JMIR Publications

ABSTRACT

Background:

Telemedicine has emerged as a critical tool in the management of acute stroke, yet its impact on clinical decision-making, particularly in the administration of tissue plasminogen activator (tPA), remains underexplored. Understanding how telemedicine adoption influences tPA use and subsequent patient outcomes, such as hemiplegia, is critical for optimizing stroke care protocols.

Objective:

This study aims to assess whether the adoption of telemedicine influences treatment decisions regarding tPA administration in stroke patients. In addition, we employ a causal mediation framework to examine the causal path between telemedicine adoption and the occurrence of hemiplegia via tPA use.

Methods:

We analyzed stroke patient data from Florida’s State Emergency Department Database (SEDD) and the Healthcare Information and Management Systems Society (HIMSS) database, covering the years 2010 to 2017 regarding telemedicine adoption. The final sample includes 314,665 stroke patient visits. A two-way fixed effects model was employed to examine the relationship between telemedicine adoption and tPA use, and between tPA use and hemiplegia occurrence. A causal mediation framework was then applied to estimate the Average Direct Effect (ADE) and the Average Causal Mediation Effect (ACME) of telemedicine on hemiplegia through tPA use. Additionally, a moderated mediation analysis was performed to explore how metropolitan status influences the mediation process.

Results:

We find that telemedicine adoption is associated with a 1% decrease in tPA use. Also, tPA use is linked to a 23.6% increase in the probability of hemiplegia. Telemedicine adoption was found to reduce the likelihood of hemiplegia by decreasing tPA usage. The causal mediation analysis shows a negative ACME, suggesting that telemedicine adoption reduces hemiplegia occurrence, while the ADE is not statistically significant. Importantly, the positive effect of telemedicine on reducing hemiplegia is observed only among metropolitan patients.

Conclusions:

This study provides evidence that telemedicine adoption can improve stroke care by reducing tPA administration, thereby lowering the risk of hemiplegia. However, the benefits appear to be more pronounced in metropolitan areas, highlighting potential regional disparities in stroke care. These findings underscore the importance of targeted interventions to ensure equitable access to telemedicine, especially in rural and underserved areas. Policymakers should focus on enhancing telemedicine infrastructure and training in these regions to optimize stroke care and reduce health inequities.