Sunday, November 30, 2008

Telemedicine Improves Outcomes

Stroke patients have a better chance of surviving and living independently when they receive specialized stroke care in community hospitals using telecommunications to communicate with major stroke centers. This has been reported in a study appearing in “Stroke: Journal of the American Heart Association”.

Most community hospitals don’t have dedicated stroke units because of a shortage of experienced physicians and lack of access to stroke related clinical expertise at major medical centers. Rural areas in particular often have inadequate resources to provide specialized stroke care.

In Germany, the Telemedical Project for Integrative Stroke Care (TEMPiS) funded by the German Federal Ministry of Research, examined the feasibility and potential value for extending specialized stroke care to a large area of the Bavarian region of Southeastern Germany. TEMPiS, is a collaborative effort between two academic stroke centers and community hospitals in Bavaria.

The TEMPiS program is to:

  • Establish stroke units at community hospitals along with multidisciplinary stroke teams to provide care
  • Install and monitor equipment and facilities
  • Train and educate the stroke team plus have specialist physicians, nurse, and therapists provide continuous bedside teaching
  • Implement standard treatment protocols
  • Provide for 24 hour telemedicine consultations by academic stroke centers

The outcomes for the stroke patients treated at five TEMPiS hospitals with patient outcomes at five non TEMPiS hospitals in the same geographic region were compared. The study included 3,060 stroke patients with 1,938 treated at TEMPiS hospitals and 1,122 treated at other hospitals.

The patients treated at the TEMPiS hospitals had a 35 percent lower probability of death and dependency at 12 months and almost a 20 percent reduced probability for a poor outcome at 30 months as compared with non TEMPiS patients.

Initial results showed that specialized stroke care improved with the use of telemedicine. Factors such as making high quality stroke care available, providing for rapid brain imaging, providing patients with clot dissolving drugs on a frequent basis, having the ability to assess stroke related swallowing disorders, initiating early stroke rehabilitation, and using telemedicine was shown to contribute to this improvement in stroke care.