Methodological Challenges and Statistical Approaches in the COMprehensive Post-Acute Stroke Services Study

ObjectivesThe policy of centralising hyperacute stroke units (HASUs) in England aims to provide stroke care in units that are both large enough to sustain expertise (>600 admissions/year) and dispersed enough to rapidly deliver time-critical treatments (<30 min maximum travel time). Currently, just over half (56%) of patients with stroke access care in such a unit. We sought to model national configurations of HASUs that would optimise both institutional size and geographical access to stroke care, to maximise the population benefit from the centralisation of stroke care.DesignModelling of the effect of the national reconfiguration of stroke services. Optimal solutions were identified using a heuristic genetic algorithm.Setting127 acute stroke services in England, serving a population of 54 million people.Participants238 887 emergency admissions with acute stroke over a 3-year period (2013–2015).InterventionModelled reconfigurations of HASUs optimised for institutional size and geographical access.Main outcome measureTravel distances and times to HASUs, proportion of patients attending a HASU with at least 600 admissions per year, and minimum and maximum HASU admissions.ResultsSolutions were identified with 75–85 HASUs with annual stroke admissions in the range of 600–2000, which achieve up to 82% of patients attending a stroke unit within 30 min estimated travel time (with at least 95% and 98% of the patients being within 45 and 60 min travel time, respectively).ConclusionsThe reconfiguration of hyperacute stroke services in England could lead to all patients being treated in a HASU with between 600 and 2000 admissions per year. However, the proportion of patients within 30 min of a HASU would fall from over 90% to 80%–82%.

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Effects of centralizing acute stroke services

Neurology ◽

10.1212/wnl.0000000000005822 ◽

2018 ◽

Vol 91 (3) ◽

pp. e236-e248 ◽

Cited By ~ 6

Author(s):

Sidsel Hastrup ◽

Soren P. Johnsen ◽

Thorkild Terkelsen ◽

Heidi H. Hundborg ◽

Paul von Weitzel-Mudersbach ◽

...

Keyword(s):

Hospital Stay ◽

Acute Stroke ◽

Stroke Care ◽

Acute Hospital ◽

Acute Stroke Care ◽

Difference In Differences ◽

Stroke Units ◽

Before And After ◽

Stroke Services

ObjectiveTo investigate the effects of centralizing the acute stroke services in the Central Denmark Region (CDR).MethodsThe CDR (1.3 million inhabitants) centralized acute stroke care from 6 to 2 designated acute stroke units with 7-day outpatient clinics. We performed a prospective “before-and-after” cohort study comparing all strokes from the CDR with strokes in the rest of Denmark to discover underlying general trends, adopting a difference-in-differences approach. The population comprised 22,141 stroke cases hospitalized from May 2011 to April 2012 and May 2013 to April 2014.ResultsCentralization was associated with a significant reduction in length of acute hospital stay from a median of 5 to 2 days with a length-of-stay ratio of 0.53 (95% confidence interval 0.38–0.75, data adjusted) with no corresponding change seen in the rest of Denmark. Similarly, centralization led to a significant increase in strokes with same-day admission (mainly outpatients), whereas this remained unchanged in the rest of Denmark. We observed a significant improvement in quality of care captured in 11 process performance measures in both the CDR and the rest of Denmark. Centralization was associated with a nonsignificant increase in thrombolysis rate. We observed a slight increase in readmissions at day 30, but this was not significantly different from the general trend. Mortality at days 30 and 365 remained unchanged, as in the rest of Denmark.ConclusionsCentralizing acute stroke care in the CDR significantly reduced the length of acute hospital stay without compromising quality. Readmissions and mortality stayed comparable to the rest of Denmark.

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Improving acute stroke services in the Netherlands

BMJ ◽

10.1136/bmj.g3957 ◽

2014 ◽

Vol 348 (jun24 3) ◽

pp. g3957-g3957 ◽

Cited By ~ 1

Author(s):

M. M. H. Lahr ◽

D.-J. van der Zee ◽

G.-J. Luijckx ◽

P. C. A. J. Vroomen ◽

E. Buskens

Keyword(s):

The Netherlands ◽

Acute Stroke ◽

Stroke Services

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FASTER (Face, Arm, Speech, Time, Emergency Response): Experience of Central Coast Stroke Services implementation of a pre-hospital notification system for expedient management of acute stroke

Journal of Clinical Neuroscience ◽

10.1016/j.jocn.2011.06.009 ◽

2012 ◽

Vol 19 (2) ◽

pp. 241-245 ◽

Cited By ~ 32

Author(s):

W. O’Brien ◽

D. Crimmins ◽

W. Donaldson ◽

R. Risti ◽

T.A. Clarke ◽

...

Keyword(s):

Acute Stroke ◽

Emergency Response ◽

Central Coast ◽

Notification System ◽

Speech Time ◽

Stroke Services ◽

Services Implementation

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Abstract NS3: A Comprehensive Post-Acute Stroke Services (COMPASS) Website for Public Use

Stroke ◽

10.1161/str.51.suppl_1.ns3 ◽

2020 ◽

Vol 51 (Suppl_1) ◽

Author(s):

Sylvia Coleman ◽

Meghan Radman ◽

Mysha Sissine ◽

Pamela Duncan ◽

Cheryl Bushnell ◽

...

Keyword(s):

Acute Stroke ◽

Human Services ◽

Transitional Care ◽

Care Plan ◽

Evidence Based ◽

Care Providers ◽

Educational Materials ◽

Health And Human Services ◽

Stroke Services

Background: Stroke patients, caregivers, and health and human services are in need of organized, evidence-based resources to improve post-acute care and outcomes. Educational materials vetted by stakeholders are scarce and difficult to develop. The COMprehensive Post-Acute Stroke Services (COMPASS) Study developed online resources by discipline for clinical providers, patients, caregivers, and health and human services teams. Purpose: This presentation introduces the COMPASS website content available and ready for immediate use to support post-acute stroke care quality improvement. Methods: Materials were developed as a component of the PCORI-funded COMPASS Study designed to implement and evaluate comprehensive transitional care (TC) for stroke survivors. Patients discharged home from 41 NC hospitals after a stroke or TIA received COMPASS TC which incorporated Centers for Medicare and Medicaid (CMS) recommendations: a follow-up phone call within two days of discharge; a comprehensive follow-up clinic visit; and delivery of a patient care plan. An interdisciplinary team of health care providers, stakeholders, and researchers developed patient and caregiver educational materials tested for sixth grade literacy, a community resource directory, and training materials for implementation of COMPASS TC that are available on the COMPASS website at www.nccompass-study.org/. Results: Educational products, including a directory of resources, training manuals, recorded webinars, instructional handouts, animated videos, and patient/caregiver materials are on the COMPASS website. An electronic application called COMPASS-Care Plan (CP) also developed can be readily integrated into Epic and Cerner electronic health records. COMPASS-CP was developed to streamline the delivery of the TC model. Since the website was made public July 1, 2019, there have been 616 views from 15 countries with the majority reviewing patient/caregiver resources. Conclusions: The COMPASS website provides health and human services teams with organized, evidence-based resources to support delivery and management of post-acute transitional care for patients and caregivers.

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