Journal Article

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)

Pfau, Mathias, Mühler, Johannes, Doerck, Sebastian, Fluri, Felix, Schneider, Rolf, Jírů-Hillmann, Steffi, Selig, Udo, Rücker, Viktoria, Benghebrid, Mohamed, Stenzel, Joachim, Soda, Hassan, Kraft, Peter, Kramer, Daniela, Volkmann, Jens, Keidel, Matthias, Haeusler, Karl Georg, Dötter, Klaus, Hoffmann, Roy, Gabriel, Katharina M. A., Heuschmann, Peter U., Rascher, Alexandra, Goebel, Tobias

2020

Overview

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.

• Publisher: BioMed Central,BioMed Central Ltd,Springer Nature B.V,BMC
• Subject: Care and treatment / Cerebrovascular disease and stroke / Cerebrovascular diseases / Data collection / Health care services accessibility / Horizontal integration / Hospitals / Medical care quality / Medical imaging / Medicine / Medicine & Public Health / Methods / Neurochemistry / Neurology / Neurosurgery / Population density / Quality / Quality management / Research Article / Rural areas / Rural hospitals / Services / Stroke / Telemedicine / Time