Effective Hub-Spoke Relationships: Lessons from the Jefferson Neuroscience Network Experience

Introduction: The stroke public health crisis is increasingly addressed by regional TeleStroke networks comprised of Hub and Spoke treatment sites. Functional Hub-Spoke (H-S) relationships are fundamental to network success. The purpose was to report on our experience developing and maintaining H-S relationships, and to propose a H-S relationship model. Methods: Jefferson Neuroscience Network (JNN) was launched in July 2010. By June 2011 it had 1 Hub and 28 Spoke sites across 2 states (PA, NJ), and had performed 836 TeleStroke consultations. Key Hub and Spoke personnel were consulted regarding H-S relationships. Feedback was organized. Results: A Hub team was assembled and trained. Three key steps to developing H-S relationships were identified: Secure Spoke physician and administration commitment; Train Spoke team; Address Spoke-specific obstacles. Two key steps to maintaining H-S relationships were identified: Continual education; Institutionalize bi-directional communication. Specific JNN initiatives are described. The proposed H-S relationship model is a patient-centered, physician-driven, voluntary collaboration between treatment sites. Hubs offer Spokes education, and access to clinical expertise, clinical trials, and a higher level of care. As a result, Spokes may increase evidence-based practice, become more comfortable administering tPA, experience stroke center accreditation opportunities, and decrease transfer of inappropriate patients. In turn, Spokes offer Hubs community partnership, meaning they choose to solicit Hub expert opinion regarding patient management. As a result, Hubs may increase their community reputation and research opportunities. Furthermore, appropriate patients may be rapidly identified and treated in the community or, if necessary, transferred to comprehensive stroke centers within time constraints. Conclusions: JNN-identified key steps for developing and maintaining H-S relationships may assist other stroke networks to build and sustain relationships between treatment sites. Different treatment sites can collaborate to improve stroke care while simultaneously achieving their own independent goals. Additional practical advice about designing and implementing functional and sustainable TeleStroke programs is needed