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More patients are receiving their acute stroke care at stroke centres: study


A comprehensive evaluation of the province’s stroke care system shows more patients are receiving their acute stroke care at designated stroke centres than ever before, according to a study released today.

The Ontario Stroke Network (OSN) and the Institute for Clinical Evaluative Sciences (ICES) today released the 2013/14 Ontario Stroke Evaluation Report (OSER), which compares the level of access and treatment of people who suffer strokes across the province, showing that the majority of indicators and benchmarks have improved since the previous performance study.

The OSER showed that the proportion of stroke patients arriving at the emergency department of designated stroke centres increased almost 12 per cent since 2003/04.

“Acute care in-hospital admission rates and all-cause readmission rates have significantly improved,” said Malcolm Moffat, Chair of the OSN Board and Executive Vice President, Programs, at Sunnybrook Health Sciences Centre in Toronto. “This progress, together with the overall decline in mortality rates during the nine years from 2003/04 to 2011/12, is a reflection of a mature, organized acute care stroke system and of regions directing patients to designated stroke centres where they are more likely to have access to clot-busting drugs, stroke unit care, healthcare providers with expertise in stroke, and inpatient rehabilitation.”

The report, which includes findings from the 2012/13 Ontario Stroke Audit, provides a comprehensive review of progress made in the provision of stroke care across the province from 2003/04 to 2012/13.

“Compared internationally, Ontario has the highest proportion of people with stroke receiving clot busting drugs,” said Dr. Mark Bayley, Chair of OSN Evaluation Committee and Medical Director of the Brain and Spinal Cord Rehabilitation Program at UHN-Toronto Rehabilitation Institute. “We still need to redouble our efforts to be best at provision of comprehensive rehabilitation and long term community support for those with residual disability after stroke.”

The report examines variations in stroke care and services by healthcare sector, including emergency department care, acute inpatient care, inpatient rehabilitation, complex continuing care, long-term care and home care services.

“We have been monitoring and reporting on the performance of stroke care in Ontario across the care continuum for a decade and this year’s report reveals remarkable progress in providing Ontarians access to best practice stroke care and in particular acute stroke care,” said Ruth Hall, lead author of the report, ICES adjunct scientist and OSN Evaluation Specialist. “More patients than we have seen before are receiving care at specialized stroke centres and associated with this more patients are receiving best practice stroke care.”

The report also shows statistically significant improvements in:

  • the proportion of patients with a stroke or mini-stroke receiving a brain scan within 24 hours (93.2 per cent)
  • the number of all stroke patients receiving inpatient rehabilitation (32.6 per cent)
  • the number of referrals to outpatient stroke rehabilitation (7.3 per cent)
  • the number of stroke patients discharged from the emergency department and referred to a stroke prevention clinic (78.5 per cent)

“Of course, there is always room for improvement,” said Ontario Stroke Network Executive Director Christina O'Callaghan. “For example, the study shows us that four of every 10 stroke patients in Ontario do not call 911 when experiencing stroke. Also, the proportion of stroke patients who receive rehabilitation services from Community Care Access Centres has declined.”

The Ontario Stroke Network provides provincial leadership and planning for the continuum of stroke care in Ontario—from health promotion and stroke prevention to acute care, recovery, rehabilitation and reintegration. For the latest OSN news, visit www.ontariostrokenetwork.ca or follow us on Twitter: @ONStrokeNetwork.

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.