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. 2020 Mar 19;20(1):104.
doi: 10.1186/s12883-020-01676-6.

Two Years' Experience of Implementing a Comprehensive Telemedical Stroke Network Comprising in Mainly Rural Region: The Transregional Network for Stroke Intervention With Telemedicine (TRANSIT-Stroke)

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Two Years' Experience of Implementing a Comprehensive Telemedical Stroke Network Comprising in Mainly Rural Region: The Transregional Network for Stroke Intervention With Telemedicine (TRANSIT-Stroke)

Katharina M A Gabriel et al. BMC Neurol. .
Free PMC article

Abstract

Background: Telemedicine improves the quality of acute stroke care in rural regions with limited access to specialized stroke care. We report the first 2 years' experience of implementing a comprehensive telemedical stroke network comprising all levels of stroke care in a defined region.

Methods: The TRANSIT-Stroke network covers a mainly rural region in north-western Bavaria (Germany). All hospitals providing acute stroke care in this region participate in TRANSIT-Stroke, including four hospitals with a supra-regional certified stroke unit (SU) care (level III), three of those providing teleconsultation to two hospitals with a regional certified SU (level II) and five hospitals without specialized SU care (level I). For a two-year-period (01/2015 to 12/2016), data of eight of these hospitals were available; 13 evidence-based quality indicators (QIs) related to processes during hospitalisation were evaluated quarterly and compared according to predefined target values between level-I- and level-II/III-hospitals.

Results: Overall, 7881 patients were included (mean age 74.6 years ±12.8; 48.4% female). In level-II/III-hospitals adherence of all QIs to predefined targets was high ab initio. In level-I-hospitals, three patterns of QI-development were observed: a) high adherence ab initio (31%), mainly in secondary stroke prevention; b) improvement over time (44%), predominantly related to stroke specific diagnosis and in-hospital organization; c) no clear time trends (25%). Overall, 10 out of 13 QIs reached predefined target values of quality of care at the end of the observation period.

Conclusion: The implementation of the comprehensive TRANSIT-Stroke network resulted in an improvement of quality of care in level-I-hospitals.

Conflict of interest statement

KGH: received lecture honoraria and/or honoraria for consulting from Bayer HealthCare, Biotronik, Bristol-Myers Squibb, Boehringer Ingelheim, Daiichi Sankyo, Edwards Lifesciences, EIP Pharma, Medtronic, W. L. Gore, Pfizer, Sanofi-Aventis and research grants from Bayer HealthCare and Sanofi-Aventis.

PUH: reports grants from German Ministry of Research and Education, German Research Foundation, European Union, Charité–Universitätsmedizin Berlin, Berlin Chamber of Physicians, German Parkinson Society, University Hospital Würzburg, Robert Koch Institute, German Heart Foundation, University Göttingen (within FIND-AF randomized, supported by an unrestricted research grant to the University Göttingen from Boehringer-Ingelheim), University Hospital Heidelberg (within RASUNOA-prime, supported by an unrestricted research grant to the University Hospital Heidelberg from Bayer, BMS, Boehringer-Ingelheim, Daiichi Sankyo), grants from Charité–Universitätsmedizin Berlin (within Mondafis, supported by an unrestricted research grant to the Charité from Bayer), outside the submitted work.

All other authors do not declare any competing interest.

Figures

Fig. 1
Fig. 1
Indicators of quality high ab initio, displayed quarterly, stratified for level of hospital, patients [%] treated as defined. a) Platelet inhibitor given within 48 h in patients with IS or TIA. b) Early mobilisation of patients with severe disability. c) Patients receiving an atrial fibrillation screening during their stay. d) Antihypertensive drugs at discharge in patients with IS or TIA. e) Platelet inhibitor given at discharge in patients with IS or TIA and no anticoagulation
Fig. 2
Fig. 2
Indicators of quality increasing over time, displayed quarterly, stratified for level of hospital, patients [%] treated as defined. a) Early cerebral imaging (< 60 min after admission) in patients eligible for thrombolysis. b) Early intravenous thrombolysis (IVT) given in patients with indication for IVT. c) Dysphagia screening. d) Early physio- / occupational therapy for patients with motor disability. e) Extracranial carotid artery diagnostic in patients with IS or TIA. f) Patients receiving statin at discharge or whom a statin was recommended. g) Discharge in rehabilitation clinic
Fig. 3
Fig. 3
Indicators of quality with no clear temporal trend, displayed quarterly, stratified for level of hospital, patients [%] treated as defined. a) Door-to-needle-time <  60 min in patients with IVT. b) Early speech and language therapy for patients with dysphagia / dysphasia / dysarthria. c) Revascularisation of symptomatic carotid stenosis in patients with IS or TIA

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