The Ontario Stroke Strategy Southeastern Ontario SEO Jan 2006 Cally Martin, BScPT, MScRehab Regional

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The Ontario Stroke StrategySoutheastern
Ontario (SEO) Jan 2006Cally Martin, BScPT,
MSc(Rehab)Regional Stroke Coordinator,
SEOTamara Lucas RN, BNSc, Quinte District
Stroke Coordinator
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Ontario Stroke Strategy

• Stroke leading cause of death and disability
  with high health care and human costs (1994
  study direct and indirect cost of stroke care in
  Ontario approached 964 million a year)
• Report of MOH and HSFO Towards an Integrated
  Stroke Strategy for Ontario
• May 2000 MOHLTC announced budget for a Provincial
  Integrated Stroke Strategy

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Based on demonstration phase spear-headed by the
HSFO3 components

• public awareness
• professional education
• systems change

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Ontario Stroke Strategy - Funding

• KGH designated a Regional Stroke Centre with a
  Stroke Prevention Clinic in 2001 (after 3 year
  demonstration phase)
• Community Stroke Prevention Clinics designated in
  Perth, Brockville, Belleville in 2003
• QHC designated a District Stroke Centre in 2004
• Funding from MOHLTC Hospitals Branch to hospitals
• Funding from MOHLTC Health Promotion Branch to
  promote health - this includes funding to HSFO
  for BP action plan and public awareness campaign.
  

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System Change, Professional Education, Public
Awareness

• Regional Stroke Centres
• District Stroke Centres
• Prevention Clinics
• Links with Rehab, Community, LTC
• Links with Health Promotion, Primary Care
• Access to Best Practice Build Stroke Expertise /
  Education

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The Ontario Stroke Strategy

Best Practice across the Continuum of Care
Patient and Family Primary Care Physician

Emergency
Acute
Prehospital
Transition
Prevention
Rehab
Community
Stroke recognition

• Stroke Strategy Principles
• Comprehensive
• Integrated
• Evidence-based
• Province-wide

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Vision

• To ensure that all Ontarians have access to the
  best possible quality stroke care, from
  prevention, through treatment and rehabilitation,
  to community re-integration.

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Principles

• Comprehensive entire continuum of care
• Integrated linkages built to optimize existing
  resources
• Evidence-based builds on practices supported by
  scientific evidence or best practice standards
• Province-wide access available to all Ontarians
  irrespective of geography.

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The Ontario Stroke Strategy

Initiatives Across the Continuum of Care

Patient and Family Primary Care Physician
Health Promotion
Acute Care
Rehabilitation
Heart Health Coalition
HSFO Blood Pressure
Regional Acute Stroke Protocol
HSFO Recognize and React

Prevention after TIA
Rehabilitation Systems and Care Plans
Stroke Survivors
HSFO Living with Stroke Stroke Support Groups
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Southeastern Ontario
H
12,500 miles2 20,000 km2
NORTHUMBERLAND
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Regional Stroke Steering Committee

• Full representation
• across region
• across continuum of care
• Subcommittees

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Regional Stroke Team

• Medical Director
• Regional Stroke Program Manager
• District Stroke Coordinator (Quinte)
• Regional and Community Prevention Clinic Staff
  (Kingston, Belleville, Brockville, Perth)
• Regional Advanced Practice Nurse and Case Manger
• Regional Education Coordinator
• Administrative support
• Enhanced KGH Acute Stroke Unit Team
• Community and Long-term Care Stroke Specialist
• Regional Tele-stroke Pilot Project Leader
• Regional Rehabilitation Coordinator

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Stroke Prevention
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Health Promotion Stroke Prevention

• Health Promotion
• Risk Factor Management in Primary care (e.g.
  Blood pressure control)
• Stroke Prevention Clinics
• Regional Stroke Centre, KGH
• community hospital prevention clinics

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Emergency and Acute Stroke Care
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Regional Acute Stroke Protocol Southeastern
Ontario

• For those with Signs and Symptoms of Stroke A
  Coordinated system response
• Bypass Protocol Implemented July 1999
• Access to thrombolytics within a 3-hour time
  window

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Time from LSN/Stroke Onset to ER Canadian Stroke
Registry - July 1 2003 to June 30 2004

• SEO time from Last seen normal to ER arrival
• 2.9 hrs (N 401)
• All sites 5.5 hrs (N 4872)

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Transport - Percentages of ER patients Canadian
Stroke Registry - July 1 2003 to June 30 2004
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tPA - Percentages of ER patients Canadian Stroke
Registry - July 1 2003 to June 30 2004
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ER Door to CT Door to Needle times (mins)
Canadian Stroke Registry - July 1 2003 to June 30
2004
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Inpatient Acute Stroke Care

• Regional Patient Flow
• Inter-disciplinary teams
• Organised stroke units
• Evidence-Based Stroke Care Pathways
• Regional Acute Stroke CNS/NP

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Stroke Rehabilitation
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Stroke Rehabilitation Consensus Panel Report
(Ontario)

• Clinicians experienced in stroke should carry out
  the initial assessment
• There should be access to specialized,
  interdisciplinary stroke rehabilitation
• Stroke survivors should have access to different
  levels of rehabilitation intensity
• Caregivers should have stroke rehabilitation
  support

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Stroke Rehabilitation Consensus Panel Report

• Long-term rehabilitation services should be
  widely available in nursing facilities, complex
  continuing care facilities, and in outpatient and
  community programs
• Strategies should be developed to prevent the
  recurrence of stroke
• Outcome data are required for stroke
  rehabilitation

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Stroke Rehabilitation Pilots

• 6 Ontario Stroke Rehab Pilot projects approved by
  MOHLTC May 2002
• SEO pilot
• transition from rehab unit to own home
• Stroke Care Diary

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Provincial proposal to MOH Rehabilitation
Assessment

• Provincial assessment framework
• Common triage tool
• Outreach Education and access to consultative
  expertise (telestroke)
• Optimal regional referral process and access to
  service
• Data collection and information system
• Awaiting news re funding for a Regional
  rehabilitation position

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Continuing Care
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Long Term Community IssuesSage Report 2001

• Need for appropriate resources and incentives,
  competing priorities, increasing complexity of
  LTC environment
• Need for better information at transition points
• Important role for expert rehabilitation
• advisors
• Importance of community programs and supportive
  networks

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Initiatives in Community/Long Term Care

• Tips and Tools for Everyday Living A resource
  for Stroke Caregivers
• LTC Resource teams work with outreach LTC
  Specialists
• Community Care Stroke Service Guidelines
• Educational opportunities
• Communication Tool for Acute to LTC Transition
  Information Plan
• Building LTC stroke network via Linkage
  Luncheons

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Sept 2004 MOHLTC Funding for LTC Stroke
Specialists

• Communication links with LTC and Community
  agencies
• Transition management
• communication tools
• protocols
• Enhance education and outreach efforts
• Network with stakeholders

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Professional education
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Stroke Strategy of SEO Website
www.strokestrategyseo.ca
HSFO Prof Ed Website

• www.heartandstroke.ca/profed