Table 3.

Comparison of hub-level practices.

GRU-REACH hub	MUSC-REACH hub
GRU-REACH hub invited most of the early spokes to become part of the network and subsidized their participation; most recent spokes sought membership without subsidies.	MUSC-REACH hub invited most of the early spokes to become part of the network, but participation was not subsidized; most recent spokes also sought membership without subsidies.
GRU administration considers telestroke as an ongoing experiment rooted in the vision and goodwill of the stroke specialists who developed REACH. As such, the specialists feel REACH is “taken for granted.” GRU administration does not provide support for telestroke operations.	MUSC administration considers telestroke an integral part of their neuroscience service line, and therefore provides ongoing support (including director’s pay, advertising budget, and administrative salary support for credentialing, billing, operations, and project management).
There is broad consensus among the hub stroke specialists that network performance would benefit from a full-time telestroke coordinator.	A dedicated telestroke coordinator at the hub has been part of the network from the start. She facilitates coordination and training of the spokes’ ED staff.
The hub has no established processes for reinforcing telestroke use and related routines at the spokes. There are no continuous quality improvement processes in place. Any problems related to stroke consultations are reported to REACH Health Inc with variable follow-up.	The hub has established processes for reinforcing telestroke use and related routines at the spokes. It has a formal continuous quality improvement process in place. Any problem during telestroke consultation is reported to REACH Health Inc and its resolution is coordinated by the hub staff.
The hub collects spokes’ telestroke use data, but there is no systematic analysis of the data.	The hub telestroke coordinator collects spokes’ usage data and conducts systematic analysis.
A hub stroke specialist visits spokes when they go live with REACH and at rare occasions for major upgrades. However, there are no ongoing training and follow-up procedures.	A hub telestroke specialist visits spokes when they go live with REACH and maintains regular communication (with some visits) to spokes to understand concerns and train ED staff.
The hub stroke specialists rarely conduct ongoing training for spokes.	The hub facilitates occasional breakfast meetings, lunch-and-learn, mock-consults, and dinners with spoke ED physicians and nurses to discuss issues.
The hub has no formal system to provide site-specific feedback.	The hub provides site-specific performance data. As an MUSC-REACH stroke specialist told us, “The sites love to receive such feedback.”