Long-term effects of specialized stroke care with telemedicine support in community hospitals on behalf of the Telemedical Project for Integrative Stroke Care (TEMPiS).

Abstract

Stroke unit treatment is effective in reducing death and dependency after stroke but is not available in many, particularly rural, areas. The implementation of a stroke network with telemedicine support was associated with improved outcome at 3 months. We report follow-up results at 12 and 30 months after acute stroke. Telemedical Project for Integrative Stroke Care (TEMPiS) consists of the set-up of specialized local stroke wards, continuous medical education, and telemedical consultation for patients with acute stroke by 2 stroke centers. In a prospective, nonrandomized, intervention study, 5 community hospitals participating in the network were compared with 5 matched control hospitals without specialized stroke facilities or telemedical support. All patients with consecutive ischemic or hemorrhagic stroke admitted between July 2003 and March 2005 were evaluated. Outcome "death and dependency" was defined by death, institutional care, or disability (Barthel index <60 or Rankin scale >3). We followed-up 3060 patients (1938 in TEMPiS and 1122 in control hospitals). Follow-up rates were 97.2% after 12 months and 95.9% after 30 months for death or institutional care, and 96.5% after 12 months and 95.7% after 30 months for death and dependency. In multivariable regression analysis, there was no significant effect of the TEMPiS intervention for reduced "death or institutional care" at 12 months (OR, 0.89; 95% CI, 0.75-1.07; P=0.23) and 30 months (OR, 0.93; 95% CI, 0.78-1.11; P=0.40) but a significant reduction of "death and dependency" at 12 months (OR, 0.65; 95% CI, 0.54-0.78; P<0.01) and 30 months (OR, 0.82; 95% CI, 0.68-0.98; P=0.031). Implementing a system of specialized stroke wards, continuing education, and telemedicine in community hospitals offers long-term benefit for acute stroke patients.