Telepresence and Provider Communication Predict Veteran Satisfaction with Telestroke

Abstract

Background: Telestroke has been demonstrated to be a cost-effective means to expand access to care and improve outcomes in stroke; however, information on patient perceptions of this system of care delivery are limited. This study seeks to examine patient feedback of a national telestroke system within the Veterans Health Administration.

Methods: Patients who received a telestroke consultation were eligible for a phone interview two weeks later, including questions about technology quality, telepresence, and telestroke provider communication. Satisfaction scores ranged from 1-7, (higher = more satisfied), and for analyses were dichotomized as 6-7 indicating high satisfaction vs. < 6. Patient variables including stroke severity (measured by the NIH Stroke Scale) were obtained from study records. Bivariate logistic regression models were used to determine what factors were associated with patient satisfaction.

Results: Over 18 months, 186 interviews were completed and 142 (76%) reported high satisfaction with telestroke. Patients with more severe stroke were less likely to recall the consultation. Factors significantly associated with patient satisfaction were higher ratings of the technology (p < 0.0001), telepresence (p < 0.0001), provider communication ratings (p < 0.0001), and overall VA satisfaction (p = 0.02). In the multivariate model, telepresence (OR 3.10, 95% CI 1.81-5.31) and provider ratings (OR 2.37, 95% CI 1.20-4.68) were independently associated with satisfaction. Veterans that were satisfied were more likely to recommend the technology (p < 0.0001).

Conclusion: Provider qualities, including telepresence and provider ratings, were associated with overall Veteran satisfaction with the telestroke consultation. Technology quality may be necessary but not sufficient to impact patient experience. Training providers to improve telepresence could improve patient experience with telestroke consultation.