Support by telestroke networks is associated with increased intravenous thrombolysis and reduced hospital transfers: A german claims data analysis.

Abstract

Background: Acute stroke treatment is time-critical. To provide qualified stroke care in areas without 24/7 availability of a stroke neurologist, the concept of teleneurology was established, which is based on remote video communication through telemedicine organized by telestroke networks. Data on the effectiveness and efficiency of stroke treatment via teleneurology is very scarce and is therefore partly questioned in the healthcare sector. The aim was to evaluate stroke care in hospitals with and without teleneurology in Northern Germany.

Methods: We conducted a retrospective case-control data analysis using health insurance claims data for the years 2018 to 2021. Based on pre-defined criteria, two models were defined and clinical as well as health economic parameters were compared. In model 1, we compared patients from hospitals with and without support by a telestroke network, while in model 2, we compared patients from hospitals with and without support by a telestroke network, including only districts without a certified stroke unit. Assessed parameters were age, length of stay, patients' comorbidities, inpatient costs, reasons for discharge, qualified stroke care treatment according to operation and procedure codes (OPS) and intravenous thrombolysis (IVT) rates.

Results: Hospitals supported by a telestroke network improved their rate of stroke care according to OPS and increased more than three-fold their IVT rate (p = 0.042). In comparison, patients from hospitals with support by a telestroke network had a higher number and rate of qualified stroke care according to OPS (model 1: 73.6% vs 2.2%, p < 0.001 and model 2: 57.0% vs 3.8%, p < 0.001), higher rate of IVT (model 1: 9.5% vs. 0.0%, p = 0.027 and model 2: 10.3% vs 0.0%, p = 0.056) and a lower rate of secondary transfers to another hospital (model 1: 5.9% vs. 28.9%, p < 0.001 and model 2: 5.6% vs 30.1%, p < 0.001). Inpatient costs were lower in cases treated in hospitals with support by a telestroke network (model 1: 4,476€ vs. 5,549€, p = 0.03 and model 2: 4,374€ vs. 5,309€, p = 0.02). In multivariate analysis costs were independently associated with length of stay and patient transfer to another hospital but not with support by a telestroke network.

Conclusion: Hospitals with support by a telestroke network are associated with improved qualified stroke care resulting in higher rates of IVT and stroke care according to OPS codes as well as lower rates of onward transfers. Costs per patient were independently associated with transfer rates and length of hospital stay.