Optimisation of the Management of Stroke and Transient Ischaemic Attack Part of the Birmingham and B

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Optimisation of the Management of Stroke and
Transient Ischaemic AttackPart of the Birmingham
and Black Country CLAHRC
Dr Richard McManus, GP and Clinical Senior
Lecturer University of Birmingham
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Whats a CLAHRC?

• CLAHRCs are NIHR Collaborations For Leadership In
  Applied Health Research And Care
• This funding scheme supports applied health
  research which aims to deliver findings that will
  have practical application for the benefit of
  patients, typically through improved health care
  or better health care delivery, within the
  relatively near future
• The BBC CLAHRC comprises 10m NIHR funding with
  matched NHS funding from the stakeholders
• There are eight themes of which Stroke and
  Transient Ischaemic Attack is one (approx 1m)

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Overall CLAHRC methods

• Step Change in Research Conduct and
  Implementation
• Evaluates big ticket items
• Simultaneous evaluation
• Extending reach beyond standard research projects
• Demonstrating value of CLAHRC model
• Sharing expertise Nationally six other CLAHRCs
  include stroke and/or TIA research and aim to
  collaborate

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The CLAHRC model
Newservice money
NIHR(research)funds
Prospectiveevaluation
Matchedfunds
Service development Laboratory
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CLAHRC Stroke and TIA Team

• Combination of stroke survivor and carer, NHS
  clinicians and University academics
• Dr Don Sims
• Dr David Sandler
• Dr Tom Walsh
• Prof Tom Quinn
• Mrs Irene Shannon
• Mr Norman Philips

• Dr Richard McManus
• Prof Jonathan Mant
• Dr Pelham Barton
• Dr Sue Jowett
• Dr Sheila Greenfield

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Partners

• PPI from Different Strokes Stroke Research
  Network
• South Birmingham PCT
• Heart of England NHS Foundation Trust
• University Hospitals Birmingham NHS Foundation
  Trust
• West Midlands Ambulance Service
• University of Birmingham

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Background TIA

• Symptoms signs of stroke that resolve within 24
  hours
• TIA epidemiology
• Annual incidence 0.6 / 1000 ie 1 per GP per year
• Community prevalence approximately 15 / GP
• Main importance is subsequent risk of stroke
• 8 within a week
• Diagnosis not straight forward and perhaps 50 of
  those referred to specialist TIA clinics are
  subsequently found to have alternative diagnosis
• Early Secondary Prevention protective (EXPRESS)

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Stroke background

• National Audit Office Report 2005 found
• lt1 of stroke sufferers received thrombolysis
• Poor coordination of emergency services
• Little knowledge of appropriate response to
  symptoms of stroke amongst public
• Stroke Strategy, NICE Acute TIA Stroke
  Guideline, Intercollegiate Stroke Guideline aim
  to improve situation but require implementation

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Aim

• To optimise the management of people with
  Transient Ischaemic Attack (TIA) and stroke in
  Birmingham through identification and breaking
  down of current barriers to timely and effective
  treatment.

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Research Plan

• Systematic data collection from emergency,
  primary secondary care providers in order to
  produce epidemiological and process of care
  report
• 20 general practices
• West Midlands Ambulance Service
• University Hospitals Birmingham NHS FT
• Heart of England NHS FT
• Comparison of current care to gold standard care
  and identification of barriers to such care

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Research Plan 2

• Population of mathematical models with local data
• Acute TIA care
• Acute Thrombolysis
• One to one interviews with patients, carers,
  clinicians and commissioners
• Feedback to local stakeholders (Clinicians,
  Commissioners, Patients and Carers) of
• Current position
• Possible policy options
• Potential effects of policy implementation

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Research Plan 3

• Cycles of data collection and feedback to provide
  iterative underpinning of the development of
  local stroke and TIA services
• Evaluation
• Cost-effectiveness of implementation (using
  models)
• Longitudinal qualitative analysis of patient and
  healthcare professional interviews
• In doing this to develop the local infrastructure
  to allow further research in stroke and TIA.

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Planned Impacts

• Improvement of Stroke and TIA outcomes in local
  area
• Guiding the implementation of the National Stroke
  Strategy Guidelines in Birmingham and beyond
• Provision of sophisticated information for local
  commissioners and other stakeholders
• Improved patient and carer representation and
  involvement
• Raise stroke research profile of Birmingham

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Optimisation of the Management of Stroke and
Transient Ischaemic Attack
Dr Richard McManus, GP and Clinical Senior
Lecturer