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Fewer Ontarians being admitted to hospital with stroke/TIA: ICES study


The rate of Ontarians being admitted to hospital with stroke or Transient Ischemic Attack (TIA) has dropped 23 per cent in less than five years despite an expected increase due to an aging population. The findings from a new stroke report out of the Institute for Clinical Evaluative Sciences (ICES) looked at provincial trends in stroke care between 2003 and 2008 and found fewer patients are being admitted to hospital for stroke, more are going to specialized stroke hospitals and a greater proportion are accessing inpatient rehabilitation.

The Ontario Stroke System (OSS) is considered to be an important initiative by the Ontario government. So much so that the government committed to a $30 million annual investment to enable integrated and best practice stroke care be available to all Ontarians and continues annual funding to monitor stroke care.

“Since the initial $70 million investment by the provincial government in 2003 to develop an integrated stroke system, there has been a 23 per cent decrease in the rate of acute inpatient admissions for stroke. In addition, more stroke patients are receiving their care in hospitals with specialized stroke services, but still more than half of inpatient stroke care is been delivered in hospitals with limited specialized stroke care,” says principal investigator and Ontario Stroke Network (OSN) evaluation specialist, Ruth Hall.

“Compared to 2003, a greater proportion of stroke patients went to inpatient rehabilitation in 2008. However, the level of disability among patients going to inpatient rehabilitation suggests patients with severe impairment have limited access and those with mild impairment are being admitted to inpatient rehabilitation due to a lack of outpatient rehabilitation services,” according to Dr. Mark Bayley, chair of the OSN Stroke Evaluation Advisory Committee.

The study of close to 60,000 stroke patients arriving at Ontario’s acute hospitals between 2003 and 2008 found:

  • Just over half Ontario stroke patients (55 per cent) arrive at the hospital by ambulance.
  • A 23 per cent decrease in the annual age- and sex- adjusted rates of acute inpatient admissions for stroke.
  • More stroke patients are receiving care in designated stroke centres (that have lower mortality and are more likely to discharge people to inpatient rehabilitation).
  • Wait times for carotid artery intervention decreased from a median 41 days in 2003 to 15 days in 2008.
  • The overall proportion of stroke patients discharged to inpatient rehabilitation following an acute hospitalization increased between 2003 and 2008 (from 20 to 23 per cent), with an associated decrease in the proportion discharged to long term care (from 8.5 to 7 per cent).
  • It is believed that up to 40 percent of stroke survivors should be discharged to inpatient rehabilitation which might further decrease the number of people requiring long term institutionalization.
  •  In 2008, the median admission measure of functional independence (FIM® score) to Ontario’s inpatient stroke rehabilitation programs was 77 (average 76) suggesting that a notable proportion of patients in the severe group (FIM® score less than 60) did not have access to inpatient rehabilitation.

“It is wonderful to see that stroke prevention and care has improved so dramatically in a number of areas, including a significant reduction in wait times and hospitalization, as well as more patients being cared for at stroke centres. However, there is more work to be done. The results vary across Ontario’s Local Health Integration Networks and there is still a gap between the number of stroke patients who need stroke rehabilitation and those who receive it. The good news is that the OSN, with a focus on continuous improvement and knowledge translation, is well positioned to address these gaps,” says Chris O'Callaghan, executive director, Ontario Stroke Network.

The “Ontario Stroke Evaluation Report 2010 Technical Report” was published April 14, 2010 by ICES.

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.



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