title: Effects of the implementation of a telemedical stroke network: the Telemedic Pilot Project for Integrative Stroke Care (TEMPiS) in Bavaria, Germany.
abstract: BACKGROUND
  Telemedical networks are a new approach to improve stroke care in community settings. We aimed to assess the effects of a stroke network with telemedical support in Germany on quality of care, according to acute processes and long-term outcome.
  
  
  METHODS
  Five community hospitals without pre-existing specialised stroke care were included in a network with telemedical support by two academic hospitals. In a non-randomised, open intervention study, five community hospitals without specialised stroke care served as the control group, matched individually to the network hospitals by predefined characteristics. Stroke patients admitted consecutively to one of the participating hospitals between July 7, 2003, and March 31, 2005, were included in the study. Patients in network and control hospitals were assessed in the same manner and were followed up for vital status, living situation, and disability at 3 months. Poor outcome was defined by death, institutional care, or disability (Barthel index <60 or modified Rankin scale >3). Predefined indicators for quality of acute stroke care were achieved.
  
  
  RESULTS
  A total of 5696 patients with a sudden, non-convulsive loss of neurological function who were diagnosed with having suspected stroke were admitted to the ten hospitals participating in the study. After exclusion, 3122 were included in the final analysis, of whom 1971 (63%) were treated in the network hospitals. All indicators related to quality of acute stroke care were more commonly met in the network than in the control hospitals. After 3 months, 44% of patients treated in network hospitals versus 54% treated in control hospitals had a poor outcome (p<0.0001). In multivariate regression analysis, treatment in network hospitals independently reduced the probability of a poor outcome (odds ratio 0.62, 95% CI 0.52-0.74; p<0.0001).
  
  
  CONCLUSIONS
  Telemedical networks with academic stroke centres offer new and innovative approaches to improve acute stroke care at community level for stroke patients living in non-urban areas.
authors.affiliation: Department of Neurology, Klinikum Harlaching, Städtisches Klinikum München GmbH, Germany.
authors.forename: Heinrich J
authors.initials: HJ
authors.lastname: Audebert
authors.forename: Johannes
authors.initials: J
authors.lastname: Schenkel
authors.forename: Peter U
authors.initials: PU
authors.lastname: Heuschmann
authors.forename: Ulrich
authors.initials: U
authors.lastname: Bogdahn
authors.forename: Roman L
authors.initials: RL
authors.lastname: Haberl
mesh_terms: D000046:Academic Medical Centers; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005858:Germany; D006748:Hospital Departments; D006764:Hospitals, Community; D006801:Humans; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D019984:Quality Indicators, Health Care; D020521:Stroke / Q000175:diagnosis / Q000628:therapy*; D017216:Telemedicine / Q000706:statistics & numerical data*; D016896:Treatment Outcome