Patients who suffer a stroke in Ontario are getting admitted to rehabilitation one day earlier: stroke report cards
Ontario stroke patients are getting into rehabilitation care earlier and more patients are meeting length of stay (LOS) targets, according to new research from the Institute for Clinical Evaluative Sciences (ICES) and the Ontario Stroke Network (OSN).
The finding is part of a comprehensive evaluation of the province’s stroke care system. The OSN and ICES released the 7th annual provincial and Local Health Integration Network (LHIN) stroke report cards that compare the level of access and treatment of people who suffer strokes, showing regional efforts to improve the quality of stroke care across the province are having an impact.
“With 14 indicators showing significant improvement compared to three years ago, this year’s Ontario stroke report card demonstrates what can be achieved when regional stroke networks work together with the LHINs to develop strategies to implement stroke best practices and improve access to high quality stroke care,” said Ruth Hall, lead author and evaluation scientist for the OSN.
Each 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 and ICES 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 is exciting and encouraging to see ongoing improvements in stroke care across Ontario,” said Linda Kelloway, director, best practices for the Ontario Stroke Network. “More patients are getting to stroke units and wait time for admission to inpatient rehabilitation has decreased. However, we need to continue to move the bar up so that improvements continue and Ontarians will benefit.”
The 2015/16 Ontario Report Card on Stroke System Performance found:
- The proportion of stroke patients accessing stroke units increased 10.8 percentage points, with an increase of 68.4 percentage points in the North West LHIN to less than one percentage point in the North Simcoe Muskoka and North East LHINs.
- The time from acute stroke to admission to inpatient rehabilitation has dropped by one day from a median of nine days a year ago, and more patients are meeting recommended LOS targets.
- The South East LHIN had the largest decline in 30-day mortality rate following an acute stroke by 2.6 percentage points, followed by the Erie St Clair LHIN by 1.3 percentage points.
- The 30-day readmission rate dropped just under a percentage point (0.9), with Waterloo Wellington having the greatest one year decline, 2.6 percentage points followed by the North West LHIN with 1.5 percentage points.
South West, Hamilton Niagara Haldimand Brant, Mississauga Halton and Central LHINs made some of the biggest improvements between 2012/13 and 2015/16 in the delivery of best practice stroke care specifically:
- Faster delivery of thrombolysis to restore blood flow to the brain and improve functional outcome
- Increasing carotid imaging to detect potential causes of stroke
- Increasing access to stroke units for better patient outcomes
- Giving stroke patients earlier access to inpatient rehabilitation
- Achieving rehabilitation LOS targets to ready patients for their return to the community
“Even with the exciting improvements, the report cards indicate that Ontario still has a way to go in achieving equitable access to high quality stroke care. If all of Ontario's health system was performing at the level of our
benchmark performers, potentially, 6,171 more patients would have access to lifesaving stroke unit care, 764 more patients would get clot busting drugs and 844 more severe stroke patients would have a chance for independence through inpatient rehabilitation,” said Dr. Mark Bayley, chair of OSN Evaluation and Quality Committee and medical director of the Brain and Spinal Cord Rehabilitation Program at UHN-Toronto Rehabilitation Institute.
Since 2011, the OSN’s annual stroke report cards and progress reports have been a key resource for province’s 11 Regional Stroke Networks.
The full report, Ontario and LHIN 2015/16 Stroke Report Cards and Progress Reports: Setting the Bar Higher, was published today. Author block: Hall R, Khan F, Levi J, Huiting M, Fang J, Martin C, Morrison K, Fearn J, Brown G, Kelloway L, Kapral MK, O’Callaghan C, Bayley M, Linkewich B.
The Institute for Clinical Evaluative Sciences (ICES) is an independent, non-profit organization that uses population-based health information to produce knowledge on a broad range of health care issues. Our unbiased evidence provides measures of health system performance, a clearer understanding of the shifting health care 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. For the latest ICES news, follow us on Twitter: @ICESOntario
About Cardiac Care Network Of Ontario — As of April 1, 2016, the Ontario Stroke Network and Cardiac Care Network have come together as a single entity to ensure a comprehensive and integrated approach to cardiac, vascular and stroke care in Ontario. The CCN is a system support to the Ministry of Health and Long-Term Care (MOHLTC), Local Health Integration Networks, hospitals, and care providers dedicated to improving quality, efficiency, access and equity in the delivery of the continuum of cardiovascular services in Ontario. For more information, visit ccn.on.ca.
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