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UNM’s Project ACCESS: A state-of-the-art stroke care network

Howard Yonas, MD

  It is a new day for stroke treatment in rural New Mexico.

Within its first 24 months of providing rural hospitals with ER-based special cameras and audio-visual conferencing, UNM physicians have helped increase state-of-the-art stroke treatments in rural areas while saving hospitals millions in expensive air ambulance costs. 

 “The numbers are in and they are impressive,” said Howard Yonas, MD, chair of the UNM School of Medicine Department of Neurosurgery and chief principal investigator for the Access to Critical Cerebral Emergency Support Services (ACCESS) grant, which provided funding for the statewide telemedicine program.

Participating rural hospitals gained more than $12 million to their bottom lines even as effective stroke treatments for their patients increased dramatically, said Yonas. 

The Department of Health and Human Services Centers for Medicare and Medicaid Services awarded UNM a three-year, $15.2 million grant to test the effectiveness of a telemedicine network in diagnosing and treating stroke and brain injury patients.

Working with the Albuquerque-based technology firm Net Medical Xpress, UNM installed a network of low cost, specialized cameras and audiovisual conferencing equipment in ERs with a focus on rural hospitals.

Stroke is the fifth leading cause of death for Americans according to the U.S. Centers for Disease Control, and it is one of the few diseases that are time sensitive. The most effective treatment options can vary depending on a number of factors that a specialist evaluates, he said. 

“Visual cues are also critical for a thorough evaluation of a suspected stroke patient,” said Yonas. “For instance, it is important to see how a patient’s face is reacting in a conversation.” 

Historically that has meant rural hospitals transferred suspected stroke patients to stroke centers. Research has taught us, however, that a significant number of those patients turned out to not be suffering from a major ischemic stroke and many could have been well treated in their hometowns, he said. 

During the first two years, UNM’s ACCESS program performed over 1200 neuro-emergent consults with physicians and hospitals throughout the state, said Yonas, 

Those consults lead to a dramatic increase at rural hospitals in the appropriate use of tPA, the most frequent clot-busting drug, jumping from just two percent to 18 percent of patients suffering from ischemic strokes. At the same time, hospitals saw their stroke transfer rates drop by 60 percent with a corresponding $20 million saved in air ambulance charges. All told, the ACCESS program added some $12 million to the bottom line of rural hospitals, said Yonas. 

At UNM, Yonas oversees a faculty of eight neurosurgeons, two of which are also cerebrovascular surgeons and endovascular specialists, three neuro-critical care specialists, an interventional neuroradiologist. The department's team includes rehabilitation spine specialists and neurosurgeons who also provide comprehensive spine care.

Patients transported to the UNMH advanced primary stroke center are under the direction of Atif Zafar, MD, a member of the department of neurology, who is a specially trained stroke neurologist. Zafar's stroke team helps direct the timely and optimum delivery of stroke care at UNMH.