An Innovative Telemedical Network to Improve Infectious Disease Management in Critically Ill Patients and Outpatients (TELnet@NRW): Stepped-Wedge Cluster Randomized Controlled Trial

• Published in: Journal of medical Internet research 2022-03, Vol.24 (3), p.e34098-e34098
• Main Authors: Marx, Gernot, Greiner, Wolfgang, Juhra, Christian, Elkenkamp, Svenja, Gensorowsky, Daniel, Lemmen, Sebastian, Englbrecht, Jan, Dohmen, Sandra, Gottschalk, Antje, Haverkamp, Miriam, Hempen, Annette, Flügel-Bleienheuft, Christian, Bause, Daniela, Schulze-Steinen, Henna, Rademacher, Susanne, Kistermann, Jennifer, Hoch, Stefan, Beckmann, Hans-Juergen, Lanckohr, Christian, Lowitsch, Volker, Peine, Arne, Juzek-Kuepper, Fabian, Benstoem, Carina, Sperling, Kathrin, Deisz, Robert
• Format: Article
• Language: English
• Subjects: Adherence; Adolescent; Adult; Analysis; Antibiotics; Antimicrobial agents; Clinical trials; Communicable diseases; Consent; Critical Care; Critical Illness - therapy; Data integrity; Digitization; Disease Management; Evidence-based medicine; Experts; Health care management; Hospitals; Humans; Immunization; Infections; Infectious diseases; Infrastructure; Inpatient care; Intensive care; Measles; Medical care; Medical records; Medical research; Medicine; Medicine, Experimental; Mortality; Multimedia; Onsite; Original Paper; Outpatient treatment; Outpatients; Patients; Physicians; Quality management; Respiratory diseases; Respiratory tract infections; Selection effects; Sepsis; Specialists; Surgery; Telemedicine; Triage; Ventilators; Virtual private networks
• ISSN: 1438-8871; 1439-4456; 1438-8871
• DOI: 10.2196/34098

Evidence-based infectious disease and intensive care management is more relevant than ever. Medical expertise in the two disciplines is often geographically limited to university institutions. In addition, the interconnection between inpatient and outpatient care is often insufficient (eg, no shared electronic health record and no digital transfer of patient findings). This study aims to establish and evaluate a telemedical inpatient-outpatient network based on expert teleconsultations to increase treatment quality in intensive care medicine and infectious diseases. We performed a multicenter, stepped-wedge cluster randomized trial (February 2017 to January 2020) to establish a telemedicine inpatient-outpatient network among university hospitals, hospitals, and outpatient physicians in North Rhine-Westphalia, Germany. Patients aged ≥18 years in the intensive care unit or consulting with a physician in the outpatient setting were eligible. We provided expert knowledge from intensivists and infectious disease specialists through advanced training courses and expert teleconsultations with 24/7/365 availability on demand respectively once per week to enhance treatment quality. The primary outcome was adherence to the 10 Choosing Wisely recommendations for infectious disease management. Guideline adherence was analyzed using binary logistic regression models. Overall, 159,424 patients (10,585 inpatients and 148,839 outpatients) from 17 hospitals and 103 outpatient physicians were included. There was a significant increase in guideline adherence in the management of Staphylococcus aureus infections (odds ratio [OR] 4.00, 95% CI 1.83-9.20; P