Telemedizin beim akuten Schlaganfall

Zusammenfassung

Aufgrund seiner guten audiovisuellen Erfassbarkeit und der zeitkritischen Effekte der evidenzbasierten Therapien ist der akute Schlaganfall eine Modellerkrankung für die telemedizinische Versorgung über videogestützte neurologische Untersuchung und Teleradiologie. In Deutschland und in vielen anderen Ländern haben sich telemedizinische Schlaganfallnetzwerke rasch verbreitet und sind inzwischen etablierter Teil der Regelversorgung. Die telekonsiliarische Indikationsstellung hat sich bei der Einleitung der Lysetherapie als sicher erwiesen und ermöglicht vielen Patienten eine Lyseehandlung auch in strukturschwachen ländlichen Gebieten. Insbesondere in Deutschland hat sich die Einbettung der telemedizinschen Beratung in das sog. TeleStroke-Unit-Konzept durchgesetzt. Hierbei werden vor Ort alle Elemente der evidenzbasierten Stroke-Unit-Behandlung vorgehalten und lediglich die neurologische Notfalluntersuchung telemedizinisch durchführt. Durch die Netzwerkstruktur ergibt sich die Möglichkeit eines konsequenten Qualitätsmanagements im gesamten Netzwerk. In diesem Konzept konnte eine Prognoseverbesserung für das funktionelle Outcome der in Tele-Stroke-Unit behandelten Schlaganfallpatienten gezeigt werden und die Qualität der Behandlung kann in entsprechenden Netzwerken gemäß der in der Arbeitsgemeinschaft Deutscher Schlaganfallregister (ADSR) etablierten Qualitätsindikatoren ein gleichwertiges Niveau wie in neurologischen Stroke Units erreichen. Entsprechend besteht für die TeleStroke-Units eine Zertifizierungsmöglichkeit durch die Deutsche Schlaganfallgesellschaft und das Behandlungskonzept ist auch vergütungsseitig in das deutsche DRG-System aufgenommen.

Abstract

Symptoms in stroke can easily be captured audiovisually and effects of evidence-based therapies are time critical. Therefore, stroke has become a model disease for telemedicine using videoconference for clinical examination and teleradiology. In Germany, and many other countries, telemedicine-linked stroke networks have rapidly expanded and are now part of the established healthcare system. Telemedicine-based decision-making on thrombolytic treatment has been shown to be safe and can be extended to underserved rural areas. Particularly in Germany, telemedicine has been embedded into the so-called TeleStroke-Unit concept. In this concept, all elements of the evidence-based Stroke Unit treatment are covered locally, except for the acute neurological examination, which is performed telemedically. When using a network structure, systematic area-wide quality management can be set up. With this concept, improved prognosis was shown for stroke patients, and the quality of treatment within those networks can be similar to that in neurological Stroke Units, assessed by the quality indicators defined by the Commission of German Stroke Registry (ADSR). As a consequence, the German Stroke Society has expanded the certification process to certified TeleStroke Units and refunds of the costs were established within the German DRG-System (diagnosis related groups – German in-patient financial refund system).

Schlüsselwörter

Telemedizin - Schlaganfall - Stroke Unit - Thrombolyse - Netzwerk

Keywords

telemedicine - stroke - stroke unit - thrombolysis - network

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