Telemedicine improves the quality of acute stroke care in rural regions with limited access to specialized stroke care. We report the first 2 years’ experience of implementing a comprehensive telemedical stroke network comprising all levels of stroke care in a defined region. The TRANSIT-Stroke network covers a mainly rural region in north-western Bavaria (Germany). All hospitals providing acute stroke care in this region participate in TRANSIT-Stroke, including four hospitals with a supra-regional certified stroke unit (SU) care (level III), three of those providing teleconsultation to two hospitals with a regional certified SU (level II) and five hospitals without specialized SU care (level I). For a two-year-period (01/2015 to 12/2016), data of eight of these hospitals were available; 13 evidence-based quality indicators (QIs) related to processes during hospitalisation were evaluated quarterly and compared according to predefined target values between level-I- and level-II/III-hospitals. Overall, 7881 patients were included (mean age 74.6 years ±12.8; 48.4% female). In level-II/III-hospitals adherence of all QIs to predefined targets was high ab initio. In level-I-hospitals, three patterns of QI-development were observed: a) high adherence ab initio (31%), mainly in secondary stroke prevention; b) improvement over time (44%), predominantly related to stroke specific diagnosis and in-hospital organization; c) no clear time trends (25%). Overall, 10 out of 13 QIs reached predefined target values of quality of care at the end of the observation period. The implementation of the comprehensive TRANSIT-Stroke network resulted in an improvement of quality of care in level-I-hospitals.

中文翻译：

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两年在主要农村地区实施全面的远程医疗卒中网络的经验：跨区域远程卒中与远程医疗网络（TRANSIT-Stroke）。

远程医疗可以提高农村地区急性中风护理的质量，而无法获得专门的中风护理。我们报告了在定义区域内实施包括中风各个级别的综合远程医疗中风网络的前两年经验。TRANSIT-Stroke网络覆盖了巴伐利亚西北部（德国）的一个主要农村地区。该地区所有提供急性中风护理的医院都参加了TRANSIT-Stroke，包括四家提供超区域认证中风病房（SU）护理的医院（III级），其中三家向拥有地区认证的SU中风病医院提供远程咨询服务的三所医院II）和五家没有SU专科护理的医院（I级）。在两年期间（2015年1月1日至2016年12月）中，有八家医院的数据可供使用；每季度评估13项与住院过程相关的循证质量指标（QIs），并根据I级和II / III级医院之间的预定目标值进行比较。总共纳入了7881名患者（平均年龄74.6岁±12.8；女性48.4％）。在II / III级医院中，所有QI均符合预定目标，从头开始。在I级医院中，观察到了QI的发展的三种模式：a）从头开始具有很高的依从性（31％），主要用于继发性中风的预防；b）随着时间的推移有所改善（44％），主要与中风特异性诊断和医院内组织有关；c）没有明确的时间趋势（25％）。总体而言，在观察期结束时，13个QI中有10个达到了预定的护理质量目标值。