Two years\u2019 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,Steffi Jírů-Hillmann,Mathias Pfau,Johannes Mühler,Hassan Soda,Viktoria Rücker,Klaus Dötter,Udo Selig,Roy Hoffmann,Tobias Goebel,Sebastian Doerck,R Schneider ,Peter U Heuschmann,Peter Kraft,Joachim Stenzel,Jens Volkmann,Daniela Krämer ,M Keidel ,Mohamed Benghebrid,Alexandra Rascher,Karl Georg Hæusler ,Felix Fluri

doi:10.1186/s12883-020-01676-6

Abstract

BackgroundTelemedicine 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.MethodsThe 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.ResultsOverall, 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.ConclusionThe implementation of the comprehensive TRANSIT-Stroke network resulted in an improvement of quality of care in level-I-hospitals.

Highlights

Telemedicine improves the quality of acute stroke care in rural regions with limited access to specialized stroke care
On the basis of a telemedical stroke network comprising all hospitals in north-western Bavaria (Germany), we aimed to evaluate the impact of the network structure on stroke care in a mainly rural area
Overall, information on 7881 patients was included in the evaluation, of which 927 (12%) were treated in level-Ihospitals

Summary

Introduction

Telemedicine improves the quality of acute stroke care in rural regions with limited access to specialized stroke care. Health care in rural areas Access to specialized health care in rural areas is often restricted due to limited availability and long travelling distances [1, 2]. This holds true for treatment of acute stroke patients where treatment delays are associated with worse outcome [3,4,5]. Approved treatments for acute stroke include intravenous thrombolysis or mechanical revascularization which may improve stroke symptoms These procedures are only effective within a certain time frame [6,7,8]. While the first can increase the awareness for stroke signs and for immediate action in the general public, the implementation of telestroke units can reduce the spatial distance to a facility providing help and, avoid time elapsing senselessly [11, 12]

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Conclusion