Kostenanalyse telemedizinischer Schlaganfallbehandlung

Schenkel, Johannes; Reitmeir, Peter; Reden, S. Von; Holle, R.; Boy, S.; Haberl, R.; Audebert, Heinrich J.

doi:10.1055/s-0032-1321779

Cited by 7 publications

(8 citation statements)

References 5 publications

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“…Patients treated at non-telestroke facilities had increased rates of ongoing care and institutionalization, requiring higher annual healthcare costs over the long term. Telestroke was cost neutral by 30 months, and for every year afterwards, cost effective by reducing lifelong costs of supportive care 20. Similar results have been replicated in other American and European contexts, demonstrating long term cost savings generated from improved functional outcomes and decreased hospital transfers 21–24.…”

Section: Expanding Access To Telestrokesupporting

confidence: 59%

“…Coordinating these efforts requires an ongoing investment that, in the near term on an institutional level, can be more expensive than not treating AIS. The financial outlook of telestroke in a real world was recently assessed in a retrospective analysis of nearly 1300 AIS cases in a large German telestroke network 20. The cost of treatment was compared for patients treated in hospitals with or without telestroke capabilities and tracked for 30 months post-stroke.…”

Section: Expanding Access To Telestrokementioning

confidence: 99%

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Telestroke—the promise and the challenge. Part two—expansion and horizons

Akbik

Hirsch

Chandra

et al. 2016

J NeuroIntervent Surg

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Acute ischemic stroke remains a major public health concern, with low national treatment rates for the condition, demonstrating a disconnection between the evidence of treatment benefit and delivery of this treatment. Intravenous thrombolysis and endovascular thrombectomy are both strongly evidence supported and exquisitely time sensitive therapies. The mismatch between the distribution and incidence of stroke presentations and the availability of specialist care significantly affects access to care. Telestroke, the use of telemedicine for stroke, aims to surmount this hurdle by distributing stroke expertise more effectively, through video consultation with and examination of patients in locations removed from specialist care. This is the second of a two part review, and is focused on the challenges telestroke faces for wider adoption. It further details the anticipated evolution of this novel therapeutic platform, and the potential roles it holds in stroke prevention, ambulance based care, rehabilitation, and research.

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Section: Expanding Access To Telestrokesupporting

confidence: 59%

Section: Expanding Access To Telestrokementioning

confidence: 99%

Telestroke—the promise and the challenge. Part two—expansion and horizons

Akbik

Hirsch

Chandra

et al. 2016

J NeuroIntervent Surg

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“…In 2002, health policy authorities decided to support telemedicine networks. When the controlled study showed that the TEMPiS concept was both improving clinical outcomes and cost effective when compared with conventional care (higher costs during acute care were fully compensated by lower rehabilitation and long-term care costs), 16 ongoing support by health insurances covering the teleconsultation service and the quality management program was decided in 2006. Meanwhile, the running costs of the TeleStroke Units for the regional hospitals are reimbursed within the German diagnosis related groups system.…”

Section: Discussionmentioning

confidence: 99%

TeleStroke Units Serving as a Model of Care in Rural Areas

Müller-Barna

Hubert

Boy

et al. 2014

Stroke

118

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Background and Purpose— Stroke Unit care improves stroke prognosis and is recommended for all patients with stroke. In rural areas, population-wide implementation of Stroke Units is challenging. Therefore, the TeleMedical Project for integrative Stroke Care (TEMPiS) was established in 2003 as a TeleStroke Unit network to overcome this barrier in Southeast Bavaria/Germany. Evaluation of its implementation between 2003 and 2005 had revealed improved process quality and clinical outcomes compared with matched hospitals without TeleStroke Units. Data on sustainability of these effects are lacking. Methods— Effects on the stroke care of the local population were analyzed by using data from official hospital reports. Prospective registries from 2003 to 2012 describe processes and outcomes of consecutive patients with stroke and transient ischemic attack treated in TEMPiS hospitals. Quality indicators assess diagnostics, treatment, and outcome. Rates and timeliness of intravenous thrombolysis as well as data on teleconsultations and secondary interhospital transfers were reported over time. Results— Within the covered area, network implementation increased the number of patients with stroke and transient ischemic attack treated in hospitals with (Tele-)Stroke Units substantially from 19% to 78%. Between February 2003 and December 2012, 54 804 strokes and transient ischemic attacks were treated in 15 regional hospitals, and 31 864 teleconsultations were performed. Intravenous thrombolysis was applied 3331 stroke cases with proportions increasing from 2.6% to 15.5% of all patients with ischemic stroke. Median onset-to-treatment times decreased from 150 (interquartile range, 127–163) to 120 minutes (interquartile range, 90–160) and door-to-needle times from 80 (interquartile range, 68–101) to 40 minutes (interquartile range, 29–59). Conclusions— TeleStroke Units can provide sustained high-quality stroke care in rural areas.

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“…a relative reduction by one fifth. The assumptions are based on the results of the TEMPiS trial [ 13 ].…”

Section: Methodsmentioning

confidence: 99%

“…Treatment of acute stroke using telemedicine resulted in more frequent and appropriate application of intravenous thrombolysis [ 10 , 11 ] and was associated with improved outcome [ 12 ]. What is more, “telestroke” proved to be cost-effective [ 13 ] making stroke one of the most frequent indications for telemedicine in several countries (Refs als from US, Germany etc).…”

Section: Introductionmentioning

confidence: 99%

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

Weber

Angermaier

Bollweg

et al. 2020

BMC Health Serv Res

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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.

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Kostenanalyse telemedizinischer Schlaganfallbehandlung

Abstract: Considering both health insurance and nursing care fund costs, the incremental costs for TeleStroke network care in hospitals are compensated by savings in outpatient care.

Cited by 7 publications

References 5 publications

Telestroke—the promise and the challenge. Part two—expansion and horizons

Telestroke—the promise and the challenge. Part two—expansion and horizons

TeleStroke Units Serving as a Model of Care in Rural Areas

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

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