WEST GTA LHIN STROKE REPORT CARDS

Stroke Report Card Indicators

20 indicators• Integral to access, efficiency, effectiveness and integration that span

the continuum of care (3 HSAA indicators – 8,11,20)

Provincial benchmarks set to enable comparison within and across LHINs

• Achievable Benchmarks of Care (ABC) methodology• Colour coded to indicate performance relative to benchmark

Provincial, LHIN and subLHIN data• Ontario Stroke Audit (10/11) (RSC 100% of stroke pop ’n – Other

30% stroke pop ’n)• Canadian Institute for Health Information (10/11)

Provincial Report Card LHIN Report Card

WEST GTA STROKE Report Card (2010/11)

Areas OF Improvement:• (1) Public Awareness and Education: % of stroke patients who

arrive at ED < 3.5 hours from stroke onsetProvincial Benchmark – 52%

• (7) Acute Stroke Management: % of ischemic stroke patients who arrived at ED less than 3.5 hours from symptom onset and received t-PA

Provincial Benchmark – 61.2%

Mississauga/Halton LHIN Stroke Report Card (2010/11)

Areas FOR Improvement:• (4) Prevention: % of ischemic stroke/TIA patients with Atrial Fibrillation

prescribed or recommended anticoagulant therapy upon Discharge from hospital

PB = 86%

• (8) Acute Stroke: % of stroke/TIA patients treated on a stroke unit at any time during their inpatient stay

PB = 87.5%

• (10) Acute Stroke: % of ALC days to total length of stay in acute care

PB = 14%

• (11) Acute Stroke: % of acute stroke patients discharged from acute care and admitted to inpatient rehabilitation

PB 42.3%

Mississauga/Halton LHIN Stroke Report Card (2010/11)

Areas FOR Improvement:

• (13) Stroke Rehabilitation: % of stroke (excluding TIA) patients discharged from acute care who received a referral for outpatient rehabilitation

PB = 12.1%

 • (18) Stroke Rehabilitation: % of stroke patients admitted to inpatient

rehabilitation with severe strokes (RPG 1100 or 1110

PB = 46.9%

Stroke Reference Group Recommendations Endorsed by the Rehab/CCC Expert Panel

(March 2011)

Emergency Care• Best Practice Standards:

• Protocols/Order sets/Algorithms to manage stroke/TIA patients• Minimize LOS

• Proposed Metrics:• LOS• Admission to stroke unit• CT scan within 24 hours of admission

Stroke Reference Group Recommendations Endorsed by the Rehab/CCC Expert Panel

(March 2011)Acute Care

• Best Practice Standards:• Should be treated on a inter-professional stroke unit (Evidence Level A)• AlphaFIM® completed on Day 3 • Initiate discharge planning• Mobilize patient within 24 hours of admission

• Proposed Metrics:• % admitted to stroke unit• Onset to rehab (5-7 days)• AlphaFIM® completed on Day 3 • % of patients with ALC days• All cause of readmission rates• % of pts. with AlphaFIM® categories D/C to planned rehab destination• % D/C to inpatient rehab

Stroke Reference Group Recommendations Endorsed by the Rehab/CCC Expert Panel

(March 2011)

Inpatient Rehabilitation

• Best Practice Standards:• Stroke Rehab Unit• Minimum of 3 hours of direct, individualized therapy/day• 7 day/week services• 7 day/week• Rehab ALC has priority access to LTC

 • Proposed Metrics:

• Provincial workload definition of direct minutes of therapy per day (therapist vs. assistant)• Discharge destination• ALC LOS• ALC rates per X patients• All cause readmission rates• FIM efficiency by RPG

Stroke Reference Group Recommendations Endorsed by the Rehab/CCC Expert Panel

(March 2011)Ambulatory Rehabilitation/Community Care

• Best Practice Standards:• Ambulatory rehab model (CCAC, community based, hospital based)• Decrease admission of mild strokes through increased access to early outpatient

rehab for those within high early outpatient rehab for those with high early FIM• Access to enhance attendant care/supports in early discharge phase for ALC pts.• Outpt. or enhanced CCAC therapy visits: 2-3 visits/week for 12 weeks

• Proposed Metrics:• CCAC referral date• Time for first CCAC visit• Readmission rate

 

WEST GTA STROKE NETWORK

3 priorities for the West GTA Stroke Network Region…

1)

2)

3)

THANK YOU!