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Barlinn J, Winzer S, Worthmann H, Urbanek C, Häusler KG, Günther A, Erdur H, Görtler M, Busetto L, Wojciechowski C, Schmitt J, Shah Y, Büchele B, Sokolowski P, Kraya T, Merkelbach S, Rosengarten B, Stangenberg-Gliss K, Weber J, Schlachetzki F, Abu-Mugheisib M, Petersen M, Schwartz A, Palm F, Jowaed A, Volbers B, Zickler P, Remi J, Bardutzky J, Bösel J, Audebert HJ, Hubert GJ, Gumbinger C. [Telemedicine in stroke-pertinent to stroke care in Germany]. Nervenarzt 2021; 92:593-601. [PMID: 34046722 PMCID: PMC8184549 DOI: 10.1007/s00115-021-01137-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 02/24/2021] [Indexed: 01/14/2023]
Abstract
BACKGROUND AND OBJECTIVE Telemedical stroke networks improve stroke care and provide access to time-dependent acute stroke treatment in predominantly rural regions. The aim is a presentation of data on its utility and regional distribution. METHODS The working group on telemedical stroke care of the German Stroke Society performed a survey study among all telestroke networks. RESULTS Currently, 22 telemedical stroke networks including 43 centers (per network: median 1.5, interquartile range, IQR, 1-3) as well as 225 cooperating hospitals (per network: median 9, IQR 4-17) operate in Germany and contribute to acute stroke care delivery to 48 million people. In 2018, 38,211 teleconsultations (per network: median 1340, IQR 319-2758) were performed. The thrombolysis rate was 14.1% (95% confidence interval 13.6-14.7%) and transfer for thrombectomy was initiated in 7.9% (95% confidence interval 7.5-8.4%) of ischemic stroke patients. Financial reimbursement differs regionally with compensation for telemedical stroke care in only three federal states. CONCLUSION Telemedical stroke care is utilized in about 1 out of 10 stroke patients in Germany. Telemedical stroke networks achieve similar rates of thrombolysis and transfer for thrombectomy compared with neurological stroke units and contribute to stroke care in rural regions. Standardization of network structures, financial assurance and uniform quality measurements may further strengthen the importance of telestroke networks in the future.
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Affiliation(s)
- J Barlinn
- Klinik für Neurologie, Universitätsklinikum Dresden, Fetscherstraße 74, 01307, Dresden, Deutschland.
| | - S Winzer
- Klinik für Neurologie, Universitätsklinikum Dresden, Fetscherstraße 74, 01307, Dresden, Deutschland
| | - H Worthmann
- Klinik für Neurologie, Medizinische Hochschule Hannover, Hannover, Deutschland
| | - C Urbanek
- Klinik für Neurologie, Klinikum der Stadt Ludwigshafen, Ludwigshafen, Deutschland
| | - K G Häusler
- Neurologische Klinik und Poliklinik, Universitätsklinikum Würzburg, Würzburg, Deutschland
| | - A Günther
- Klinik für Neurologie, Universitätsklinikum Jena, Jena, Deutschland
| | - H Erdur
- Klinik und Hochschulambulanz für Neurologie, Charité - Universitätsmedizin Berlin, Berlin, Deutschland
| | - M Görtler
- Klinik für Neurologie, Universitätsklinikum Magdeburg, Magdeburg, Deutschland
| | - L Busetto
- Klinik für Neurologie, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - C Wojciechowski
- Klinik für Neurologie, Universitätsklinikum Dresden, Fetscherstraße 74, 01307, Dresden, Deutschland
| | - J Schmitt
- Zentrum für Evidenzbasierte Gesundheitsversorgung, Universitätsklinikum Dresden, Dresden, Deutschland
| | - Y Shah
- Klinik für Neurologie, Klinikum Kassel, Kassel, Deutschland
| | - B Büchele
- Klinik für Neurologie, Städtisches Klinikum Karlsruhe, Karlsruhe, Deutschland
| | - P Sokolowski
- Klinik für Neurologie und neurologische Intensivmedizin, Fachkrankenhaus Hubertusburg, Hubertusburg, Deutschland
| | - T Kraya
- Klinik für Neurologie, Klinikum St.Georg Leipzig, Leipzig, Deutschland
| | - S Merkelbach
- Klinik für Neurologie, Heinrich-Braun-Klinikum Zwickau, Zwickau, Deutschland
| | - B Rosengarten
- Klinik für Neurologie, Klinikum Chemnitz, Chemnitz, Deutschland
| | - K Stangenberg-Gliss
- Klinik für Neurologie, BG Klinikum Unfallkrankenhaus Berlin, Berlin, Deutschland
| | - J Weber
- Klinik und Hochschulambulanz für Neurologie, Charité - Universitätsmedizin Berlin, Berlin, Deutschland
| | - F Schlachetzki
- Klinik für Neurologie, Universität Regensburg, Regensburg, Deutschland
| | - M Abu-Mugheisib
- Klinik für Neurologie, Städtisches Klinikum Braunschweig, Braunschweig, Deutschland
| | - M Petersen
- Klinik für Neurologie, Klinikum Osnabrück, Osnabrück, Deutschland
| | - A Schwartz
- Klinik für Neurologie, Klinikum Region Hannover, Hannover, Deutschland
| | - F Palm
- Klinik für Neurologie, Helios Klinikum Schleswig, Schleswig, Deutschland
| | - A Jowaed
- Klinik für Neurologie, Westküstenkliniken Heide, Heide, Deutschland
| | - B Volbers
- Klinik für Neurologie, Universitätsklinikum Erlangen, Erlangen, Deutschland
| | - P Zickler
- Klinik für Neurologie und Klinische Neurophysiologie, Universitätsklinikum Augsburg, Augsburg, Deutschland
| | - J Remi
- Klinik für Neurologie, Klinikum der LMU München-Großhadern, München, Deutschland
| | - J Bardutzky
- Klinik für Neurologie, Universitätsklinikum Freiburg, Freiburg, Deutschland
| | - J Bösel
- Klinik für Neurologie, Klinikum Kassel, Kassel, Deutschland
| | - H J Audebert
- Klinik und Hochschulambulanz für Neurologie, Charité - Universitätsmedizin Berlin, Berlin, Deutschland.,Centrum für Schlaganfallforschung Berlin, Charité - Universitätsmedizin Berlin, Berlin, Deutschland
| | - G J Hubert
- Klinik für Neurologie, München-Klinik Harlaching, München, Deutschland
| | - C Gumbinger
- Klinik für Neurologie, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
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Weber JE, Angermaier A, Bollweg K, Erdur H, Ernst S, Flöel A, Gorski C, Kandil FI, Kinze S, Kleinsteuber K, Kurth T, Schmehl I, Theen S, Endres M, Audebert HJ. Acute neurological care in north-east Germany with telemedicine support (ANNOTeM): protocol of a multi-center, controlled, open-label, two-arm intervention study. BMC Health Serv Res 2020; 20:755. [PMID: 32807159 PMCID: PMC7430113 DOI: 10.1186/s12913-020-05576-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 07/23/2020] [Indexed: 11/09/2022] Open
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
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Affiliation(s)
- J E Weber
- 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. .,Clinical Research Unit, Berlin Institute of Health, Berlin, Germany.
| | - A Angermaier
- Department of Neurology, University Medicine Greifswald, Greifswald, Germany
| | - K Bollweg
- Klinik und Hochschulambulanz für Neurologie, Charité - Universitätsmedizin Berlin, Hindenburgdamm 30, D-12203, Berlin, Germany
| | - H Erdur
- 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
| | - S Ernst
- Clinical Research Unit, Berlin Institute of Health, Berlin, Germany.,Institute of Public Health, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - A Flöel
- Department of Neurology, University Medicine Greifswald, Greifswald, Germany.,German Center for Neurodegenerative Diseases, partner site, Rostock, Greifswald, Germany
| | - C Gorski
- Institute of Public Health, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - F I Kandil
- Institute of Public Health, Charité - Universitätsmedizin Berlin, Berlin, Germany.,Institute for Biometry and Clinical Epidemiology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - S Kinze
- Unfallkrankenhaus Berlin, Berlin, Germany
| | - K Kleinsteuber
- Institute of Public Health, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - T Kurth
- Institute of Public Health, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - I Schmehl
- Unfallkrankenhaus Berlin, Berlin, Germany
| | - S Theen
- Institute of Public Health, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - M Endres
- 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.,Excellence Cluster NeuroCure, Berlin, Germany.,German Center for Neurodegenerative Diseases (DZNE), partner site Berlin, Berlin, Germany.,German Centre for Cardiovascular Research (DZHK), partner site Berlin, Berlin, Germany
| | - H J Audebert
- 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
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3
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Erdur H, Siegerink B, Ganeshan R, Audebert HJ, Endres M, Nolte CH, Scheitz JF. Myocardial injury in transient global amnesia: a case-control study. Eur J Neurol 2019; 26:986-991. [DOI: 10.1111/ene.13920] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Accepted: 01/22/2019] [Indexed: 01/27/2023]
Affiliation(s)
- H. Erdur
- Department of Neurology; Charité - Universitätsmedizin Berlin; Berlin
- Berlin Institute of Health (BIH); Berlin
| | - B. Siegerink
- Center for Stroke Research Berlin; Charité - Universitätsmedizin Berlin; Berlin
| | - R. Ganeshan
- Department of Neurology; Charité - Universitätsmedizin Berlin; Berlin
| | - H. J. Audebert
- Department of Neurology; Charité - Universitätsmedizin Berlin; Berlin
- Center for Stroke Research Berlin; Charité - Universitätsmedizin Berlin; Berlin
| | - M. Endres
- Department of Neurology; Charité - Universitätsmedizin Berlin; Berlin
- Berlin Institute of Health (BIH); Berlin
- Center for Stroke Research Berlin; Charité - Universitätsmedizin Berlin; Berlin
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin; Berlin
- DZNE (German Center for Neurodegenerative Diseases), Partner Site Berlin; Berlin Germany
| | - C. H. Nolte
- Department of Neurology; Charité - Universitätsmedizin Berlin; Berlin
- Berlin Institute of Health (BIH); Berlin
- Center for Stroke Research Berlin; Charité - Universitätsmedizin Berlin; Berlin
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin; Berlin
- DZNE (German Center for Neurodegenerative Diseases), Partner Site Berlin; Berlin Germany
| | - J. F. Scheitz
- Department of Neurology; Charité - Universitätsmedizin Berlin; Berlin
- Center for Stroke Research Berlin; Charité - Universitätsmedizin Berlin; Berlin
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin; Berlin
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4
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Nolte CH, Erdur H, Grittner U, Schneider A, Piper SK, Scheitz JF, Wellwood I, Bath PMW, Diener HC, Lees KR, Endres M. Impact of heart rate on admission on mortality and morbidity in acute ischaemic stroke patients - results from VISTA. Eur J Neurol 2016; 23:1750-1756. [DOI: 10.1111/ene.13115] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Accepted: 06/27/2016] [Indexed: 01/24/2023]
Affiliation(s)
- C. H. Nolte
- Department of Neurology; Center for Stroke Research; Berlin Institute of Health; Charite-Universitätsmedzin; Berlin Germany
- Centre for Stroke Research; Berlin Germany
| | - H. Erdur
- Department of Neurology; Center for Stroke Research; Berlin Institute of Health; Charite-Universitätsmedzin; Berlin Germany
| | | | | | | | - J. F. Scheitz
- Department of Neurology; Center for Stroke Research; Berlin Institute of Health; Charite-Universitätsmedzin; Berlin Germany
- Centre for Stroke Research; Berlin Germany
| | - I. Wellwood
- Department of Public Health and Primary Care; University of Cambridge; Cambridge UK
| | - P. M. W. Bath
- School of Medicine; University of Nottingham; Nottingham UK
| | - H.-C. Diener
- Klinik für Neurologie und Schlaganfall-Zentrum Universitätsklinikum; Essen Germany
| | - K. R. Lees
- Institute of Cardiovascular and Medical Sciences; University of Glasgow; Glasgow UK
| | - M. Endres
- Department of Neurology; Center for Stroke Research; Berlin Institute of Health; Charite-Universitätsmedzin; Berlin Germany
- Centre for Stroke Research; Berlin Germany
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