BACKGROUND: Systems of stroke care delivery have been promoted as a means of improving the quality of stroke care, but little is known about their effectiveness. We assessed the effect of the Ontario Stroke System, a province-wide strategy of regionalized stroke care delivery, on stroke care and outcomes in Ontario, Canada. METHODS: We used population-based provincial administrative databases to identify all emergency department visits and hospital admissions for acute stroke and transient ischemic attack from Jan. 1, 2001, to Dec. 31, 2010. Using piecewise regression analyses, we assessed the effect of the full implementation of the Ontario Stroke System in 2005 on the proportion of patients who received care at stroke centres, and on rates of discharge to long-term care facilities and 30-day mortality after stroke. RESULTS: We included 243 287 visits by patients with acute stroke or transient ischemic attack. The full implementation of the Ontario Stroke System in 2005 was associated with an increase in rates of care at stroke centres (before implementation: 40.0%; after implementation: 46.5%), decreased rates of discharge to long-term care facilities (before implementation: 16.9%; after implementation: 14.8%) and decreased 30-day mortality for hemorrhagic (before implementation: 38.3%; after implementation: 34.4%) and ischemic stroke (before implementation: 16.3%; after implementation: 15.7%). The system's implementation was also associated with marked increases in the proportion of patients who received neuroimaging, thrombolytic therapy, care in a stroke unit and antithrombotic therapy. INTERPRETATION: The implementation of an organized system of stroke care delivery was associated with improved processes of care and outcomes after stroke.
BACKGROUND: Systems of stroke care delivery have been promoted as a means of improving the quality of stroke care, but little is known about their effectiveness. We assessed the effect of the Ontario Stroke System, a province-wide strategy of regionalized stroke care delivery, on stroke care and outcomes in Ontario, Canada. METHODS: We used population-based provincial administrative databases to identify all emergency department visits and hospital admissions for acute stroke and transient ischemic attack from Jan. 1, 2001, to Dec. 31, 2010. Using piecewise regression analyses, we assessed the effect of the full implementation of the Ontario Stroke System in 2005 on the proportion of patients who received care at stroke centres, and on rates of discharge to long-term care facilities and 30-day mortality after stroke. RESULTS: We included 243 287 visits by patients with acute stroke or transient ischemic attack. The full implementation of the Ontario Stroke System in 2005 was associated with an increase in rates of care at stroke centres (before implementation: 40.0%; after implementation: 46.5%), decreased rates of discharge to long-term care facilities (before implementation: 16.9%; after implementation: 14.8%) and decreased 30-day mortality for hemorrhagic (before implementation: 38.3%; after implementation: 34.4%) and ischemic stroke (before implementation: 16.3%; after implementation: 15.7%). The system's implementation was also associated with marked increases in the proportion of patients who received neuroimaging, thrombolytic therapy, care in a stroke unit and antithrombotic therapy. INTERPRETATION: The implementation of an organized system of stroke care delivery was associated with improved processes of care and outcomes after stroke.
Authors: Mark J Alberts; Richard E Latchaw; Warren R Selman; Timothy Shephard; Mark N Hadley; Lawrence M Brass; Walter Koroshetz; John R Marler; John Booss; Richard D Zorowitz; Janet B Croft; Ellen Magnis; Diane Mulligan; Andrew Jagoda; Robert O'Connor; C Michael Cawley; J J Connors; Jean A Rose-DeRenzy; Marian Emr; Margo Warren; Michael D Walker Journal: Stroke Date: 2005-06-16 Impact factor: 7.914
Authors: Lee H Schwamm; Arthur Pancioli; Joe E Acker; Larry B Goldstein; Richard D Zorowitz; Timothy J Shephard; Peter Moyer; Mark Gorman; S Claiborne Johnston; Pamela W Duncan; Phil Gorelick; Jeffery Frank; Steven K Stranne; Renee Smith; William Federspiel; Katie B Horton; Ellen Magnis; Robert J Adams Journal: Stroke Date: 2005-02-02 Impact factor: 7.914
Authors: Moira K Kapral; Jiming Fang; Shabbir M H Alibhai; Peter Cram; Angela M Cheung; Leanne K Casaubon; Marla Prager; Melissa Stamplecoski; Brennan Rashkovan; Peter C Austin Journal: Neurology Date: 2016-11-23 Impact factor: 9.910
Authors: Moira K Kapral; Ruth Hall; Jiming Fang; Peter C Austin; Frank L Silver; David J Gladstone; Leanne K Casaubon; Melissa Stamplecoski; Jack V Tu Journal: Neurology Date: 2016-03-25 Impact factor: 9.910
Authors: Aravind Ganesh; Patrice Lindsay; Jiming Fang; Moira K Kapral; Robert Côté; Ian Joiner; Antoine M Hakim; Michael D Hill Journal: Neurology Date: 2016-02-05 Impact factor: 9.910
Authors: Steffi Hillmann; Silke Wiedmann; Alec Fraser; Juan Baeza; Anthony Rudd; Bo Norrving; Kjell Asplund; Maciej Niewada; Martin Dennis; Peter Hermanek; Charles D A Wolfe; Peter U Heuschmann Journal: Biomed Res Int Date: 2015-12-09 Impact factor: 3.411
Authors: Janet E Squires; Danielle Cho-Young; Laura D Aloisio; Robert Bell; Stephen Bornstein; Susan E Brien; Simon Decary; Melissa Demery Varin; Mark Dobrow; Carole A Estabrooks; Ian D Graham; Megan Greenough; Doris Grinspun; Michael Hillmer; Tanya Horsley; Jiale Hu; Alan Katz; Christina Krause; John Lavis; Wendy Levinson; Adrian Levy; Michelina Mancuso; Steve Morgan; Letitia Nadalin-Penno; Andrew Neuner; Tamara Rader; Wilmer J Santos; Gary Teare; Joshua Tepper; Amanda Vandyk; Michael Wilson; Jeremy M Grimshaw Journal: CMAJ Date: 2022-02-28 Impact factor: 16.859