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首页> 外文期刊>Journal of stroke and cerebrovascular diseases: The official journal of National Stroke Association >A Case for Telestroke in Military Medicine: A Retrospective Analysis of Stroke Cost and Outcomes in US Military Health-Care System
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A Case for Telestroke in Military Medicine: A Retrospective Analysis of Stroke Cost and Outcomes in US Military Health-Care System

机译：军事医学中的Telestroke案例：对美国军事保健系统中风成本和结果的回顾性分析

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Background: The development of primary stroke centers has improved outcomes for stroke patients. Telestroke networks have expanded the reach of stroke experts to underserved, geographically remote areas. This study illustrates the outcome and cost differences between neurology and primary care ischemic stroke admissions to demonstrate a need for telestroke networks within the Military Health System (MHS). Materials and Methods: All adult admissions with a primary diagnosis of ischemic stroke in the MHS Military Mart database from calendar years 2010 to 2015 were reviewed. Neurology, primary care, and intensive care unit (ICU) admissions were compared across primary outcomes of (1) disposition status and (2) intravenous tissue plasminogen activator administration and for secondary outcomes of (1) total cost of hospitalization and (2) length of stay (LOS). Results: A total of 3623 admissions met the study's parameters. The composition was neurology 462 (12.8%), primary care 2324 (64.1%), ICU 677 (18.7%), and other/ unknown 160 (4.4%). Almost all neurology admissions (97%) were at the 3 neurology training programs, whereas a strong majority of primary care admissions (80%) were at hospitals without a neurology admitting service. Hospitals without a neurology admitting service had more discharges to rehabilitation facilities and higher rates of in-hospital mortality. LOS was also longer in primary care admissions. Conclusions: Ischemic stroke admissions to neurology had better outcomes and decreased LOS when compared to primary care within the MHS. This demonstrates a possible gap in care. Implementation of a hub and spoke telestroke model is a potential solution.
机译：背景：原发性中风中心的发展具有改善的中风患者的结果。 Telestroke网络扩展了卒中专家的范围，以提供服务，地理位置偏远地区。本研究说明了神经学和初级保健缺血性卒中录取的结果和成本差异，以证明军事卫生系统（MHS）内的Telestroke网络需要。综述了材料和方法：综述了MHS Marmentart数据库中缺血脑卒中初步诊断的所有成人入学。比较了神经病学，初级保健和重症监护病房（ICU）录取（1）个子化状态和（2）静脉内组织纤溶酶原激活剂管理和（1）总住院费用和（2）长度的二次结果逗留（洛杉矶）。结果：共有3623名招生达到了研究的参数。该组合物是神经病学462（12.8％），初级护理2324（64.1％），ICU 677（18.7％）和其他/未知160（4.4％）。几乎所有神经学录取（97％）都是在3个神经学培训方案中，而大多数初级保健录取（80％）在没有神经学录取服务的医院。没有神经内科的医院录取服务的康复设施更多地放入康复设施和较高的住院地死亡率。洛杉矶也在初级保健录取中。结论：与MHS内的初级保健相比，神经内科的缺血性卒中释放有更好的结果和减少洛杉矶。这证明了可能的差距。枢纽的实施和辐条电气沟模型是一个潜在的解决方案。

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