scholarly journals Impact of Evidence‐Based Stroke Care on Patient Outcomes: A Multilevel Analysis of an International Study

2019 ◽  
Vol 8 (13) ◽  
Author(s):  
Paula Muñoz Venturelli ◽  
Xian Li ◽  
Sandy Middleton ◽  
Caroline Watkins ◽  
Pablo M. Lavados ◽  
...  
Keyword(s):  
Multilevel Analysis ◽  
Patient Outcomes ◽  
International Study ◽  
Stroke Care ◽  
Evidence Based

Influence of stroke coordinators on delivery of acute stroke care and hospital outcomes: An observational study

2017 ◽  
Vol 13 (6) ◽  
pp. 585-591 ◽  
Author(s):  
Tara Purvis ◽  
Monique F Kilkenny ◽  
Sandy Middleton ◽  
Dominique A Cadilhac
Keyword(s):  
Length Of Stay ◽  
Observational Study ◽  
Acute Stroke ◽  
Patient Outcomes ◽  
Stroke Unit ◽  
Stroke Care ◽  
Initial Assessment ◽  
Evidence Based ◽  
Clinical Practices ◽  
Evidence Based Care

Background Stroke coordinators have been inconsistently used in various countries to support stroke care in hospital. Aim To investigate the association between stroke coordinators and the provision of evidence-based care and patient outcomes in hospitals with acute stroke units. Methods Observational study using cross-sectional data from the 2015 National Acute Services Audit Program (Australia): including a retrospective medical record audit (40 records from each hospital) and a self-reported survey of organizational resources for stroke. Multilevel random effects logistic regression for patient outcomes including complications, independence on discharge, and death. Median regression for length of stay comparisons. Results A total of 109 hospitals submitted 4060 cases; 59 (54%) had a stroke coordinator. Compared with patients from stroke unit hospitals with no stroke coordinator ( N = 33, 1333 cases), patients in stroke unit hospitals with a stroke coordinator ( N = 53, 2072 cases) were more likely to receive clinical practices including rehabilitation therapy within 48 hours of initial assessment (88 vs. 82%, p < 0.001), risk factor modification advice (62 vs. 55%, p = 0.003) and receive a discharge care plan (65 vs. 48%, p < 0.001). No differences in complications, independence on discharge, or deaths were evident. Patients from hospitals with a stroke coordinator were more likely to access inpatient rehabilitation (adjusted odds ratio 1.8, 95% confidence interval 1.1–2.8) and have a reduced length of acute stay if discharged (median 14 h, p = 0.03). Conclusion Presence of stroke coordinators was associated with reduced length of stay and improved delivery of evidence-based care in hospitals with a stroke unit.

scholarly journals Large-scale implementation of stroke early supported discharge: the WISE realist mixed-methods study

2021 ◽  
Vol 9 (22) ◽  
pp. 1-150
Author(s):  
Rebecca J Fisher ◽  
Niki Chouliara ◽  
Adrian Byrne ◽  
Trudi Cameron ◽  
Sarah Lewis ◽  
...  
Keyword(s):  
Patient Outcomes ◽  
Care Pathway ◽  
Stroke Care ◽  
Realist Evaluation ◽  
Mixed Methods Study ◽  
Evidence Based ◽  
Work Package ◽  
Early Supported Discharge ◽  
Consensus Score ◽  
Core Components

Background In England, the provision of early supported discharge is recommended as part of an evidence-based stroke care pathway. Objectives To investigate the effectiveness of early supported discharge services when implemented at scale in practice and to understand how the context within which these services operate influences their implementation and effectiveness. Design A mixed-methods study using a realist evaluation approach and two interlinking work packages was undertaken. Three programme theories were tested to investigate the adoption of evidence-based core components, differences in urban and rural settings, and communication processes. Setting and interventions Early supported discharge services across a large geographical area of England, covering the West and East Midlands, the East of England and the North of England. Participants Work package 1: historical prospective patient data from the Sentinel Stroke National Audit Programme collected by early supported discharge and hospital teams. Work package 2: NHS staff (n = 117) and patients (n = 30) from six purposely selected early supported discharge services. Data and main outcome Work package 1: a 17-item early supported discharge consensus score measured the adherence to evidence-based core components defined in an international consensus document. The effectiveness of early supported discharge was measured with process and patient outcomes and costs. Work package 2: semistructured interviews and focus groups with NHS staff and patients were undertaken to investigate the contextual determinants of early supported discharge effectiveness. Results A variety of early supported discharge service models had been adopted, as reflected by the variability in the early supported discharge consensus score. A one-unit increase in early supported discharge consensus score was significantly associated with a more responsive early supported discharge service and increased treatment intensity. There was no association with stroke survivor outcome. Patients who received early supported discharge in their stroke care pathway spent, on average, 1 day longer in hospital than those who did not receive early supported discharge. The most rural services had the highest service costs per patient. NHS staff identified core evidence-based components (e.g. eligibility criteria, co-ordinated multidisciplinary team and regular weekly multidisciplinary team meetings) as central to the effectiveness of early supported discharge. Mechanisms thought to streamline discharge and help teams to meet their responsiveness targets included having access to a social worker and the quality of communications and transitions across services. The role of rehabilitation assistants and an interdisciplinary approach were facilitators of delivering an intensive service. The rurality of early supported discharge services, especially when coupled with capacity issues and increased travel times to visit patients, could influence the intensity of rehabilitation provision and teams’ flexibility to adjust to patients’ needs. This required organising multidisciplinary teams and meetings around the local geography. Findings also highlighted the importance of good leadership and communication. Early supported discharge staff highlighted the need for collaborative and trusting relationships with patients and carers and stroke unit staff, as well as across the wider stroke care pathway. Limitations Work package 1: possible influence of unobserved variables and we were unable to determine the effect of early supported discharge on patient outcomes. Work package 2: the pragmatic approach led to ‘theoretical nuggets’ rather than an overarching higher-level theory. Conclusions The realist evaluation methodology allowed us to address the complexity of early supported discharge delivery in real-world settings. The findings highlighted the importance of context and contextual features and mechanisms that need to be either addressed or capitalised on to improve effectiveness. Trial registration Current Controlled Trials ISRCTN15568163. Funding This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 9, No. 22. See the NIHR Journals Library website for further project information.

scholarly journals Evolution of Evidence-Based Medicine in Stroke

2021 ◽  
pp. 1-12
Author(s):  
Graeme J. Hankey
Keyword(s):  
Medical Research ◽  
Patient Care ◽  
Patient Outcomes ◽  
Evidence Based Medicine ◽  
Stroke Care ◽  
The State ◽  
Evidence Based ◽  
Empirical Testing ◽  
Based Medicine ◽  
Scientific Endeavour

The introduction and evolution of evidence-based stroke medicine has realized major advances in our knowledge about stroke, methods of medical research, and patient outcomes that continue to complement traditional individual patient care. It is humbling to recall the state of knowledge and scientific endeavour of our forebears who were unaware of what we know now and yet pursued the highest standards for evaluating and delivering effective stroke care. The science of stroke medicine has evolved from pathophysiological theory to empirical testing. Progress has been steady, despite inevitable disappointments and cul-de-sacs, and has occasionally been punctuated by sensational breakthroughs, such as the advent of reperfusion therapies guided by imaging.

scholarly journals How to do health services research in stroke: A focus on performance measurement and quality improvement

2018 ◽  
Vol 13 (2) ◽  
pp. 166-174 ◽  
Author(s):  
Dominique A Cadilhac ◽  
Rebecca Fisher ◽  
Julie Bernhardt
Keyword(s):  
Health Services Research ◽  
Health Services ◽  
Patient Outcomes ◽  
Stroke Care ◽  
Evidence Based ◽  
Clinical Services ◽  
Policy And Practice ◽  
Services Research ◽  
Inadequate Knowledge ◽  
Improve Health

The objective of this “How to” research series article is to provide guidance on getting started in Health Services Research. The purpose of health services research is to contribute knowledge that can be used to help improve health systems and clinical services through influencing policy and practice. The methods used are broad, have varying levels of rigor, and may require different specialist skills. This paper sets out practical steps for undertaking health services research. Importantly, use of the highlighted techniques can identify solutions to address inadequate knowledge translation or promote greater access to evidence-based stroke care to optimize patient outcomes.

scholarly journals Methods of Implementation of Evidence-Based Stroke Care in Europe

Stroke ◽  
2015 ◽  
Vol 46 (8) ◽  
pp. 2252-2259 ◽  
Author(s):  
Antonio Di Carlo ◽  
Francesca Romana Pezzella ◽  
Alec Fraser ◽  
Francesca Bovis ◽  
Juan Baeza ◽  
...  
Keyword(s):  
Stroke Care ◽  
Evidence Based

Abstract TP252: Using Hospital Door-to-Needle Times to Individualize Hospital Bypass Times in Order to Minimize Regional Onset-to-Needle Times

Stroke ◽  
2016 ◽  
Vol 47 (suppl_1) ◽  
Author(s):  
Jin-Moo Lee ◽  
Andria Ford ◽  
Jo-Ann Burns ◽  
Peter Panagos
Keyword(s):  
Patient Outcomes ◽  
Treatment Options ◽  
Stroke Care ◽  
Smartphone Application ◽  
System Level ◽  
Acute Stroke Care ◽  
Web Based ◽  
Arrival Times ◽  
Get With The Guidelines ◽  
Individual Hospital

Introduction: With enhanced treatment options but limited resources, acute stroke care is becoming regionalized. Regional pre-hospital triage plans are being developed to permit bypass of certain hospitals in order to deliver patients to hospitals with higher-level resources for advanced treatment options. One of the most contentious issues in these plans is the “bypass time”_time allowed for EMS to bypass one hospital in order to transport to a hospital with presumed higher level stroke care. Hypothesis: Incorporating transport times and individual hospital door-to-needle times (DNTs) into regional pre-hospital triage bypass plans will expedite regional treatment times which may lead to improved patient outcomes at the system level. Methods: To minimize onset-to-needle times (ONTs), it is essential not only to find the fastest route to the nearest capable hospital, but to find the nearest capable hospital with the shortest DNTs. We examined specific time components comprising ONT, including Onset-to-Arrival times (OATs) and DNTs using Get-with-the-Guidelines data (GWTG), comparing the hospital with fastest DTN times (Hospital A) with that of the average in the St. Louis metropolitan area. Results: Hospital A had a mean DNT that was 20 min faster than the average St. Louis DNT (31 min vs. 51 min, p<.0.001), while OATs were not different. This 20 min advantage might be translated into a longer bypass time specifically for hospital A, to provide equivalent or faster ONTs for patients in the region. Conclusion: The incorporation of hospital DNTs into regional pre-hospital triage plans can individualize bypass times for each hospital. This practice may accelerate treatment times throughout a region, and could be trialed with the aid of web-based smartphone application that could provide EMS with important information that could minimize both transport times and DNTs.

Lower extremity osteoarthritis: optimising musculoskeletal health is a growing global concern: a narrative review

2018 ◽  
Vol 53 (13) ◽  
pp. 806-811 ◽  
Author(s):  
Richard D Leech ◽  
Jillian Eyles ◽  
Mark E Batt ◽  
David J Hunter
Keyword(s):  
Patient Outcomes ◽  
Key Management ◽  
Structural Changes ◽  
Healthcare Professionals ◽  
Disease Process ◽  
Evidence Based ◽  
Musculoskeletal Health ◽  
Proactive Approach ◽  
Global Concern ◽  
Improve Patient

The burden of non-communicable diseases, such as osteoarthritis (OA), continues to increase for individuals and society. Regrettably, in many instances, healthcare professionals fail to manage OA optimally. There is growing disparity between the strength of evidence supporting interventions for OA and the frequency of their use in practice. Physical activity and exercise, weight management and education are key management components supported by evidence yet lack appropriate implementation. Furthermore, a recognition that treatment earlier in the disease process may halt progression or reverse structural changes has not been translated into clinical practice. We have largely failed to put pathways and procedures in place that promote a proactive approach to facilitate better outcomes in OA. This paper aims to highlight areas of evidence-based practical management that could improve patient outcomes if used more effectively.

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