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Cornelis C, den Hartog SJ, Bastemeijer CM, Roozenbeek B, Nederkoorn PJ, Van den Berg-Vos RM. Patient-Reported Experience Measures in Stroke Care: A Systematic Review. Stroke 2021; 52:2432-2435. [PMID: 33966497 DOI: 10.1161/strokeaha.120.034028] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Patient-reported experience measures (PREMs) assess patients' perception of health care. We aimed to identify all reported PREMs for stroke care and critically appraise psychometric properties of PREMs validated for patients with stroke. METHODS Studies on the development, validation, or utilization of PREMs for adult patients with stroke were systematically identified. The Consensus-Based Standards for the Selection of Health Measurement Instruments criteria were used to appraise psychometric performance. RESULTS We included 18 studies, examining 13 PREMs. Two PREMs had been developed for stroke care: Consumer Quality Index: Cerebrovascular Accident and Riksstroke. Consumer Quality Index: Cerebrovascular Accident was given a positive psychometric assessment, but its length and limited language applicability impede clinical implementation. Riksstroke was appraised as doubtful. Eleven PREMs were generic. The psychometric performance of 5 generic PREMS, validated for patients with stroke, received conflicting assessments. Six generic PREMs had not been validated in patients with stroke and were therefore not assessed for instrument performance. CONCLUSIONS Thirteen PREMs have been published for use in stroke care. The stroke-specific Consumer Quality Index: Cerebrovascular Accident has favorable psychometric performance but lacks practical feasibility. Other PREMs have inadequate or unknown psychometric properties. This indicates the need for developing stroke-specific PREMs to support quality improvement and enhance patient-centered care.
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Affiliation(s)
- Cosette Cornelis
- Department of Neurology, Amsterdam University Medical Center, the Netherlands (C.C., P.J.N., R.M.V.d.B.-V.)
| | - Sanne J den Hartog
- Department of Neurology (S.J.d.H., B.R.), Erasmus MC, University Medical Center, Rotterdam, the Netherlands.,Department of Radiology and Nuclear Medicine (S.J.d.H., B.R.), Erasmus MC, University Medical Center, Rotterdam, the Netherlands.,Department of Public Health (S.J.d.H., C.M.B.), Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - Carla M Bastemeijer
- Department of Public Health (S.J.d.H., C.M.B.), Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - Bob Roozenbeek
- Department of Neurology (S.J.d.H., B.R.), Erasmus MC, University Medical Center, Rotterdam, the Netherlands.,Department of Radiology and Nuclear Medicine (S.J.d.H., B.R.), Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - Paul J Nederkoorn
- Department of Neurology, Amsterdam University Medical Center, the Netherlands (C.C., P.J.N., R.M.V.d.B.-V.)
| | - Renske M Van den Berg-Vos
- Department of Neurology, Amsterdam University Medical Center, the Netherlands (C.C., P.J.N., R.M.V.d.B.-V.).,Department of Neurology, OLVG, Amsterdam, the Netherlands (R.M.V.d.B.-V.)
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2
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Fulop NJ, Ramsay AIG, Hunter RM, McKevitt C, Perry C, Turner SJ, Boaden R, Papachristou I, Rudd AG, Tyrrell PJ, Wolfe CDA, Morris S. Evaluation of reconfigurations of acute stroke services in different regions of England and lessons for implementation: a mixed-methods study. HEALTH SERVICES AND DELIVERY RESEARCH 2019. [DOI: 10.3310/hsdr07070] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Background
Centralising acute stroke services is an example of major system change (MSC). ‘Hub and spoke’ systems, consisting of a reduced number of services providing acute stroke care over the first 72 hours following a stroke (hubs), with a larger number of services providing care beyond this phase (spokes), have been proposed to improve care and outcomes.
Objective
To use formative evaluation methods to analyse reconfigurations of acute stroke services in different regions of England and to identify lessons that will help to guide future reconfigurations, by studying the following contrasting cases: (1) London (implemented 2010) – all patients eligible for Hyperacute Stroke Units (HASUs); patients admitted 24 hours a day, 7 days a week; (2) Greater Manchester A (GMA) (2010) – only patients presenting within 4 hours are eligible for HASU treatment; one HASU operated 24/7, two operated from 07.00 to 19.00, Monday to Friday; (3) Greater Manchester B (GMB) (2015) – all patients eligible for HASU treatment (as in London); one HASU operated 24/7, two operated with admission extended to the hours of 07.00–23.00, Monday to Sunday; and (4) Midlands and East of England – planned 2012/13, but not implemented.
Design
Impact was studied through a controlled before-and-after design, analysing clinical outcomes, clinical interventions and cost-effectiveness. The development, implementation and sustainability of changes were studied through qualitative case studies, documentation analysis (n = 1091), stakeholder interviews (n = 325) and non-participant observations (n = 92; ≈210 hours). Theory-based framework was used to link qualitative findings on process of change with quantitative outcomes.
Results
Impact – the London centralisation performed significantly better than the rest of England (RoE) in terms of mortality [–1.1%, 95% confidence interval (CI) –2.1% to –0.1%], resulting in an estimated additional 96 lives saved per year beyond reductions observed in the RoE, length of stay (LOS) (–1.4 days, 95% –2.3 to –0.5 days) and delivering effective clinical interventions [e.g. arrival at a Stroke Unit (SU) within 4 hours of ‘clock start’ (when clock start refers to arrival at hospital for strokes occurring outside hospital or the appearance of symptoms for patients who are already in-patients at the time of stroke): London = 66.3% (95% CI 65.6% to 67.1%); comparator = 54.4% (95% CI 53.6% to 55.1%)]. Performance was sustained over 6 years. GMA performed significantly better than the RoE on LOS (–2.0 days, 95% CI –2.8 to –1.2 days) only. GMB (where 86% of patients were treated in HASU) performed significantly better than the RoE on LOS (–1.5 days, 95% CI –2.5 to –0.4 days) and clinical interventions [e.g. SU within 4 hours: GMB = 79.1% (95% CI 77.9% to 80.4%); comparator = 53.4% (95% CI 53.0% to 53.7%)] but not on mortality (–1.3%, 95% CI –2.7% to 0.01%; p = 0.05, accounting for reductions observed in RoE); however, there was a significant effect when examining GMB HASUs only (–1.8%, 95% CI –3.4% to –0.2%), resulting in an estimated additional 68 lives saved per year. All centralisations except GMB were cost-effective at 10 years, with a higher net monetary benefit than the RoE at a willingness to pay for a quality-adjusted life-year (QALY) of £20,000–30,000. Per 1000 patients at 10 years, London resulted in an additional 58 QALYs, GMA resulted in an additional 18 QALYs and GMB resulted in an additional 6 QALYs at costs of £1,014,363, –£470,848 and £719,948, respectively. GMB was cost-effective at 90 days. Despite concerns about the potential impact of increased travel times, patients and carers reported good experiences of centralised services; this relied on clear information at every stage. Planning change – combining top-down authority and bottom-up clinical leadership was important in co-ordinating multiple stakeholders to agree service models and overcome resistance. Implementation – minimising phases of change, use of data, service standards linked to financial incentives and active facilitation of changes by stroke networks was important. The 2013 reforms of the English NHS removed sources of top-down authority and facilitative capacity, preventing centralisation (Midlands and East of England) and delaying implementation (GMB). Greater Manchester’s Operational Delivery Network, developed to provide alternative network facilitation, and London’s continued use of standards suggested important facilitators of centralisation in a post-reform context.
Limitations
The main limitation of our quantitative analysis was that we were unable to control for stroke severity. In addition, findings may not apply to non-urban settings. Data on patients’ quality of life were unavailable nationally, clinical interventions measured changed over time and national participation in audits varied. Some qualitative analyses were retrospective, potentially influencing participant views.
Conclusions
Centralising acute stroke services can improve clinical outcomes and care provision. Factors related to the service model implemented, how change is implemented and the context in which it is implemented are influential in improvement. We recommend further analysis of how different types of leadership contribute to MSC, patient and carer experience during the implementation of change, the impact of change on further clinical outcomes (disability and QoL) and influence of severity of stroke on clinical outcomes. Finally, our findings should be assessed in relation to MSC implemented in other health-care specialties.
Funding
The National Institute for Health Research Health Services and Delivery Research programme.
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Affiliation(s)
- Naomi J Fulop
- Department of Applied Health Research, University College London, London, UK
| | - Angus IG Ramsay
- Department of Applied Health Research, University College London, London, UK
| | - Rachael M Hunter
- Research Department of Primary Care and Population Health, University College London, London, UK
| | - Christopher McKevitt
- Department of Population Health Sciences, School of Population Health & Environmental Sciences Research, King’s College London, London, UK
| | - Catherine Perry
- Alliance Manchester Business School, University of Manchester, Manchester, UK
| | - Simon J Turner
- Centre for Primary Care, Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester, UK
| | - Ruth Boaden
- Alliance Manchester Business School, University of Manchester, Manchester, UK
| | | | - Anthony G Rudd
- Guy’s and St Thomas’ NHS Foundation Trust, St Thomas’ Hospital, London, UK
| | - Pippa J Tyrrell
- Stroke and Vascular Centre, University of Manchester, Manchester Academic Health Science Centre, Salford Royal Hospitals NHS Foundation Trust, Salford, UK
| | - Charles DA Wolfe
- Department of Population Health Sciences, School of Population Health & Environmental Sciences Research, King’s College London, London, UK
| | - Stephen Morris
- Department of Applied Health Research, University College London, London, UK
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3
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Abstract
Over the last 20 years, England, Wales and Northern Ireland have developed an audit programme that now encompasses nearly all patients admitted to hospital with a stroke. This article records and reviews some questions that have been answered using data from the audit: Is the rate of institutional care after rehabilitation a possible measure of outcome? Does stroke unit care in routine practice give the benefits shown in randomized controlled trials? How is the quality of stroke care affected by a patient's age and the time of their stroke? Do patient-reported measures match those obtained from the professionals recording of processes of care? How do the processes of care after stroke affect mortality? Is thrombolysis safe to use in patients over the age of 80? Do staffing levels matter? Does assessing the safety of swallowing really make a difference? Do clinicians make rational decisions about end-of-life care in patients with haemorrhage? Does socioeconomic status influence the risk of stroke, outcome after stroke and the quality of stroke care? How much does stroke really cost in England, Wales and Northern Ireland? The article concludes that this national audit has improved stroke care across the United Kingdom, has given answers to important questions that could not be answered in any other way and has shown that benefits found in research do generalize into real clinical benefits in day-to-day practice.
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Affiliation(s)
- Anthony G Rudd
- 1 Department of Stroke Medicine, King's College London, London, UK.,2 Stroke Programme, Royal College of Physicians (RCP), London, UK
| | - Alex Hoffman
- 2 Stroke Programme, Royal College of Physicians (RCP), London, UK
| | - Lizz Paley
- 2 Stroke Programme, Royal College of Physicians (RCP), London, UK
| | - Benjamin Bray
- 2 Stroke Programme, Royal College of Physicians (RCP), London, UK
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4
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Perry C, Papachristou I, Ramsay AIG, Boaden RJ, McKevitt C, Turner SJ, Wolfe CDA, Fulop NJ. Patient experience of centralized acute stroke care pathways. Health Expect 2018; 21:909-918. [PMID: 29605966 PMCID: PMC6186538 DOI: 10.1111/hex.12685] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/17/2018] [Indexed: 12/01/2022] Open
Abstract
Background In 2010, Greater Manchester (GM) and London centralized acute stroke care services into a reduced number of hyperacute stroke units, with local stroke units providing on‐going care nearer patients’ homes. Objective To explore the impact of centralized acute stroke care pathways on the experiences of patients. Design Qualitative interview study. Thematic analysis was undertaken, using deductive and inductive approaches. Final data analysis explored themes related to five chronological phases of the centralized stroke care pathway. Setting and participants Recruitment from 3 hospitals in GM (15 stroke patients/8 family members) and 4 in London (21 stroke patients/9 family members). Results Participants were impressed with emergency services and initial reception at hospital: disquiet about travelling further than a local hospital was allayed by clear explanations. Participants knew who was treating them and were involved in decisions. Difficulties for families visiting hospitals a distance from home were raised. Repatriation to local hospitals was not always timely, but no detrimental effects were reported. Discharge to the community was viewed less positively. Discussion and conclusions Patients on the centralized acute stroke care pathways reported many positive aspects of care: the centralization of care pathways can offer patients a good experience. Disadvantages of travelling further were perceived to be outweighed by the opportunity to receive the best quality care. This study highlights the necessity for all staff on a centralized care pathway to provide clear and accessible information to patients, in order to maximize their experience of care.
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Affiliation(s)
- Catherine Perry
- Alliance Manchester Business School, University of Manchester, Manchester, UK
| | | | - Angus I G Ramsay
- Department of Applied Health Research, University College London, London, UK
| | - Ruth J Boaden
- Alliance Manchester Business School, University of Manchester, Manchester, UK
| | - Christopher McKevitt
- Department of Primary Care and Public Health Sciences, Kings College London, London, UK.,National Institute of Health Research Comprehensive Biomedical Research Centre, Guy's and St Thomas' NHS Foundation Trust, King's College London, London, UK
| | - Simon J Turner
- Centre for Primary Care, Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Charles D A Wolfe
- Department of Primary Care and Public Health Sciences, Kings College London, London, UK.,National Institute of Health Research Comprehensive Biomedical Research Centre, Guy's and St Thomas' NHS Foundation Trust, King's College London, London, UK.,National Institute of Health Research, Collaboration for Leadership in Applied Health Research and Care South London, London, UK
| | - Naomi J Fulop
- Department of Applied Health Research, University College London, London, UK
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5
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Flott KM, Graham C, Darzi A, Mayer E. Can we use patient-reported feedback to drive change? The challenges of using patient-reported feedback and how they might be addressed. BMJ Qual Saf 2016; 26:502-507. [PMID: 27325796 DOI: 10.1136/bmjqs-2016-005223] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Revised: 05/17/2016] [Accepted: 05/28/2016] [Indexed: 11/04/2022]
Affiliation(s)
- Kelsey Margaret Flott
- Centre for Health Policy, Institute of Global Health Innovation, Imperial College London, London, UK
| | - Chris Graham
- Centre for Health Policy, Institute of Global Health Innovation, Imperial College London, London, UK
| | - Ara Darzi
- Centre for Health Policy, Institute of Global Health Innovation, Imperial College London, London, UK
| | - Erik Mayer
- Centre for Health Policy, Institute of Global Health Innovation, Imperial College London, London, UK
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6
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Relationship Between Adolescent Report of Patient-Centered Care and of Quality of Primary Care. Acad Pediatr 2016; 16:770-776. [PMID: 26802684 PMCID: PMC4958046 DOI: 10.1016/j.acap.2016.01.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Revised: 01/11/2016] [Accepted: 01/15/2016] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Few studies have examined adolescent self-report of patient-centered care (PCC). We investigated whether adolescent self-report of PCC varied by patient characteristics and whether receipt of PCC is associated with measures of adolescent primary care quality. METHODS We analyzed cross-sectional data from Healthy Passages, a population-based survey of 4105 10th graders and their parents. Adolescent report of PCC was derived from 4 items. Adolescent primary care quality was assessed by measuring access to confidential care, screening for important adolescent health topics, unmet need, and overall rating of health care. We conducted weighted bivariate analyses and multivariate logistic regression models of the association of PCC with adolescent characteristics and primary care quality. RESULTS Forty-seven percent of adolescents reported that they received PCC. Report of receiving PCC was associated with high quality for other measures, such as having a private conversation with a clinician (adjusted odds ratio [aOR] 2.2; 95% confidence interval [CI] [1.9, 2.6]) and having talked about health behaviors (aOR 1.6; 95% CI 1.4, 1.8); it was also associated with lower likelihood for self-reported unmet need for care (aOR 0.8; 95% CI 0.7, 0.9) and having a serious untreated health problem (aOR 0.4; 95% CI 0.3, 0.5). CONCLUSIONS Many adolescents do not report receiving PCC. Adolescent-reported PCC positively correlates with measures of high-quality adolescent primary care. Our study provides support for using adolescent-report of PCC as a measure of adolescent primary care quality.
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7
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Hewitt G, Sims S, Greenwood N, Jones F, Ross F, Harris R. Interprofessional teamwork in stroke care: Is it visible or important to patients and carers? J Interprof Care 2014; 29:331-9. [PMID: 25158116 DOI: 10.3109/13561820.2014.950727] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Interprofessional teamwork is seen in healthcare policy and practice as a key strategy for providing safe, efficient and holistic healthcare and is an accepted part of evidence-based stroke care. The impact of interprofessional teamwork on patient and carer experience(s) of care is unknown, although some research suggests a relationship might exist. This study aimed to explore patient and carer perceptions of good and poor teamwork and its impact on experiences of care. Critical incident interviews were conducted with 50 patients and 33 carers in acute, inpatient rehabilitation and community phases of care within two UK stroke care pathways. An analytical framework, derived from a realist synthesis of 13 'mechanisms' (processes) of interprofessional teamwork, was used to identify positive and negative 'indicators' of teamwork. Participants identified several mechanisms of teamwork, but it was not a subject most talked about readily. This suggests that interprofessional teamwork is not a concept that is particularly important to stroke patients and carers; they do not readily perceive any impacts of teamwork on their experiences. These findings are a salient reminder that what might be expected by healthcare professionals to be important influences on experience may not be perceived to be so by patients and carers.
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Affiliation(s)
- Gillian Hewitt
- Cardiff School of Social Sciences, Cardiff University , Cardiff , UK and
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8
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Moynihan B, Paul S, Markus HS. User experience of a centralized hyperacute stroke service: a prospective evaluation. Stroke 2013; 44:2743-7. [PMID: 23908064 DOI: 10.1161/strokeaha.113.001675] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Centralizing hyperacute stroke unit (HASU) care services allows improved access to thrombolysis but could be associated with worse patient experience, particularly when early repatriation to a local stroke recovery unit occurs as this may result in discontinuity of care. A centralized model of care was introduced in London, United Kingdom, with 8 HASUs providing acute care for the whole 8.3 million population, with repatriation on day 3 to a local stroke recovery unit. The patient and carer experience of this model of care has not been previously reported. METHODS We undertook a prospective observational study of the new model of care in the South West London sector. Patient and carer experiences were evaluated using a modified Picker Questionnaire. Separate questionnaires were used for patients discharged directly home from the HASU, those repatriated to local stroke recovery units, and for carers of patients admitted to the HASU. RESULTS Despite moving from a selected to nonselected admission pattern, thrombolysis rates increased from 6% to 9%. High satisfaction rates were reported among both patients and carers. Patients discharged directly home had higher satisfaction levels than those requiring repatriation to their local stroke unit, who were older and had more severe stroke. A total of 47% of carers expressed anxiety over the repatriation from the HASU back to the local stroke recovery unit, but few patients and carers reported an impact of this move on patient recovery. CONCLUSION Centralized HASU care is associated with good levels of patient and carer satisfaction.
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Affiliation(s)
- Barry Moynihan
- From the Stroke and Dementia Research Centre, St George's University of London, London, United Kingdom
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9
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Struwe JH, Baernholdt M, Noerholm V, Lind J. How is nursing care for stroke patients organised? Nurses' views on best practices. J Nurs Manag 2013; 21:141-51. [DOI: 10.1111/jonm.12016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/13/2012] [Indexed: 11/28/2022]
Affiliation(s)
| | - Marianne Baernholdt
- School of Nursing and Department of Public Health Sciences; University of Virginia; Charlottesville VA USA
| | - Vibeke Noerholm
- School of Nursing UC Diakonissestiftelsen; Copenhagen Denmark
| | - Jette Lind
- School of Nursing UC Diakonissestiftelsen; Copenhagen Denmark
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10
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Myint PK, Potter JF, Price GM, Barton GR, Metcalf AK, Hale R, Dalton G, Musgrave SD, George A, Shekhar R, Owusu-Agyei P, Walsh K, Ngeh J, Nicholson A, Day DJ, Warburton EA, Bachmann MO. Evaluation of stroke services in Anglia Stroke Clinical Network to examine the variation in acute services and stroke outcomes. BMC Health Serv Res 2011; 11:50. [PMID: 21356059 PMCID: PMC3055813 DOI: 10.1186/1472-6963-11-50] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2011] [Accepted: 02/28/2011] [Indexed: 11/08/2022] Open
Abstract
Background Stroke is the third leading cause of death in developed countries and the leading cause of long-term disability worldwide. A series of national stroke audits in the UK highlighted the differences in stroke care between hospitals. The study aims to describe variation in outcomes following stroke and to identify the characteristics of services that are associated with better outcomes, after accounting for case mix differences and individual prognostic factors. Methods/Design We will conduct a cohort study in eight acute NHS trusts within East of England, with at least one year of follow-up after stroke. The study population will be a systematically selected representative sample of patients admitted with stroke during the study period, recruited within each hospital. We will collect individual patient data on prognostic characteristics, health care received, outcomes and costs of care and we will also record relevant characteristics of each provider organisation. The determinants of one year outcome including patient reported outcome will be assessed statistically with proportional hazards regression models. Self (or proxy) completed EuroQol (EQ-5D) questionnaires will measure quality of life at baseline and follow-up for cost utility analyses. Discussion This study will provide observational data about health service factors associated with variations in patient outcomes and health care costs following hospital admission for acute stroke. This will form the basis for future RCTs by identifying promising health service interventions, assessing the feasibility of recruiting and following up trial patients, and provide evidence about frequency and variances in outcomes, and intra-cluster correlation of outcomes, for sample size calculations. The results will inform clinicians, public, service providers, commissioners and policy makers to drive further improvement in health services which will bring direct benefit to the patients.
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Affiliation(s)
- Phyo K Myint
- Norwich Medical School, Faculty of Medicine & Health Sciences, Norwich, UK.
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11
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Horgan F, McGee H, Hickey A, Whitford DL, Murphy S, Royston M, Cowman S, Shelley E, Conroy RM, Wiley M, O’Neill D. From Prevention to Nursing Home Care: A Comprehensive National Audit of Stroke Care. Cerebrovasc Dis 2011; 32:385-92. [DOI: 10.1159/000330640] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2011] [Accepted: 06/22/2011] [Indexed: 11/19/2022] Open
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Luker JA, Wall K, Bernhardt J, Edwards I, Grimmer-Somers K. Measuring the Quality of Dysphagia Management Practices following Stroke: A Systematic Review. Int J Stroke 2010; 5:466-76. [DOI: 10.1111/j.1747-4949.2010.00488.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Adherence to recommended clinical practices improves stroke outcomes. As a result, stroke clinicians are increasingly expected to evaluate the quality of the care they provide so that areas for improvement can be targeted. Finding the best method to evaluate the quality of dysphagia management can be challenging. Aim To systematically review process indicators used to assess the quality of care provided to patients with dysphagia following acute stroke and examine the level of evidence underpinning these indicators. Methods Databases were systematically searched to identify publications (January 2006–April 2009) that describe process indicators relating to the clinical management of acute stroke-related dysphagia. Relevant process indicators were extracted from the reviewed publications for detailed post hoc analysis including supporting evidence and alignment to the current Australian and English stroke guidelines. Results Title and abstract review found 150 potential studies. Full-text review resulted in 25 publications that met the study's inclusion criteria. Thirteen process indicators were identified in the literature that related to the initial assessment, clinical management, rehabilitation and discharge planning for patients with acute stroke-related dysphagia. These processes were supported by levels of evidence ranging from high ‘level 1’ (8%) down to ‘expert opinion’ evidence (46%). Two process indicators did not align to recommendations in the clinical guidelines. This systematic review underpins informed selection of process indicators for evaluating the quality of dysphagia management following stroke. The selection of quality indicators is complicated by equivocal supporting evidence; however, indicators should reflect expected local practices, align with national stroke guidelines and be feasible for clinical auditing.
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Affiliation(s)
- Julie A. Luker
- International Centre for Allied Health Evidence, University of South Australia, North Terrace, Adelaide, SA, Australia
| | - Kylie Wall
- Flinders Medical Centre, Speech Pathology & Audiology, Bedford Park, SA, Australia
| | - Julie Bernhardt
- School of Physiotherapy, La Trobe University, Melbourne, Vic., Australia
- Stroke Division, Florey Neuroscience Institutes, Heidelberg Heights, Melbourne, Vic., Australia
| | - Ian Edwards
- School of Health Science, University of South Australia, Adelaide, SA, Australia
| | - Karen Grimmer-Somers
- International Centre for Allied Health Evidence, University of South Australia, North Terrace, Adelaide, SA, Australia
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13
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Heinzerling L, Burbach G, van Cauwenberge P, Papageorgiou P, Carlsen KH, Lødrup Carlsen KC, Zuberbier T. Establishing a standardized quality management system for the European Health Network GA2LEN. Allergy 2010; 65:743-52. [PMID: 19886923 DOI: 10.1111/j.1398-9995.2009.02235.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND Quality management is increasingly important in clinical practice. The Global Allergy and Asthma European Network (GA(2)LEN) is a network of clinical and scientific excellence with originally 25 allergy centres in 16 European countries, a scientific society (European Academy of Allergology and Clinical Immunology), and a patient organization (European Federation of Allergy and Airways Diseases Patients' Associations). Although some allergy centres adhere to internal quality criteria, the implementation of a standardized quality management system for allergy centres across Europe was lacking. OBJECTIVES To implement standardized quality criteria among allergy centres organized within GA(2)LEN and thus ensure equal standards of diagnosis and care as well as to establish a culture of continuous quality improvement. METHODS Quality criteria covering, e.g., diagnostic and therapeutic procedures, and emergency preparedness to assure patient safety were developed and agreed upon by all 25 participating centres. To assure implementation of quality criteria, centres were audited to check quality indicators and document deviations. A follow-up survey was used to assess the usefulness of the project. RESULTS Deviations were documented mainly in the areas of emergency care/patient safety (27.3% lacked regular emergency training of doctors and nurses; 22.7% inadequate emergency intervention equipment; 22.7% lacked critical incidence reporting/root cause analyses) and handling of extracts/pharmaceuticals (31.8% lacked temperature logs of fridges; 4.5% inadequate check of expiration dates). Quality improvement was initiated as shown by findings of re-audits. Usefulness of the project was rated high. CONCLUSION The establishment of a quality management system with joint standards of care and harmonized procedures can be achieved in an international health network and ensures quality of care.
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Affiliation(s)
- L Heinzerling
- Department of Dermatology and Allergy, Charité Universitätsmedizin-Berlin, Berlin, Germany
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Asplund K, Jonsson F, Eriksson M, Stegmayr B, Appelros P, Norrving B, Terént A, Åsberg KH. Patient Dissatisfaction With Acute Stroke Care. Stroke 2009; 40:3851-6. [DOI: 10.1161/strokeaha.109.561985] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and Purpose—
Riks-Stroke, the Swedish Stroke Register, was used to explore patient characteristics and stroke services as determinants of patient dissatisfaction with acute in-hospital care.
Methods—
All 79 hospitals in Sweden admitting acute stroke patients participate in Riks-Stroke. During 2001 to 2007, 104 876 patients (87% of survivors) responded to a follow-up questionnaire 3 months after acute stroke; this included questions on satisfaction with various aspects of stroke care.
Results—
The majority (>90%) were satisfied with acute in-hospital stroke care. Dissatisfaction was closely associated with outcome at 3 months. Patient who were dependent regarding activities of daily living, felt depressed, or had poor self-perceived general health were more likely to be dissatisfied. Dissatisfaction with global acute stroke care was linked to dissatisfaction with other aspects of care, including rehabilitation and support by community services. Patients treated in stroke units were less often dissatisfied than patients in general wards, as were patients who had been treated in a small hospital (vs medium or large hospitals) and patient who had participated in discharge planning. In multivariate analyses, the strongest predictor of dissatisfaction with acute care was poor outcome (dependency regarding activities of daily living, depressed mood, poor self-perceived health).
Conclusions—
Dissatisfaction with in-hospital acute stroke care is part of a more extensive complex comprising poor functional outcome, depressive mood, poor self-perceived general health, and dissatisfaction not only with acute care but also with health care and social services at large. Several aspects of stroke care organization are associated with a lower risk of dissatisfaction.
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Affiliation(s)
- Kjell Asplund
- From Riks-Stroke (K.A., F.J., M.E.), Department of Medicine, University Hospital, Umeå, Sweden; Epidemiologic Center (B.S.), National Board of Health and Welfare, Stockholm, Sweden; Department of Neurology (P.A.), University Hospital. Örebro, Sweden; Department of Neurology (B.N.), University Hospital, Lund, Sweden; Department of Medicine (A.T.), Akademiska University Hospital, Uppsala, Sweden; Department of Medicine (K.H.Å.), Enköping Hospital, Enköping, Sweden
| | - Fredrik Jonsson
- From Riks-Stroke (K.A., F.J., M.E.), Department of Medicine, University Hospital, Umeå, Sweden; Epidemiologic Center (B.S.), National Board of Health and Welfare, Stockholm, Sweden; Department of Neurology (P.A.), University Hospital. Örebro, Sweden; Department of Neurology (B.N.), University Hospital, Lund, Sweden; Department of Medicine (A.T.), Akademiska University Hospital, Uppsala, Sweden; Department of Medicine (K.H.Å.), Enköping Hospital, Enköping, Sweden
| | - Marie Eriksson
- From Riks-Stroke (K.A., F.J., M.E.), Department of Medicine, University Hospital, Umeå, Sweden; Epidemiologic Center (B.S.), National Board of Health and Welfare, Stockholm, Sweden; Department of Neurology (P.A.), University Hospital. Örebro, Sweden; Department of Neurology (B.N.), University Hospital, Lund, Sweden; Department of Medicine (A.T.), Akademiska University Hospital, Uppsala, Sweden; Department of Medicine (K.H.Å.), Enköping Hospital, Enköping, Sweden
| | - Birgitta Stegmayr
- From Riks-Stroke (K.A., F.J., M.E.), Department of Medicine, University Hospital, Umeå, Sweden; Epidemiologic Center (B.S.), National Board of Health and Welfare, Stockholm, Sweden; Department of Neurology (P.A.), University Hospital. Örebro, Sweden; Department of Neurology (B.N.), University Hospital, Lund, Sweden; Department of Medicine (A.T.), Akademiska University Hospital, Uppsala, Sweden; Department of Medicine (K.H.Å.), Enköping Hospital, Enköping, Sweden
| | - Peter Appelros
- From Riks-Stroke (K.A., F.J., M.E.), Department of Medicine, University Hospital, Umeå, Sweden; Epidemiologic Center (B.S.), National Board of Health and Welfare, Stockholm, Sweden; Department of Neurology (P.A.), University Hospital. Örebro, Sweden; Department of Neurology (B.N.), University Hospital, Lund, Sweden; Department of Medicine (A.T.), Akademiska University Hospital, Uppsala, Sweden; Department of Medicine (K.H.Å.), Enköping Hospital, Enköping, Sweden
| | - Bo Norrving
- From Riks-Stroke (K.A., F.J., M.E.), Department of Medicine, University Hospital, Umeå, Sweden; Epidemiologic Center (B.S.), National Board of Health and Welfare, Stockholm, Sweden; Department of Neurology (P.A.), University Hospital. Örebro, Sweden; Department of Neurology (B.N.), University Hospital, Lund, Sweden; Department of Medicine (A.T.), Akademiska University Hospital, Uppsala, Sweden; Department of Medicine (K.H.Å.), Enköping Hospital, Enköping, Sweden
| | - Andreas Terént
- From Riks-Stroke (K.A., F.J., M.E.), Department of Medicine, University Hospital, Umeå, Sweden; Epidemiologic Center (B.S.), National Board of Health and Welfare, Stockholm, Sweden; Department of Neurology (P.A.), University Hospital. Örebro, Sweden; Department of Neurology (B.N.), University Hospital, Lund, Sweden; Department of Medicine (A.T.), Akademiska University Hospital, Uppsala, Sweden; Department of Medicine (K.H.Å.), Enköping Hospital, Enköping, Sweden
| | - Kerstin Hulter Åsberg
- From Riks-Stroke (K.A., F.J., M.E.), Department of Medicine, University Hospital, Umeå, Sweden; Epidemiologic Center (B.S.), National Board of Health and Welfare, Stockholm, Sweden; Department of Neurology (P.A.), University Hospital. Örebro, Sweden; Department of Neurology (B.N.), University Hospital, Lund, Sweden; Department of Medicine (A.T.), Akademiska University Hospital, Uppsala, Sweden; Department of Medicine (K.H.Å.), Enköping Hospital, Enköping, Sweden
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Sullivan KA, Katajamaki A. Stroke education: retention effects in those at low- and high-risk of stroke. PATIENT EDUCATION AND COUNSELING 2009; 74:205-212. [PMID: 18926660 DOI: 10.1016/j.pec.2008.08.024] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2008] [Revised: 07/29/2008] [Accepted: 08/31/2008] [Indexed: 05/26/2023]
Abstract
OBJECTIVE Relatively few studies have tracked retention effects of stroke education in low- and high-risk groups. Such information is important to improve the design of stroke prevention programs. METHODS The frequency of risk factors within the sample was defined as "high" if 30% or more of participants in that group had that risk. Only one stroke risk factor was present at this level in the low-risk group (n=29; all less than 50 years old). The high-risk group was 44 individuals aged 50 years or over, with four stroke risk factors present at this level. Stroke knowledge was tested on three occasions: baseline, post-education, and retention. Education consisted of reading a published stroke brochure. RESULTS Stroke knowledge improved over time, from baseline to post-education, but not from post-education to retention. The performance of both groups increased, but there was a differential learning effect: low-risk participants learned more than high-risk participants. Important information was learned and included details such when TIA symptoms dissipate. This particular issue was one about which both groups knew little at baseline (less than 15% of combined sample answered this item correctly), but post-education at least 75% of participants got this question correct. CONCLUSION Both low- and high-risk individuals can learn information about stroke and retain it over the short term. The "durable" effects in learning observed in this study are important because the benefit of brochure-only approaches to education have not yet been convincingly demonstrated. PRACTICE IMPLICATIONS Information about stroke from education brochures is retained by at-risk populations for at least 1 week.
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Affiliation(s)
- Karen A Sullivan
- School of Psychology and Counselling, Queensland University of Technology, Queensland, Australia.
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