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First of its kind report examines stroke care for each of Ontario’s 14 LHINs


June is stroke awareness month and in an effort to highlight stroke care in Ontario and where improvements can be made, the Institute for Clinical Evaluative Sciences (ICES) is releasing a first of its kind report card as part of the 2011 Stroke Evaluation report. This report examines stroke care for each of Ontario’s Local Health Integration Networks (LHINs).

“The Ontario Stroke Evaluation program has been reporting on the stroke systems performance since 2005 but stakeholder consultation revealed we needed a more concise format that would allow for more focused stroke system and stakeholder engagement,” says principal investigator and Ontario Stroke Network (OSN) Evaluation Specialist, Ruth Hall.

The report cards allow for consistency in comparing performance of the Ontario Stroke System across LHINs and quick identification of gaps and regional improvement initiatives.

“This is exactly the type of information we need, as LHINs, to focus our activities to improve the stroke patient’s experience. The report shows us information across the care spectrum that we can use to improve patient services with our healthcare providers,” says Brad Keeler, Sr. Director, Delivery & Implementation, Erie St. Clair LHIN.

The report card examines 20 key indicators that are integral to system efficiency and effectiveness and found:

  • In 2008/09, almost 90 per cent of patients received neuroimaging within 24 hours of arrival at hospital.
  • Only one in three stroke victims arrived at hospital in time to be considered for therapy that would dramatically improve outcomes (e.g., stroke thrombolysis).
  • There is a wide variation across the LHINs in access to inpatient rehabilitation, and patients requiring community-based rehabilitation received inadequate service levels.
  • Among the 14 LHINs, 11 had one to four indicators exhibiting exemplary performance. Half of the LHINs have performance below the 50th percentile for 13 out of 15 indicators.

Other findings in the report include:

  • Despite Ontario’s aging population there was a decrease in the rate of emergency department visits and in hospital stays for stroke or transient ischemic attack (TIA) between 2003/04 and 2009/10.
  • Specialized stroke centres were much more likely to provide stroke care best practices, including: access to stroke thrombolysis, admission to stroke units; and discharge to inpatient rehabilitation.
  • Despite a two-day reduction in wait time for inpatient rehabilitation in 2009/10 compared to 2003/04, access to inpatient rehabilitation among severely disabled stroke patients has decreased.
  • A province-wide, standardized, early-assessment tool to rapidly determine eligibility for rehabilitation should be established.

“The LHIN Stroke Report Cards have provided meaningful system-level data to assist in better understanding progress, identifying gaps, and strategically informing improvement initiatives,” says Beth Linkewich, Regional Director, North & East GTA Stroke Network. “It has started a dialogue with our steering committees and LHIN representatives relating to stroke care that has not been otherwise consistent across LHINs.”

The “Ontario Stroke Evaluation Report 2011: Improving System Efficiency by Implementing Stroke Best Practices” was published June 20, 2011 by ICES.

Author block: Ruth Hall, PhD; Ferhana Khan, MPH; Christina O’Callaghan, BAppSc (PT); Sarah Meyer, BA; Jiming Fang, PhD; Kathryn Hodwitz, BA; Mark Bayley, MD, FRCPC.

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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