Objective: In this study, we identify community and hospital characteristics associated with adoption of telestroke among acute care hospitals in North Carolina (NC).

Methods: Our sample included 107 acute care hospitals located in NC. Our analytic dataset included variables from the American Hospital Association (AHA) Annual Survey, AHA Health IT supplement, Healthcare Cost Report Information System (HCRIS), and the Centers for Disease Control and Prevention's WONDER online database. We supplemented our secondary sources with data on telestroke adoption (for which there is no national data source) and market-level variables developed for NC. We used the Consolidated Framework for Implementation Research and previous telehealth studies to guide our selection of variables to include in our model. We conducted a multivariate logistic regression to determine which variables were associated with telestroke adoption.

Results: Proportion of discharges that are Medicare (OR=1.93, p<0.04) and total operating margin (OR=2.89, p=0.00) were positively associated with telestroke adoption. Critical Access Hospital status was positively associated telestroke adoption, although not at p<0.05 (OR=5.61, p=0.07). Distance to the nearest hospital with a telestroke program (OR=0.91, p=0.01) and volume of emergency department visits (OR=0.98, p<0.05) were both negatively associated with telestroke adoption.

Conclusions: Our study is novel in its focus on telestroke adoption specifically, rather than telehealth adoption generally, and for including variables not included in previous telehealth analyses. Our findings suggest some hospitals may have neither the financial resources nor the ability to pool resources for acquiring needed technology, and differences in adoption may result in geographic inequities in access to telestroke services.