Since 2011, annual Stroke Report Cards and Progress Reports have been a key resource for Ontario’s 11
regional stroke networks. The information they provide drives system change and allows for consistent planning across the province. This report marks the ninth edition of the provincial and LHIN report cards, capturing data from the 2017/18 fiscal year.
Many of the indicators have slightly improved, most notably in the acute management of stroke, such as timely administration of tissue plasminogen activator (tPA) and increased access to stroke unit care. Median door to needle time for patients who received tPA decreased by 2 minutes to 45 minutes equating to approximately 4 million neurons saved per patient,1 and the proportion of stroke patients receiving stroke unit care in Ontario increased by over seven percent to 52.8%.
Despite improvements, Ontario’s stroke report card identified wide variation across the province in delivering best practices on many indicators, which means that people receive different quality of care depending on where they live or receive that care. For example, there was a wide range across LHINs (16% - 81%) of the proportion of stroke/TIA patients who received care on a stroke unit. Additionally, there was a wide range across LHINs (22 – 93 minutes) in the amount of required rehabilitation therapy patients received after a stroke. Many patients failed to receive the required rehabilitation therapy (intensity), receiving 67 minutes per day of direct therapy, well under the 180 minutes per day of direct therapy that is recommended in the Canadian Stroke Best Practices and adopted by Health Quality Ontario and the Ministry of Health and Long-Term Care, Quality Based Procedures Clinical Handbook for Stroke.
The annual report cards and progress reports act as a foundation for knowledge exchange and quality improvement at a system and organizational level. CorHealth Ontario will continue to collaborate with Ontario’s 11 Regional Stroke Networks to align operating plans, knowledge translation approaches and implementation strategies to continue to advance best practice stroke care across the province.
1Boulanger, J., Lindsay, M., Gubitz, G., Smith, E., Stotts, G., Foley, N., … Butcher, K. (2018). Canadian Stroke Best Practice Recommendations for Acute Stroke Management: Prehospital, Emergency Department, and Acute Inpatient Stroke Care, 6th Edition, Update 2018. International Journal of Stroke, 13(9), 949–984. https://doi.org/10.1177/1747493018786616