Understanding and Improving Acute Telestroke Care

/ABSTRACT Acute ischemic stroke (AIS) is a leading cause of death and permanent impairment in adults. There are highly efficacious treatments for AIS, including intravenous thrombolysis (IVT) and endovascular thrombectomy (EVT). Stroke treatment is exquisitely time-sensitive, and guidelines recommend time targets for receipt of thrombolysis [door-to-needle (DTN) time] and interhospital transfer for EVT [door-in-door-out (DIDO) time]. However, most US hospitals do not have in-person stroke specialists to facilitate these life-saving stroke treatments. Telestroke is an acute form of telehealth that virtually connects stroke experts to acute stroke patients presenting to such hospitals. Telestroke has expanded stroke care access, increased rates of IVT and EVT, and approximately half of all emergency departments in the US now have telestroke services. Yet, multiple prior studies and our own preliminary work have demonstrated significantly prolonged DTN and DIDO times for AIS patients who get telestroke evaluation compared to conventional in-person evaluation. The mechanisms for these treatment and transfer delays via telestroke remain poorly understood. The aims of this project are: 1) to identify modifiable systems factors associated with DTN and DIDO time delays via telestroke using the national Get With the Guidelines-Stroke registry; 2) to ascertain telestroke-specific determinants of DTN and DIDO time through a sequential mixed methods study within the Paul Coverdell Michigan Acute Stroke Registry; and 3) to use systems engineering methods to rank order factors associated with DTN and DIDO delays via telestroke and develop a first-generation Acute Telestroke Toolkit using participatory design. This project is a critical step in discovering effective telestroke interventions that reduce DTN and DIDO times and reduce permanent neurological impairment after stroke. The candidate, Brian Stamm, MD MSc, will pursue a mentored research plan designed to enhance his skills in the methods necessary to understand the mechanisms of DTN and DIDO delays via telestroke and to develop interventions to improve these systems. A detailed career development plan will promote Dr. Stamm’s development of expertise in three key areas: 1) advanced statistical analyses using multilevel modeling to perform large-scale study of stroke registry data; 2) mixed methods study design and qualitative data analysis to understand complex systems of care; 3) systems engineering and participatory design to develop stroke systems interventions. This K23 award will enable the candidate, Dr. Stamm, to become an independent physician-scientist focused on understanding and improving acute telestroke systems of care. The project will result in a first-generation Acute Telestroke Toolkit to be tested in a future R01. This work could influence clinical care guidelines, lead to faster treatment times, and improve patient outcomes via telestroke. Project Number: 1K23NS146645-01 | Fiscal Year: 2026 | NIH Institute/Center: National Institute of Neurological Disorders and Stroke (NINDS) | Principal Investigator: Brian Stamm | Institution: UNIVERSITY OF MICHIGAN AT ANN ARBOR, ANN ARBOR, MI | Award Amount: $233,280 | Activity Code: K23 | Study Section: Special Emphasis Panel[ZRG1 HSS-X (90)] View on NIH RePORTER: https://reporter.nih.gov/project-details/11281044