Stroke care system passes annual exam: steady progress being made

A detailed evaluation of the province’s stroke care system shows patients are receiving better care, and there is still room for more improvement. Today, the Institute for Clinical Evaluative Sciences (ICES) and the Ontario Stroke Network (OSN) released a report card that compares the level of access, treatment and rehabilitation of people who suffer strokes across the province, showing that wait times for preventive surgery and diagnostic testing are being reduced across the province.

Each Local Health Integration Network (LHIN) received its own detailed report card, which shows the progress being made, and will be used to review gaps and identify solutions that will further enhance the stroke care system. A first in Canada, the OSN stroke report cards, introduced in 2011, grade the delivery of care for each of Ontario’s 14 LHINs providing data on stroke care and service, both regionally and provincially.

“It’s encouraging to see that the 14 LHINs have made progress enhancing access and care for the thousands of patients who suffer strokes in Ontario each year,” says Christina O’Callaghan, Executive Director of OSN. “While these results are encouraging, the detailed analysis shows that we still have a way to go in stroke rehabilitation and in making sure that everyone understands the signs and symptoms of strokes so patients can get care as quickly as possible,” she says.

The following areas of improvement in stroke care were identified in the report:

• Reduced LHIN variation and increased percentage of stroke/TIA patients arriving by ambulance.
• Increased percentage of stroke/TIA patients receiving a brain scan within 24 hours of hospital arrival. Increased percentage of patients receiving the clotbusting drug for stroke within 60 minutes.
• Increased percentage of patients accessing stroke unit care.
• Reduced in-hospital, 30-day and one-year stroke mortality rate
• Reduced wait times for admission to in-patient rehabilitation from acute care.

The report cards both illustrate the progress being made and also demonstrate to the LHINs where further improvements are needed, an important achievement given the complexity of making change in healthcare. The OSN and the Regional Stroke Networks are well positioned to implement further innovations. “The report cards’ concise presentation makes this a very useful tool,” says Mimi Lowi-Young, CEO of the Central West LHIN. “It allows us to quickly identify gaps, prioritize investments and improve care.”

Some of the recommendations made by the report include: Improve public awareness of signs, symptoms and stroke risk factors. Stroke can be prevented by better management of risk factors, such as hypertension, heart disease, diabetes, atrial fibrillation and smoking. This is especially important over the next 10 years as more baby boomers move into the age group where strokes most often occur. Once a stroke is suspected, the faster patients get to hospital, the better their chances of receiving treatments that could help minimize the effects of the stroke:

• Improve access to secondary prevention clinics for TIA patients.
• Patients who display symptoms of a minor stroke or transient ischemic attack must undergo a comprehensive evaluation to confirm the diagnosis and begin treatment to reduce the risk of major stroke.
• Admitted stroke patients need to be cared for in a stroke unit.
• Acute stroke patients, admitted to the hospital should be cared for by a team of experts in stroke, preferably in a special dedicated unit. Expert care results in reduced complications and decreased death and disability.
• Improve access and appropriateness of rehabilitation following acute stroke.
• People who have difficulty with daily activities should have access to rehabilitation therapy services.
• Pediatric stroke care needs attention: The first ever Ontario pediatric stroke data shows important gaps that could be improved by the implementation of a specialized pediatric stroke program in the province.

Shannonville, Ontario mom Brandy Englesdorfer knows firsthand about how the report cards are improving access and care.

She suffered a stroke just one month before her 36th birthday. Englesdorfer had prepared breakfast for her three children and suddenly experienced extreme vision problems. She instructed her five-year-old daughter to call 911. When Englesdorfer arrived at Belleville General Hospital, staff activated their Code Stroke process which links to several report card indicators including access to the drug tPA, which destroys blood clots and can limit stroke damage. Englesdorfer says the stroke team gave her incredible support with Melissa Roblin, the stroke resource nurse there to help her navigate every step of the way. Englesdorfer calls the care she received personal medicine. “Being able to arrive quickly to hospital, getting the tPA, having in-hospital and outpatient rehabilitation—has given me back my life,” says Englesdorfer. “I’ll get to see my kids grow up.”

June is Stroke Awareness Month, an opportunity for Canadians to learn about strokes and their warning signs, as well as how to reduce the odds of experiencing a stroke. Strokes are one of the leading causes of death, disability and illness in Canada. Strokes affect not only the patient, but also family members and caregivers who help with recovery. The sooner a patient is treated after experiencing stroke symptoms, the better the chances of limiting damage. To learn more about stroke warning signs and how to reduce the risk of developing a stroke, visit Ontario Stroke Network Website.

ICES is an independent, non-profit organization that uses population-based health information to produce knowledge on a broad range of healthcare issues. Our unbiased evidence provides measures of health system performance, a clearer understanding of the shifting healthcare needs of Ontarians, and a stimulus for discussion of practical solutions to optimize scarce resources. ICES knowledge is highly regarded in Canada and abroad, and is widely used by government, hospitals, planners, and practitioners to make decisions about care delivery and to develop policy.

The Ontario Stroke Network (OSN), created in 2008, is a non-profit organization funded by the Ministry of Health and Long-Term Care. OSN provides leadership for the Ontario Stroke System, which represents 11 regional stroke networks that support the LHINS. OSN is committed to creating innovations in stroke prevention and care and regularly evaluates the stroke system, partners to achieve best practices, promotes excellent stroke care and vascular health while advocating for fewer strokes and better outcomes. The Canadian Stroke Network and ICES collaborated with OSN in creating the evaluation report and stroke report cards.

FOR FURTHER INFORMATION PLEASE CONTACT:

• Deborah Creatura
• Communications, ICES
• [email protected]
• (o) 416-480-4780