利用常规数据评估 NeuroNet 远程卒中护理的质量。
Using routine data for quality assessment in NeuroNet telestroke care.
机构信息
Institute of Clinical Neuroscience and Medical Psychology, Heinrich Heine University of Düsseldorf, Düsseldorf, Germany; Faculty of Economics and Management, Otto von Guericke University Magdeburg, Magdeburg, Germany.
出版信息
J Stroke Cerebrovasc Dis. 2013 Oct;22(7):984-90. doi: 10.1016/j.jstrokecerebrovasdis.2012.01.012. Epub 2012 Feb 22.
BACKGROUND
Systematic clinical trials are often unavailable to evaluate and optimize operational telestroke networks. In a complementary approach, readily available routine clinical data were analyzed in this study to evaluate the effect of a telestroke network over a 4-year period.
METHODS
Routine clinical data from the HELIOS hospital information system were compared before and after implementation of the NeuroNet concept, including neurologic acute stroke teleconsultations, standard operating procedures, and peer review quality management in 3 hospital cohorts: 5 comprehensive stroke centers, 5 NeuroNet hospitals, and 5 matched control hospitals.
RESULTS
During the study period, the rate of thrombolytic therapy increased by 4.8% in NeuroNet hospitals, while ischemic stroke in-hospital mortality decreased (relative risk reduction ~29% in NeuroNet and control hospitals). The odds ratio for thrombolytic therapy in comprehensive stroke centers compared to NeuroNet hospitals was reduced from 3.7 to 1.3 between 2006 and 2009. Comprehensive stroke care coding according to German Diagnosis Related Groups definitions increased by 45% in NeuroNet (P < .0001) and by 18% in control hospitals.
CONCLUSIONS
Routine clinical data on in-hospital mortality, the rate of thrombolytic therapy, and comprehensive stroke care coding reflect different aspects of acute stroke care improvement related to the implementation of the telemedical NeuroNet concept and unified quality management (standard operating procedure teaching concept, peer review process). Similar evaluation processes could contribute to quality monitoring in other telestroke networks.
背景
系统的临床试验通常无法用于评估和优化远程卒中网络的运作。在一种互补的方法中，本研究分析了现有的常规临床数据，以评估远程卒中网络在 4 年期间的效果。
方法
比较了 HELIOS 医院信息系统中的常规临床数据，这些数据在实施 NeuroNet 概念前后，包括神经急性卒中远程咨询、标准操作程序和同行评审质量管理，涉及 3 个医院队列：5 个综合卒中中心、5 个 NeuroNet 医院和 5 个匹配的对照医院。
结果
在研究期间，NeuroNet 医院的溶栓治疗率增加了 4.8%，而缺血性卒中住院死亡率下降（NeuroNet 和对照医院的相对风险降低约 29%）。2006 年至 2009 年，与 NeuroNet 医院相比，综合卒中中心进行溶栓治疗的比值比从 3.7 降至 1.3。根据德国诊断相关组定义，NeuroNet 医院的综合卒中护理编码增加了 45%（P<0.0001），对照医院增加了 18%。
结论
住院死亡率、溶栓治疗率和综合卒中护理编码的常规临床数据反映了与远程医疗 NeuroNet 概念和统一质量管理（标准操作程序教学概念、同行评审过程）实施相关的急性卒中护理改善的不同方面。类似的评估流程可能有助于其他远程卒中网络的质量监测。
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