Roadmapping stroke healthcare in Colombia: a comprehensive telestroke network evaluation

BACKGROUND: In Colombia, a web-based telestroke network has been developed that provides a framework for the implementation, monitoring, and evaluation of stroke services. This study aimed to present preliminary results of using a telestroke platform to integrate healthcare care delivery while evaluating potential discrepancies between standardized clinical guidelines and actual care provided within our hospitals. METHODS: We included consecutive patients with stroke symptoms who came to the emergency department of three centers of the public health system and a comprehensive private facility. In our telestroke platform, three healthcare settings (HSs) were defined: primary (PHS), intermediate (IHS), and advanced (AHS). The intraclass correlation coefficient (ICC) was used to assess the correlation between the patient care recommendations generated by the telestroke platform according to the standardized stroke guidelines and the actual care administered, whose information was stored in the electronic health record (EHR). RESULTS: Among the 171 patients included in the present study, 89.8% were considered appropriate for transfer (that is, IHS or AHS) within the PHS. A total of 89.3% of the patients exhibited clinical evaluations consistent with acute neurological deficits in the intermediate healthcare setting (IHS), while the documentation indicated similar characteristics in 87.2% of the patients in the advanced healthcare setting (AHS). At the IHS, 29.2% of the patients received intravenous thrombolysis (IVT), 48.9% received intravenous thrombolysis at the AHS, and 17% received mechanical thrombectomy (MT). Excellent agreement was observed between the recommendations generated by the telestroke platform and the actual care administered in the IHS in IVT (ICC = 0.96). At the AHS, good agreement was observed with respect to IVT (ICC = 0.86), and excellent agreement was observed with respect to MT (ICC = 1.0). CONCLUSIONS: Our comprehensive telestroke solution facilitates the evaluation of adherence to evidence-based stroke care guidelines, effectively bridging fragmented healthcare systems in rural and urban areas of our country. This approach has the potential to reduce the mortality and disability rates associated with stroke in developing countries.