远程卒中单元作为农村地区的医疗模式：远程医疗综合卒中护理项目的10年经验
TeleStroke units serving as a model of care in rural areas: 10-year experience of the TeleMedical project for integrative stroke care.
作者信息
Müller-Barna Peter, Hubert Gordian J, Boy Sandra, Bogdahn Ulrich, Wiedmann Silke, Heuschmann Peter U, Audebert Heinrich J
机构信息
From the Department of Neurology, Klinikum Harlaching, Städtisches Klinikum München GmbH, München, Germany (P.M.-B., G.J.H.); Department of Neurology, Krankenhaus Agatharied, Hausham, Germany (P.M.-B.); Department of Neurology, University Hospital Regensburg, Regensburg, Germany (S.B., U.B.); Institute of Clinical Epidemiology and Biometry (S.W., P.U.H.) and Comprehensive Heart Failure Center (S.W., P.U.H.), University of Würzburg, Würzburg, Germany; Clinical Trial Center Würzburg, University Hospital Würzburg, Würzburg, Germany (S.W., P.U.H.); and Klinik und Hochschulambulanz für Neurologie (H.J.A.) and Center for Stroke Research (H.J.A.), Charité-Universitätsmedizin Berlin, Berlin, Germany.
出版信息
Stroke. 2014 Sep;45(9):2739-44. doi: 10.1161/STROKEAHA.114.006141.
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.
背景与目的
卒中单元护理可改善卒中预后，推荐应用于所有卒中患者。在农村地区，广泛实施卒中单元具有挑战性。因此，2003年设立了综合卒中护理远程医疗项目（TEMPiS）作为远程卒中单元网络，以克服德国巴伐利亚州东南部的这一障碍。2003年至2005年对其实施情况的评估显示，与未设远程卒中单元的对照医院相比，其流程质量和临床结局有所改善。目前缺乏这些效果可持续性的数据。
方法
利用官方医院报告中的数据，分析对当地人群卒中护理的影响。2003年至2012年的前瞻性登记描述了在TEMPiS医院接受治疗的连续卒中患者和短暂性脑缺血发作患者的流程和结局。质量指标评估诊断、治疗和结局。报告了静脉溶栓的比率和及时性以及远程会诊和二次院间转诊的数据随时间的变化情况。
结果
在覆盖区域内，网络实施使设有（远程）卒中单元的医院中治疗的卒中和短暂性脑缺血发作患者数量大幅从19%增至78%。2003年2月至2012年12月期间，15家区域医院共治疗了54804例卒中和短暂性脑缺血发作患者，并进行了31864次远程会诊。3331例卒中患者接受了静脉溶栓治疗，其在所有缺血性卒中患者中的比例从2.6%增至15.5%。中位发病至治疗时间从150分钟（四分位间距，127 - 163）降至120分钟（四分位间距，90 - 160），门到针时间从80分钟（四分位间距，68 - 101）降至40分钟（四分位间距，29 - 59）。
结论
远程卒中单元可为农村地区提供持续的高质量卒中护理。
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