NURS-FPX4040 Evidence-Based Proposal and Annotated Bibliography Paper

NURS-FPX4040 Evidence-Based Proposal and Annotated Bibliography Paper

NURS-FPX4040 Evidence-Based Proposal and Annotated Bibliography Paper

Evidence-Based Proposal and Annotated Bibliography On Technology in Nursing

Introduction

With the ongoing COVID-19 Pandemic, Telehealth visits have become increasingly popular to expand access to care, reducing disease exposure and reducing the staffing demands on offices or hospital settings. Telehealth is the use of digital information and communication technologies, such as computers and mobile devices, to access health care services remotely and manage your health care (Mayo Clinic Staff, 2020). These apps or websites allows the patient to speak to a Physician or APRN to discuss symptoms of minor illnesses and receive treatment, or serve as a standard appointment for Primary Care or specialty offices.

Telehealth appointments have been adapted by a widespread of healthcare organizations and continues to drive successful patient care. For this assignment, I used Capella’s Library, Summon, to research telehealth and telemedicine services, using Peer-reviewed articles within the last 5 years. These annotated bibliographies provide insight of the successes of telehealth visits and the direct impact they have made on healthcare professionals and patients.

Annotated Bibliography (NURS-FPX4040 Evidence-Based Proposal and Annotated Bibliography Paper)

This article discusses the need and importance of telehealth services during the COVID- 19 Pandemic for patients with behavioral health and substance abuse disorders. National data concludes that 7.8% of people in the last year met criteria for a substance use disorder. Because of the increase in mental health disorders, the author states there is also an increase in overdose and suicide. Because treatments and psychosocial services were disrupted by COVID-19, it became imperative to use telehealth services to address mental health needs. Because of the pandemic, there have been many 5 major changes which have reduced barriers in using telehealth services: 1. The allowance of physicians to prescribe controlled substances without patients first coming to a clinic in person, 2. The US Department of Health and Human Services announced it will waive Health Insurance Portability and Accountability Act penalties for “good faith uses of telehealth”,

3. Disclosure of patient identifying information applying to behavioral health could not apply in medical emergencies determined by a physician, 4. The allowance of providers to prescribe Buprenorphine (used to treat opioid disorders) without a in person visit, and
4. Medicare covers costs for telehealth services for behavioral health. The author contributes these changes to creating effective medication and psychotherapy treatments and reducing the spread of COVID-19 as well. Patients also reported they felt their care were patient-centered, personalized and effective.

This article discusses the ways in which telemedicine and telehealth have improved access of care in rural areas. The author recognizes that there are many rural areas within the United States which have been affected by socioeconomic factors, geographic circumstances and workforce shortages which have proven to be barriers to receiving care. Telehealth services provide a broad variety of services – clinical and nonclinical often provided by Nurses or APRN’s, which include: education, help with medications and troubleshooting other health issues. Telemedicine refers to other technologies such as diagnostic testing or monitoring post-treatment, and these services are usually provided by a Physician.

Because of these services, patients in rural areas, typically those far from hospitals or clinics, are able to receive supportive care, especially during the Pandemic, and during winter months, where weather may pose a barrier to care. The author notes the widespread variety of telehealth services has also aided those who are uncomfortable with face-to-face interaction to seek care; they can stay within their own homes or communities and avoid unnecessary travel or expense. The article notes the most substantial barrier to telehealth/telemedicine helping in rural communities are the lack thereof these services. These hospitals face barriers such as startup equipment, training and maintenance costs which delay them from expanding their telehealth services.

This article capsules a study using a randomized controlled trial design to determine if telehealth visits impacted outcomes of patients with Diabetes Mellitus (type 1 and 2). The author recognizes that telehealth provides a unique opportunity for primary healthcare professionals to reach socially disadvantaged groups who have a limit on healthcare access due to location, cost or accessibility. During the COVID-19 Pandemic, more physicians were forced to embrace the use of technology and telehealth services to continue to render care, while also combatting the spread of the virus. The study deep dives into diabetes, recognizing it affects over 463 million people, and is expected to affect over 578 million by 2030.

Telehealth services have allowed providers to focus on diabetes management and prevention by having 1:1 conversations with patients at their convenience to discuss disease management, diet, exercise, medication administration, glucose monitoring and overall wellbeing. The patients involved in this study participated in monitoring of their glucose levels, HgBA1C, LDL and HDL levels, planned and unplanned hospital visits. They were monitored throughout the trial via video and telephone visits with a physician. The conclusion of the study was that telehealth interventions addressed type 1 and 2 diabetes management behaviors, had a significant effect on lowering A1C levels compared to usual care alone and patients understood long term behavioral changes for their disease management.

The COVID-19 Pandemic has created a surge of Palliative Care and hospice patients who, their preferred place of care is their own home. This article summarizes the increase in patient and family satisfaction in regard to quality and accessibility of care due to telehealth services. Typically, palliative care patients are uncertain about the urgency of their needs, who they should contact in times of need, what the response may be and what follow up will be required.

Telehealth services are mentioned to be useful for conditions that require closer monitoring, clinical assessment, preventing unwanted hospital admissions and improved quality of life in EOL situations. Patients interviewed for this study felt that the use of telehealth increased and improved their access to healthcare professionals at home and felt they had increased access to healthcare professions in case of an emergency (such as in the middle of the night). They also noted they felt like they were “being cared for at home, felt connectedness, relief, tranquility and extra security”.

Providers also noted they felt they were able to create a more trusted connection with their patients, as well as their families. The results indicate that the use of telehealth improved access to health care professionals, although patients remained at their own homes. The use of telehealth seems to support the patient’s choice of living at home for as long as possible, which is important for many patients. Patients may feel more comfortable, in control, and in a safer place at home compared with being in hospitals.

Conclusion

With advancements in technology and healthcare services, telehealth and telemedicine has proven to be an effective resource for providing healthcare services to patients. This technology has the potential to improve the quality of healthcare and make is accessible to patients in rural areas, facing comorbidities, end of life and is aiding in reducing the spread of COVID-19. Telehealth services allows providers to connect to patients, providing a variety of services ranging from primary care, to specialization, behavioral health and various other services. Patients are able to receive personalized, quality care at their best convenience, while hospitals are also able to reduce healthcare costs and admissions/readmissions. Furthermore, telehealth services continues to prove itself to be a value to the healthcare system and will allow for growth and improved accessibility and quality of care for patients.

References for NURS-FPX4040 Evidence-Based Proposal and Annotated Bibliography Paper

• Lin L, Fernandez AC, Bonar EE. Telehealth for Substance-Using Populations in the Age of Coronavirus Disease 2019: Recommendations to Enhance Adoption. JAMA Psychiatry. 2020;77(12):1209–1210. doi:10.1001/jamapsychiatry.2020.1698.
• Mayo Clinic Staff. (2020, May 15). Managing your health in the age of wi-fi. Mayo Clinic. Retrieved December 31, 2021, from https://www.mayoclinic.org/healthy-lifestyle/consumer-health/in-depth/telehealth/art-20044878
• Nelson, R. (2017). Telemedicine and Telehealth. AJN, American Journal of Nursing, 117 (6), 17- 18. doi: 10.1097/01.NAJ.0000520244.60138.1c.
• Robson, N., & Hosseinzadeh, H. (2021). Impact of telehealth care among adults living with type 2 diabetes in primary care: A systematic review and meta-analysis of randomised controlled trials. International Journal of Environmental Research and Public Health, 18(22), 12171. doi:http://dx.doi.org/10.3390/ijerph182212171.
• Steindal, S. A., Andréa Aparecida, G. N., Godskesen, T. E., Dihle, A., Lind, S., Winger, A., & Klarare, A. (2020). Patients’ experiences of telehealth in palliative home care: Scoping review. Journal of Medical Internet Research, 22(5) doi:http://dx.doi.org/10.2196/16218.

Evidence-Based Proposal and Annotated Bibliography on Technology in Nursing

As technology advances daily, healthcare technology has not been left behind. Different healthcare technology platforms, devices, and modalities have been developed to improve patient care services, enhance patient safety, and minimize the cost of healthcare service provision. In addition, direct patient care technologies such as robotics and patient sensor devices have also gained popularity recently. However, various studies have supported the use of these technologies. Others critiqued their effectiveness in patient care and even raised concerns about patient safety, the nurse-patient relationship, and related costs. This paper presents an annotated bibliography based on remote patient monitoring direct patient care technology, providing an evidence base/recommendation for its implementation.

The reason for selecting remote patient monitoring systems as the direct patient technology of focus is due to their increased use, especially for patients with chronic illnesses, such as diabetes, that require constant monitoring. Remote patient monitoring systems and devices interest me since they make nursing care easier and enable patients to receive services in the comfort of their homes. I used the google scholar search engine to locate studies from reputable databases and journals, including PubMed, ScienceDirect, and Medline. I used the search terms “effectiveness of remote patient monitoring” and “remote patient monitoring and patient care.” 

Annotated Bibliography

Farias, F. A. C., Dagostini, C. M., Bicca, Y. A., Falavigna, V. F., & Falavigna, A. (2020). Remote Patient Monitoring: A Systematic Review. Telemedicine Journal and E-health: The Official Journal of the American Telemedicine Association, 26(5), 576–583. https://doi.org/10.1089/tmj.2019.0066

The focus of this study was to evaluate the effectiveness of telemonitoring, or the use of various remote patient monitoring systems, devices, and applications in maximizing patient care and the effectiveness of treatment, based on different studies that have been published focusing on different health conditions and patient populations. The review identified studies about telemonitoring, particularly case reports which had to have more than five cases. According to Farias et al. (2020), studies published over the years showed positive results of using remote patient monitoring technologies in patient care outcomes. In addition, remote patient monitoring technologies are being used in post-operative care and patient monitoring for chronic illness patients receiving home-based care. Wireless devices such as smartphone patient monitoring apps were mainly used for remote patient monitoring since it is easier to send information to the care provider (Farias et al., 2020).

Patient safety and the quality of care have improved using remote patient monitoring technology since patients receive care services faster and their health is monitored on time. In addition, remote patient monitoring technologies have made nursing care easier since the nurse does not have to monitor the patient’s health physically. Since information from the monitoring system is shared electronically, it makes the work of the Interprofessional team easier since making decisions and providing feedback is faster (Farias et al., 2020). Farias et al. (2020) were selected from many publications since it reviews many remote patient monitoring technologies, thus providing more extensive information.

Malasinghe, L. P., Ramzan, N., & Dahal, K. (2019). Remote patient monitoring: a comprehensive study. Journal of Ambient Intelligence and Humanized Computing, 10, 57-76. https://doi.org/10.1007/s12652-017-0598-x

This research article focuses on the recent advances in remote patient monitoring technologies that have direct and indirect contact with the patient. In addition, Malasinghe et al. (2019) discuss the common issues regarding remote patient monitoring technologies, including concerns about patient safety, care quality, and the impact of these technologies on Interprofessional collaboration. According to Malasinghe et al. (2019), recent remote patient monitoring technologies include mobile health applications, pulse oximeters, blood glucose meters, blood pressure monitors, and weight scales. These technologies are mainly connected with a communication system that enables the care provider to receive the information monitored, thus being able to make decisions on patient care.

Malasinghe et al. (2019) further note that the use of the new remote patient monitoring technologies has enhanced patient safety and improved the quality of care since it cuts down on patients’ infection risks and enables the care provider to act on the collected health data as part of the patient treatment plan. The Interprofessional team’s work is also made easier since healthcare professionals can act on the treatment plan and the collected patient information as soon as it is received, thus enabling them to play their role effectively (Malasinghe et al., 2019)

Shaik, T., Tao, X., Higgins, N., Li, L., Gururajan, R., Zhou, X., & Acharya, U. R. (2023). Remote patient monitoring using artificial intelligence: Current state, applications, and challenges. Wiley Interdisciplinary Reviews: Data Mining and Knowledge Discovery, e1485. https://doi.org/10.1002/widm.1485  

This research study reviews different remote patient monitoring and the adopted advanced technologies, such as artificial intelligence, and their impact on remote patient monitoring, patient safety, and healthcare costs. The challenges and trends for adopted technologies on remote patient monitoring systems in their implementation are also mentioned in this article. According to Shaik et al. (2023), the remote patient monitoring technologies adopted include telehealth, wearable devices, contact-based sensors, and motion recognition parameters.

The challenges that have been encountered while implementing these technologies include high costs, the need to educate the patients and their families on how to use these technologies, which requires time and resources, and personal limitations such as old age, which may prevent the patient from using the remote patient monitoring technologies effectively. Shaik et al. (2023) note that remote patient monitoring technology has promoted patient safety by enabling the patient and care providers to prevent disease complications and other patient safety issues such as falls.

Additionally, nursing practice has become more efficient since patients can receive timely feedback, and nurses can provide care to many patients as opposed to physical patient monitoring. Despite the challenges in implementing remote patient monitoring systems, the work of the Interprofessional team has also been made easier since the team can converse and provide feedback on the same platform, thus providing more efficient care services to the patients. The reason for selecting this article is because it includes the challenges of implementing remote patient monitoring systems which is vital information for healthcare professionals to beware of before implementing these symptoms.

Gordon, W. J., Henderson, D., DeSharone, A., Fisher, H. N., Judge, J., Levine, D. M., MacLean, L., Sousa, D., Su, M. Y., & Boxer, R. (2020). Remote Patient Monitoring Program for Hospital Discharged COVID-19 Patients. Applied Clinical Informatics, 11(5), 792–801. https://doi.org/10.1055/s-0040-1721039

This study aimed to assess the effectiveness of a remote patient monitoring program that entailed Covid-19 patients who had just been discharged. Clinical outcomes were also identified based on the remote patient monitoring program and systems. The patient monitoring devices used in the program were pulse oximeters and thermometers. The study found that the remote patient monitoring program was associated with positive clinical outcomes, including improved symptom remission, reduced hospital readmissions, decreased risk of symptoms acceleration, and emergency visits.

According to Gordon et al. (2020), remote patient monitoring technological devices positively impact patient safety and the quality of care since remote monitoring of patients after discharge reduces their possibility of re-infections and helps the care providers develop a plan of care based on the collected patient information. In addition, nursing practice and Interprofessional teamwork were made more efficient (Gordon et al., 2019). The article has provided the perspective of remote patient monitoring systems in an entire program, focusing on a disease with a high risk of re-infection emergency visits.

Summary of Recommendation

Based on the four articles annotated above, remote patient monitoring technology has been widely utilized to enhance patient care, especially among chronic patients who manage their conditions at home. The mostly used remote patient monitoring technologies include pulse oximeters, weight scales, and glucose monitoring devices (Gordon et al., 2019). All the sources show that using remote patient monitoring technologies is associated with improved patient safety, better care quality, and work efficiency for the Interprofessional team (Farias et al., 2020; Gordon et al., 2019; Malasinghe et al., 2019; Shaik et al., 2023). However, there are different challenges in implementing remote patient monitoring systems, including costs and personal patient limitations (Shaik et al., 2023). Therefore, it is recommended that the healthcare team identify current remote patient monitoring technologies and plan to overcome the challenges that may arise during implementation.        

NURS-FPX4040 Evidence-Based Proposal and Annotated Bibliography Paper References

Farias, F. A. C., Dagostini, C. M., Bicca, Y. A., Falavigna, V. F., & Falavigna, A. (2020). Remote Patient Monitoring: A Systematic Review. Telemedicine Journal and e-health: the official journal of the American Telemedicine Association, 26(5), 576–583. https://doi.org/10.1089/tmj.2019.0066

Gordon, W. J., Henderson, D., DeSharone, A., Fisher, H. N., Judge, J., Levine, D. M., MacLean, L., Sousa, D., Su, M. Y., & Boxer, R. (2020). Remote Patient Monitoring Program for Hospital Discharged COVID-19 Patients. Applied Clinical Informatics, 11(5), 792–801. https://doi.org/10.1055/s-0040-1721039

Malasinghe, L. P., Ramzan, N., & Dahal, K. (2019). Remote patient monitoring: a comprehensive study. Journal of Ambient Intelligence and Humanized Computing, 10, 57-76. https://doi.org/10.1007/s12652-017-0598-x

Shaik, T., Tao, X., Higgins, N., Li, L., Gururajan, R., Zhou, X., & Acharya, U. R. (2023). Remote patient monitoring using artificial intelligence: Current state, applications, and challenges. Wiley Interdisciplinary Reviews: Data Mining and Knowledge Discovery, e1485.  https://doi.org/10.1002/widm.1485

NURS-FPX4040 Evidence-Based Proposal and Annotated Bibliography Paper – Telestroke in Nursing Care

Stroke is one of the multisystemic diseases with devastating patient outcomes. Management of stroke benefits from preventive and remote care strategies such as the use of technologies. Telestroke technology has been implemented in some healthcare settings and communities to manage stroke and related outcomes telestroke. Telestroke, also known as stroke telemedicine, is a remote telehealth technology that allows patients to access specialist services remotely and prevent complications through timely management and consultation.

 

Trained stroke specialists work collaboratively with local emergency departments to direct timely care and save patients with stroke or with signs of impending stroke. This technology interests me because it concerns quality care in my clinical field of interest in my future professional nursing.

As a nurse, I will be the patient care coordinator and advocate. Therefore, this technology will help ensure that my patients receive timely, effective, efficient, and safe care. The purpose of this paper is to present an annotated bibliography of evidence-based sources with information on the implementation use and outcomes of telestroke in nursing and healthcare.

Literature Search

My search strategy was to assemble primary and secondary literature sources. This included primary research studies and review studies from peer-reviewed and scholarly resources. I searched literature resources from the Cochrane library, PubMed, and Medline databases. Key terms that I used were telestroke, nursing, nursing care, primary care, and telestroke outcomes.

I then filtered the returned results to display only research articles published within the past five years, that is, from 2019 to 2023. Search filtering also included selecting results based on their methodology in the PubMed database. Articles that were unavailable as full texts in non-premium access to these databases were not included.

Annotated Bibliography

Chen, N., Wu, X., Zhou, M., Yang, R., Chen, D., Liao, M., Deng, Y., Hong, Z., Zhou, D., & He, L. (2021). Telestroke for the treatment of ischemic stroke in Western China during the COVID-19 pandemic: A multicenter observational study. Frontiers in Neurology, 12, 822342. https://doi.org/10.3389/fneur.2021.822342

This resource is a multisite observational study conducted by Chen and colleagues in China. It focuses on the use of telestroke technology for the treatment of ischemic stroke in Western China during the COVID-19 pandemic. The authors of this study aimed at investigating the feasibility and effectiveness of telestroke in the treatment of acute ischemic stroke during the COVID-19 outbreak.

According to this study, telestroke improved the speed of treatment and reduced the risk of complications, leading to improved patient safety and quality of care. I selected this source because it provides valuable information on the use of telestroke technology in a real-world setting during a pandemic, which is a unique and important context for healthcare practitioners to consider in contemporary practice. Implementing this technology in nursing will require considering organizational policies, resources, culture/social norms, commitment, training programs, and employee empowerment for usability, safety, and efficiency purposes.

Lazarus, G., Permana, A. P., Nugroho, S. W., Audrey, J., Wijaya, D. N., & Widyahening, I. S. (2020). Telestroke strategies to enhance acute stroke management in rural settings: A systematic review and meta-analysis. Brain and Behavior, 10(10), e01787. https://doi.org/10.1002/brb3.1787

I selected this resource because it is a high level of evidence, thus asserting its credibility in providing trustworthy information on the use and benefits of telestroke use in primary care settings, especially rural settings. The authors of this article the authors aimed to investigate the effectiveness of telestroke in improving stroke outcomes in rural areas.

The summary of the findings of this article supports the use of telestroke in rural areas because of its improved clinical outcomes compared to usual care for stroke patients. This article emphasizes prehospital and in-hospital telestroke implementation to improve the emergency approach to stroke.

Sevilis, T., McDonald, M., Avila, A., Heath, G., Gao, L., O’Brien, G., Zaman, M., Heller, A., Masud, M., Mowzoon, N., & Devlin, T. (2022). Telestroke: Maintaining quality acute stroke care during the COVID-19 pandemic. Telemedicine Journal and E-Health: The Official Journal of the American Telemedicine Association, 28(4), 481–485. https://doi.org/10.1089/tmj.2021.0149

This resource explores stroke management in the COVID-19 pandemic era using the telestroke approach. I selected this article because the authors assessed the impacts that COVID-19 had on stroke management using telestroke acute stroke services. This article assessed the timeliness and frequency of access to telestroke services in the pandemic era.

This multisite study involved 19 states that included 171 hospitals with participants in pre-intervention and post-intervention groups. This article found that telestroke improves acute stroke care continuity with reduced interruptions. The time within which stroke patients received care after being seen by the doctor was significantly reduced. Implementation of these findings would aim at improving care timeliness, one of the healthcare quality domains. Therefore, an organization focused on reducing the reception of care by acute care stroke patients would select this technology to improve care quality.

Shea, C. M., Turner, K., Alishahi Tabriz, A., & North, S. (2019). Implementation strategies for telestroke: A qualitative study of telestroke networks in North Carolina. Telemedicine Journal and E-Health: The Official Journal of the American Telemedicine Association, 25(8), 708–716. https://doi.org/10.1089/tmj.2018.0131

This resource focuses on the implementation and logistics of telestroke network technologies. I selected this article because it focused on the implementation aspect of telestroke technology and provides sustainability information from research perspectives. Getting the best of a given technology depends on the usability and sustainability of the given technology to ensure that users and patients benefit from the technology.

The authors of this study found that tailoring technology to meet hospital and user needs is paramount and should be a priority of future research. Implementing these recommendations would require systematic needs analysis that would favor the technologies sustainability.

Zachrison, K. S., Sharma, R., Wang, Y., Mehrotra, A., & Schwamm, L. H. (2021). National trends in telestroke utilization in US commercial platforms before the COVID-19 pandemic. Journal of Stroke and Cerebrovascular Diseases: The Official Journal of National Stroke Association, 30(10), 106035. https://doi.org/10.1016/j.jstrokecerebrovasdis.2021.106035

This resource focuses on national data on telestroke networks and platforms before the COVID-19 pandemic. The authors of this article focused on the characteristics of telestroke consultation systems nationally. I selected this article due to its credibility academically and relevance to the national practice of stroke management and technology use. The usual emergency stroke management ranges from ED arrival to NIHSS, CT scan, imaging review, consult, and alteplase administration.

Alteplase is a thrombolytic agent whose early use prevents the further development of clots and breaks the already formed ones, thus preventing the worsening of ischemic stroke. This process averts adverse outcomes from a stroke but has a timeline for implementation. Making this decision depends on the time for patient timely consultation and the specialist’s decision-making that telestroke technology aims at reducing. This article collected, analyzed and reported national data related to this process of telestroke use.

The key findings from this study were that alteplase administration time was reduced, participation in telestroke activities increased, and time for consultation was reduced. Organizations willing to implement telestroke technologies should consider workforce and system readiness to adopt this technology so that time taken to receive care is reduced and evidence based.

Conclusion

This annotated bibliography included five scholarly peer-reviewed and systematically selected sources from known journals and databases. The annotated sources explored evidence-based data and information on telestroke technology implementations and benefits. Evidence-based information on how technology promotes patient safety, care quality, and the need for interdisciplinary participation are emphasized in these sources.

Telestroke improves the speed of treatment and reduces the risk of complications, leading to improved patient safety and quality of care. The use of telestroke in rural areas improves clinical outcomes as compared to usual care for stroke patients due to improved patient safety and healthcare quality. This is because telestroke improves acute stroke care continuity due to reduced interruptions.

The time within which stroke patients received care after being seen by the doctor was significantly reduced. However, tailoring technology to meet hospital and user’s needs is paramount and should be a priority of future research. Key care qualities focused on by this technology are timeliness, safety, equitability, patient-centeredness, and efficiency.

NURS-FPX4040 Evidence-Based Proposal and Annotated Bibliography Paper References

Chen, N., Wu, X., Zhou, M., Yang, R., Chen, D., Liao, M., Deng, Y., Hong, Z., Zhou, D., & He, L. (2021). Telestroke for the treatment of ischemic stroke in Western China during the COVID-19 pandemic: A multicenter observational study. Frontiers in Neurology, 12, 822342. https://doi.org/10.3389/fneur.2021.822342

Lazarus, G., Permana, A. P., Nugroho, S. W., Audrey, J., Wijaya, D. N., & Widyahening, I. S. (2020). Telestroke strategies to enhance acute stroke management in rural settings: A systematic review and meta-analysis. Brain and Behavior, 10(10), e01787. https://doi.org/10.1002/brb3.1787

Sevilis, T., McDonald, M., Avila, A., Heath, G., Gao, L., O’Brien, G., Zaman, M., Heller, A., Masud, M., Mowzoon, N., & Devlin, T. (2022). Telestroke: Maintaining quality acute stroke care during the COVID-19 pandemic. Telemedicine Journal and E-Health: The Official Journal of the American Telemedicine Association, 28(4), 481–485. https://doi.org/10.1089/tmj.2021.0149

Shea, C. M., Turner, K., Alishahi Tabriz, A., & North, S. (2019). Implementation strategies for telestroke: A qualitative study of telestroke networks in North Carolina. Telemedicine Journal and E-Health: The Official Journal of the American Telemedicine Association, 25(8), 708–716. https://doi.org/10.1089/tmj.2018.0131

Zachrison, K. S., Sharma, R., Wang, Y., Mehrotra, A., & Schwamm, L. H. (2021). National trends in telestroke utilization in a US commercial platform before the COVID-19 pandemic. Journal of Stroke and Cerebrovascular Diseases: The Official Journal of National Stroke Association, 30(10), 106035. https://doi.org/10.1016/j.jstrokecerebrovasdis.2021.106035

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