusted odds of achieving American Heart Association Target: Stroke-recommended treatment within 60 minutes.