On the evaluation of pre-hospital telemedicine in acute stroke care

Sammanfattning: Purpose: To propose a blueprint of how the policymakers responsible for health care reforms in the county of Scania (Sweden) could evaluate a prospective stroke care intervention from a societal point of view. More specifically, the intervention will consist in the introduction of telemedicine technology to their ambulance fleet. In addition, key methodological issues, of interest to the policymaker, are to be discerned and commented on. Method: The vantage point will be a Markov simulation. The various methodological considerations pertaining to such simulations will be highlighted. In particular, the variables one ought to consider will be thoroughly discussed. Furthermore, there will be suggestions as to what kind of data the policymaker will need in order to make the simulation as interesting and realistic as possible. The definition of the outcome variables will be wide so as to encompass a societal point of view. Results: At the moment, the direct (and indirect) costs associated with the intervention seem rather uncharted. In addition, there are no studies indicating that there indeed is a clinical effect of the intervention. A simple way to facilitate the evaluation would be to try and keep track of (i) how discharged stroke patients are distributed across mRS-categories, and (ii) how the intervention affects this distribution. The main reason for this is that a lot of academic effort has already been invested in relating mRS to health care costs, quality of life, and mortality.