Telemedic Project for integrative Stroke Care (TEMPiS)

Dr. Gordian Hubert

Long-term effects on medical outcome in telemedicine use

networks

• teleconsultation only

• telethrombolysis network

• integrative stroke network

Stroke Units in Bavaria in 2002

4 Stroke Unit

Stroke Center

Network-Hospital

Stroke-Networks in Bavaria

4

STENO

TESS

TESAURUS

TEMPiS

Stroke Unit

Stroke Center

Network-Hospital

Exchange of Experience Teleconsultations

Key features of the TEMPiS-Network

Implementation of Stroke

wards in each hospital

Standard treatment protocols

Quality Management

Training –

center-based and onsite

63,2%58,6%

30,3%

54,4%

70,1%

64,9%

56,4%

43,3%

50,9%49,6%50,8%

63,5%60,6%

66,9%65,9%

55,8%55,6%

0%

10%

20%

30%

40%

50%

60%

70%

80%

Burg

l`fel

d

Bad

Töl

z

Zwie

sel

Mühl

dorf

Kel

heim

Eber

sb.

Strau

bing

Freis

ing

Egge

nf.

Cham

Pas

ing

Traunst

.

Dac

hau

Lands

hut

Rose

nh.

TEM

PiS

BAQ

6. Teleconsultation – mobile solution

works with fast UMTS = HSDPA (High Speed Downlink Packet Access)

rate of i.v.-thrombolysis with r-tPA Source : number of thrombolysis: TEMPiS-database of teleconsultations;

number of ischemic strokes: controlling data of hospitals

10

72

115

161

222249

356

435

504

0

200

400

2002 2003 2004 2005 2006 2007 2008 2009 2010

3,2 %

5,4 %

4,4 %

10,2 %

8,3 %

8,1 %

12,4%

% of ischemic

strokes

0,4 %

TEMPiS project

ECASS 3

number of thrombolytic

therapies per year

13,8%

91%

95%

91%

90%

92%

98%

95%

95%

95%

76%

65%

81%

7%

5%

0% 20% 40% 60% 80% 100%

Information given

Early physio/occupational therapy

Early mobilisation

Dysphagia screening

Early S&L therapy

Early cerebral imaging

Extracranial carotid artery diagnostic

Early Platelet inhibition

Platelet inhibition at discharge

Anticoagulation for AF

Early thrombolysis

Door to needle time <60min

Pneumonia

Hospital mortality

5. Quality Management

Source: BAQ; analysis for 2010

TEMPiS

Teleconsultations

since 2003 more than 25.000 teleconsultations

currently ~ 360 per month

Thrombolysis with rt-PA

since 2003 about 2.300 thrombolysis

currently ~ 45 per month

~ 6.500 strokes per year in the 15 regional

network hospitals

Lancet Neurology 2006

Does Telemedical Network offer benefits?

TEMPiS outcome trial

• Prospectively obtained data of 3122 stroke patients • Comparing Outcome of patients treated in network hospitals to

Outcome of patients treated in control hospitals

• poor Outcome dead or institutional care or

at home with severe disability

Lancet Neurol 2006; 5: 742–48

Poor Outcome after 3 Months

TEMPiS Control hospitals

18,1% 16,2% Dead

Institutional Care

12,5% 14,2%

At home with severe disability 14,3% 21%

-10,4%**

Lancet Neurol 2006; 5: 742–48

43,0% 53,4%

Stroke 2009

Does the Network offer long-term benefits?

Poor Outcome after 12 Months

TEMPiS Control hospitals

Dead

Institutional Care

At home with severe disability

Stroke 2009

24,6% 22,8%

9,4% 11,5%

13,9% 19,4%

-9,4%**

Poor Outcome after 30 Months

TEMPiS Control hospitals

35% 33,4%

8,7% 10,2%

11,2% 13,2%

-5,2%*

Stroke 2009

Dead

Institutional Care

At home with severe disability

Summary – Outcome analysis

► The concept of this telemedical network reduces the probability

of poor outcome after 3 months, 12 months and 30 months

► But: The influence of the videoconferencing has not been proven

in this network

• Thank you for your attention!