Across the globe, more than 12 million people suffer a stroke every year – that’s one every three seconds.
Six-and-a-half million die from a stroke annually worldwide. And over 100 million people are living with the aftermath of a stroke – a figure that has almost doubled over the last three decades.
According to figures compiled by the World Stroke Organisation, the total global cost every year of this serious life-threatening medical condition is $4.51bn.
Stroke patients have multifaceted needs, requiring complicated care delivered by multidisciplinary teams.
In the journal Stroke’s annual review of quality improvement advances in stroke care studies in the US, Indianapolis-based Regenstrief Institute research scientists update fellow researchers, clinicians and healthcare administrators on advances in the field, highlighting the challenges of scalability and sustainability.
Founded in 1969 the Regenstrief Institute is dedicated to a world where better information empowers people to end disease and realise true health.
Its research scientists are responsible for a growing number of major healthcare innovations and studies, ranging from the development of global health information technology standards to improving patient-doctor communications, and creating models of care that inform practice and improve the lives of those under medical supervision around the world.
Dr Dawn Bravata, a section editor of Stroke as well as a research scientist at the Regenstrief Institute, and a professor of neurology at the Indiana University School of Medicine, said: “Quality improvement exists to ensure that every patient with stroke or at risk of stroke is getting the care that they are eligible to receive. Quality improvement activities can happen at a clinic level or hospital level or nationwide level.
“Stroke is a complex disease and stroke patients often require care by a variety of clinicians – neurologists, internists, nurses, pharmacists, physical therapists, rehab specialists and others.
“All can make contributions to quality improvement. Innovations that are multidimensional and multicomponent are often the ones that were successful in improving quality of care.”
Studies published in 2022 cover the continuum of care, from prehospitalisation to acute care and rehabilitation settings.
As in prior years, the overwhelming majority of quality improvement for stroke care research focused on the hyperacute (immediate post-stroke) period.
Most studies continued to be from urban settings within developed nations with only one study of a rural population. Studies cover the spectrum from single hospital reports to regional and national care evaluations.
The review authors identify five gaps in stroke quality improvement research:
- Studies are needed to describe quality improvement initiatives from rural healthcare settings, small facilities and underrepresented countries;
- Segments of the continuum of care require attention, especially transitions of care, primary care and risk-factor management;
- Studies on quality improvement for haemorrhagic stroke and transient ischemic attack are needed, as most studies focused on acute ischemic stroke;
- Approaches to support scalability and sustainability of quality improvement initiatives should be evaluated; and
- De-implementation projects should be undertaken to reduce inappropriate care.
They also write that, from a policy evaluation perspective, comparison of stroke care quality across hospitals “before” versus “after” the public reporting of medical institutions performance data is critical to motivating quality improvement.
