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Ontarians getting high quality of stroke care but regional variations still exist


Stroke is a leading cause of death and disability in Canada. The findings from a new stroke audit conducted by the Institute for Clinical Evaluative Sciences (ICES) and the Canadian Stroke Network (CSN) looked at provincial trends in stroke care between 2002 and 2009 and found that there have been marked improvements in the stroke care that Ontarians receive since the Ontario Stroke System was initiated by the provincial government a decade ago.

“Since the initial investment by the provincial government in 2000 to develop an integrated stroke system, there have been significant improvements in almost all aspects of stroke care delivery. In particular, rates of use of thrombolysis (clot-busting therapy) for acute stroke match or exceed those seen in most jurisdictions worldwide,” says principal investigator and ICES Scientist Dr. Moira Kapral.

The study of close to 4,000 stroke patients arriving at Ontario’s acute hospitals in 2008/09 found:

  • Thrombolysis was administered to 27 per cent of patients presenting within 2.5 hours of stroke onset, a significant increase compared to 9.5 per cent in 2002/03.
  • Thrombolysis rates were 42 per cent at regional stroke centres – rates that match or exceed those seen in most jurisdictions worldwide.
  • Neuroimaging is required to confirm diagnosis. In 2008/09, 93 per cent of patients received neuroimaging during hospitalization—a marked improvement from 82 per cent in 2004/05 and 77 per cent in 2002/03.
  • 24 per cent of patients with stroke or TIA were admitted to a stroke unit – a significant increase compared to 3 per cent in 2002/03 but still below recommended standards.
  • Rates of discharge to inpatient rehabilitation were higher in 2008/09 compared to 2004/05 but similar to 2002/03, but remain lower than projected.

“These excellent results may be attributable to Ontario's organized system of stroke care. 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 unit care and stroke rehabilitation and those who receive it. The good news is that the Ontario Stroke Network, 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.

“Registry of the Canadian Stroke Network – Report on the 2008/09 Ontario Stroke Audit” was published April 4, 2011 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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