{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,8]],"date-time":"2026-09-08T18:11:10Z","timestamp":1788891070123,"version":"build-2803163510"},"reference-count":18,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"5","license":[{"start":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T00:00:00Z","timestamp":1788220800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["SVIN"],"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:sec>\n                    <jats:title>BACKGROUND:<\/jats:title>\n                    <jats:p>Many primary stroke centers (PSCs) lack vascular neurologists, unnecessarily transferring thrombolysis patients to comprehensive stroke centers (CSCs). We implemented a telemedicine inpatient stroke nurse practitioner (NP) PSC service to reduce unnecessary transfers.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS:<\/jats:title>\n                    <jats:p>A prospective observational study was conducted to assess the feasibility and quality of telemedicine-delivered inpatient NP acute stroke management at CSC-affiliated PSCs. Following systemic thrombolysis treatment directed by telemedicine CSC vascular neurologists, uncomplicated patients were admitted to PSC internal medicine hospitalists; hospitalists ordered stroke consultation by either in-person community general neurologists (GNs) or a CSC stroke\u2013trained telemedicine NP. We analyzed demographics, clinical management variables, complications, and stroke core measure compliance between patients receiving GN or NP consultation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS:<\/jats:title>\n                    <jats:p>\n                      Among 1237 patients, 720 (58.2%) were managed by GNs and 517 (41.8%) by NPs. Patient sex and admission National Institutes of Health Stroke Scale scores were similar, but NP patients were younger than GN patients (64.5\u2009+\u200914 versus 69\u2009+\u200913 years;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt;0.001) and more racially diverse (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      =0.012), with more admitted to the low socioeconomic hospital (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt;0.001). NPs managed most (98.5%;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt;0.001) post-tPA (tissue-type plasminogen activator) patients due to GN refusal. GN patients had higher modified Rankin Scale score prestroke disability (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      =0.006) and more with left middle cerebral artery or posterior circulation (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt;0.001) stroke. On multivariate analyses, National Institutes of Health Stroke Scale score documentation within 12 hours of admission was better by NPs (90.5%) than GNs (69.7%;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt;0.001). NPs were also significantly more compliant than GNs (92.6% versus 41.3%;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt;0.001) in documenting stroke mechanism and more compliant (83.3% versus 19.9%;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt;0.001) than GNs with ordering extended external cardiac monitoring or implantable loop recorders for embolic stroke of unknown source; readmissions within 30 days of discharge for new stroke events were clinically but not statistically different (GN 34.4% versus NP 17.6%;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      =ns).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS:<\/jats:title>\n                    <jats:p>NP telemedicine\u2013delivered inpatient stroke care in vascular neurologist\u2013underserved PSCs is feasible and results in improved adherence to several guideline-directed core measures for stroke center quality monitoring. These findings support expanded use with further study of the impact of telemedicine stroke NPs in PSC hospitals to prevent unnecessary patient transfers to CSCs.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1161\/svin.125.002313","type":"journal-article","created":{"date-parts":[[2026,8,6]],"date-time":"2026-08-06T09:00:11Z","timestamp":1786006811000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Impact of Telemedicine Stroke Nurse Practitioner Care on Inpatient Management in Vascular Neurologist Underserved Primary Stroke Centers"],"prefix":"10.1161","volume":"6","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4457-4818","authenticated-orcid":true,"given":"Wendy","family":"Dusenbury","sequence":"first","affiliation":[{"name":"Department of Neurology, University of Tennessee Health Science Center, College of Medicine, Memphis (W.D., B.K., C.E., K.N., A.W.A.)."},{"name":"Banner University Medical Center, Phoenix, AZ (W.D., V.M.S., A.V.A.)."},{"name":"Department of Neurology, College of Medicine, The University of Arizona, Phoenix (W.D., A.V.A.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Victoria M.","family":"Swatzell","sequence":"additional","affiliation":[{"name":"Banner University Medical Center, Phoenix, AZ (W.D., V.M.S., A.V.A.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5825-1799","authenticated-orcid":true,"given":"Balaji","family":"Krishnaiah","sequence":"additional","affiliation":[{"name":"Department of Neurology, University of Tennessee Health Science Center, College of Medicine, Memphis (W.D., B.K., C.E., K.N., A.W.A.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9473-8051","authenticated-orcid":true,"given":"Cheran","family":"Elangovan","sequence":"additional","affiliation":[{"name":"Department of Neurology, University of Tennessee Health Science Center, College of Medicine, Memphis (W.D., B.K., C.E., K.N., A.W.A.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7918-4233","authenticated-orcid":true,"given":"Katherine","family":"Nearing","sequence":"additional","affiliation":[{"name":"Department of Neurology, University of Tennessee Health Science Center, College of Medicine, Memphis (W.D., B.K., C.E., K.N., A.W.A.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8871-1023","authenticated-orcid":true,"given":"Andrei V.","family":"Alexandrov","sequence":"additional","affiliation":[{"name":"Banner University Medical Center, Phoenix, AZ (W.D., V.M.S., A.V.A.)."},{"name":"Department of Neurology, College of Medicine, The University of Arizona, Phoenix (W.D., A.V.A.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4060-6766","authenticated-orcid":true,"given":"Anne W.","family":"Alexandrov","sequence":"additional","affiliation":[{"name":"Department of Neurology, University of Tennessee Health Science Center, College of Medicine, Memphis (W.D., B.K., C.E., K.N., A.W.A.)."},{"name":"NET SMART Advanced Practice Stroke Fellowship, Health Outcomes Institute, LLC-P, Fountain Hills, AZ (A.W.A.)."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_3_2_2","doi-asserted-by":"publisher","DOI":"10.1002\/emp2.12673"},{"key":"e_1_3_3_3_2","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0b013e318294b1cf"},{"key":"e_1_3_3_4_2","volume-title":"Vascular neurology match","author":"National Resident Matching Program","unstructured":"National Resident Matching Program. 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