http://stroke.ahajournals.org/content/45/9/2739.abstract?etoc
10-Year Experience of the TeleMedical Project for Integrative Stroke Care
- Peter Müller-Barna, MD*;
- Gordian J. Hubert, MD*;
- Sandra Boy, MD;
- Ulrich Bogdahn, MD;
- Silke Wiedmann, PhD;
- Peter U. Heuschmann, MD, MPH;
- Heinrich J. Audebert, MD
+ Author Affiliations
- Correspondence to Peter Müller-Barna, MD, Department of Neurology, Krankenhaus Agatharied, Norbert-Kerkel-Platz, 83734 Hausham, Germany. E-mail peter.mueller-barna@khagatharied.de
-
↵* Drs Müller-Barna and Hubert contributed equally.
Abstract
Background and Purpose—Stroke
Unit care improves stroke prognosis and is recommended for all patients
with stroke. In rural areas, population-wide
implementation of Stroke Units is
challenging. Therefore, the TeleMedical Project for integrative Stroke
Care (TEMPiS) was
established in 2003 as a TeleStroke Unit
network to overcome this barrier in Southeast Bavaria/Germany.
Evaluation of its
implementation between 2003 and 2005 had
revealed improved process quality and clinical outcomes compared with
matched hospitals
without TeleStroke Units. Data on
sustainability of these effects are lacking.
Methods—Effects on
the stroke care of the local population were analyzed by using data from
official hospital reports. Prospective
registries from 2003 to 2012 describe
processes and outcomes of consecutive patients with stroke and transient
ischemic attack
treated in TEMPiS hospitals. Quality
indicators assess diagnostics, treatment, and outcome. Rates and
timeliness of intravenous
thrombolysis as well as data on
teleconsultations and secondary interhospital transfers were reported
over time.
Results—Within the
covered area, network implementation increased the number of patients
with stroke and transient ischemic attack
treated in hospitals with (Tele-)Stroke Units
substantially from 19% to 78%. Between February 2003 and December 2012,
54 804
strokes and transient ischemic attacks were
treated in 15 regional hospitals, and 31 864 teleconsultations were
performed.
Intravenous thrombolysis was applied 3331
stroke cases with proportions increasing from 2.6% to 15.5% of all
patients with
ischemic stroke. Median onset-to-treatment
times decreased from 150 (interquartile range, 127–163) to 120 minutes
(interquartile
range, 90–160) and door-to-needle times from
80 (interquartile range, 68–101) to 40 minutes (interquartile range,
29–59).
Conclusions—TeleStroke Units can provide sustained high-quality stroke care in rural areas.
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