TY  - JOUR
AU  - Weber, J. E.
AU  - Angermaier, A.
AU  - Bollweg, K.
AU  - Erdur, H.
AU  - Ernst, S.
AU  - Flöel, A.
AU  - Gorski, C.
AU  - Kandil, F. I.
AU  - Kinze, S.
AU  - Kleinsteuber, K.
AU  - Kurth, T.
AU  - Schmehl, I.
AU  - Theen, S.
AU  - Endres, M.
AU  - Audebert, H. J.
TI  - Acute neurological care in north-east Germany with telemedicine support (ANNOTeM): protocol of a multi-center, controlled, open-label, two-arm intervention study
JO  - BMC health services research
VL  - 20
IS  - 1
SN  - 1472-6963
CY  - London
PB  - BioMed Central
M1  - DZNE-2020-01424
SP  - 755
PY  - 2020
AB  - BackgroundBoth diagnosis and treatment of neurological emergencies require neurological expertise and are time-sensitive. The lack of fast neurological expertise in regions with underserved infrastructure poses a major barrier for state-of-the-art care of patients with acute neurological diseases and leads to disparity in provision of health care. The main purpose of ANNOTeM (acute neurological care in North East Germany with telemedicine support) is to establish effective and sustainable support structures for evidence based treatments for stroke and other neurological emergencies and to improve outcome for acute neurological diseases in these rural regions.MethodsA “hub-and-spoke” network structure was implemented connecting three academic neurological centres (“hubs”) and rural hospitals (“spokes”) caring for neurological emergencies. The network structure includes (1) the establishment of a 24/7 telemedicine consultation service, (2) the implementation of standardized operating procedures (SOPs) in the network hospitals, (3) a multiprofessional training scheme, and (4) a quality management program. Data from three major health insurance companies as well as data from the quality management program are being collected and evaluated. Primary outcome is the composite of first time of receiving paid outpatient nursing care, first time of receiving care in a nursing home, or death within 90 days after hospital admission.DiscussionBeyond stroke only few studies have assessed the effects of telemedically supported networks on diagnosis and outcome of neurological emergencies. ANNOTeM will provide information whether this approach leads to improved outcome. In addition, a health economic analysis will be performed.
KW  - Acute Disease
KW  - Adult
KW  - Critical Care: organization & administration
KW  - Female
KW  - Germany
KW  - Health Services Research
KW  - Hospitals, Rural: organization & administration
KW  - Humans
KW  - Male
KW  - Nervous System Diseases: therapy
KW  - Research Design
KW  - Stroke: therapy
KW  - Telemedicine: organization & administration
LB  - PUB:(DE-HGF)16
C6  - pmid:32807159
C2  - pmc:PMC7430113
DO  - DOI:10.1186/s12913-020-05576-w
UR  - https://pub.dzne.de/record/153427
ER  -