德国东北部的急性神经科护理与远程医疗支持（ANNOTeM）：一项多中心、对照、开放标签、双臂干预研究的方案。

Acute neurological care in north-east Germany with telemedicine support (ANNOTeM): protocol of a multi-center, controlled, open-label, two-arm intervention study.

机构信息

Klinik und Hochschulambulanz für Neurologie, Charité - Universitätsmedizin Berlin, Hindenburgdamm 30, D-12203, Berlin, Germany.

Center for Stroke Research Berlin (CSB), Charité - Universitätsmedizin Berlin, Berlin, Germany.

出版信息

BMC Health Serv Res. 2020 Aug 17;20(1):755. doi: 10.1186/s12913-020-05576-w.

DOI:10.1186/s12913-020-05576-w

PMID:32807159

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7430113/

Abstract

BACKGROUND

Both diagnosis and treatment of neurological emergencies require neurological expertise and are time-sensitive. The lack of fast neurological expertise in regions with underserved infrastructure poses a major barrier for state-of-the-art care of patients with acute neurological diseases and leads to disparity in provision of health care. The main purpose of ANNOTeM (acute neurological care in North East Germany with telemedicine support) is to establish effective and sustainable support structures for evidence based treatments for stroke and other neurological emergencies and to improve outcome for acute neurological diseases in these rural regions.

METHODS

A "hub-and-spoke" network structure was implemented connecting three academic neurological centres ("hubs") and rural hospitals ("spokes") caring for neurological emergencies. The network structure includes (1) the establishment of a 24/7 telemedicine consultation service, (2) the implementation of standardized operating procedures (SOPs) in the network hospitals, (3) a multiprofessional training scheme, and (4) a quality management program. Data from three major health insurance companies as well as data from the quality management program are being collected and evaluated. Primary outcome is the composite of first time of receiving paid outpatient nursing care, first time of receiving care in a nursing home, or death within 90 days after hospital admission.

DISCUSSION

Beyond stroke only few studies have assessed the effects of telemedically supported networks on diagnosis and outcome of neurological emergencies. ANNOTeM will provide information whether this approach leads to improved outcome. In addition, a health economic analysis will be performed.

STUDY REGISTRATION

German Clinical Trials Register DRKS00013067, date of registration: November 16 th, 2017, URL: http://www.drks.de/DRKS00013068.

摘要

背景

神经急症的诊断和治疗都需要神经科专业知识，且十分耗时。在基础设施不完善的地区，缺乏快速的神经科专业知识，这对急性神经疾病患者的最新治疗造成了重大障碍，并导致医疗服务提供方面存在差异。ANNOTeM（德国东北部急性神经疾病的远程医疗支持）的主要目的是为卒中及其他神经急症的循证治疗建立有效的、可持续的支持结构，并改善这些农村地区急性神经疾病的预后。

方法

采用“枢纽-辐射”网络结构，连接三个学术性神经中心（“枢纽”）和负责神经急症的农村医院（“辐射”）。网络结构包括：（1）建立 24/7 远程医疗咨询服务；（2）在网络医院实施标准化操作流程（SOPs）；（3）多专业培训计划；（4）质量管理计划。从三大健康保险公司收集数据，并从质量管理计划中评估数据。主要结果是住院后 90 天内首次接受有偿门诊护理、首次入住疗养院或死亡的综合结果。