title: Using routine data for quality assessment in NeuroNet telestroke care.
abstract: 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.
authors.affiliation: 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.
authors.forename: Stephan
authors.initials: S
authors.lastname: Theiss
authors.forename: Franziska
authors.initials: F
authors.lastname: Günzel
authors.forename: Anna
authors.initials: A
authors.lastname: Storm
authors.forename: Patrick
authors.initials: P
authors.lastname: Hausn
authors.forename: Stefan
authors.initials: S
authors.lastname: Isenmann
authors.forename: Joachim
authors.initials: J
authors.lastname: Klisch
authors.forename: Guntram W
authors.initials: GW
authors.lastname: Ickenstein
mesh_terms: D000368:Aged; D002545:Brain Ischemia / Q000175:diagnosis* / Q000188:drug therapy; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D011785:Quality Assurance, Health Care; D019114:Remote Consultation; D020521:Stroke / Q000175:diagnosis* / Q000188:drug therapy; D017216:Telemedicine / Q000592:standards*; D015912:Thrombolytic Therapy / Q000379:methods*; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use*
chemical_list: D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator