June 2016

With June being stroke month, it makes sense to focus on some of the work we are doing around stroke and it just so happens that a timely release by the Ontario Stroke Network (OSN) gives me the perfect opportunity.

On June 1st, the OSN published its annual Stroke Report Cards, a detailed report which evaluates the delivery of care and compares the level of access and treatment of people who experience a stroke across each of the 14 LHINs.

Overall the report was very positive and showed significant progress made in stroke treatment and prevention in Ontario. Provincially, the report noted improvements in 14 of 16 indicators, while at the same time, the benchmarks they were scored against became more stringent. The highlight, however, was the news that Ontario's stroke mortality rate in 2015 was the lowest ever reported, making our province the leading jurisdiction in the world in this metric.

While this is no doubt fantastic news and the result of much hard work, collaboration and sharing of best practices among regional stroke networks, health care providers and coordinating bodies like the LHINs, there is a real understanding that we can and need to do better. In spite of the improvement observed in most areas, as a province we are still falling short of established targets on all indicators.

Here in the HNHB LHIN, of the 16 measures, we saw significant improvement on 8 indicators and improvement on a further 3 indicators. Among the areas of particular note were two measures where our LHIN was singled out for exemplary performance. Specifically, our LHIN was the top performer for delivering clot-busting treatment (tPA) in the shortest period of time, with Niagara Health System’s Greater Niagara General site being recognized as the best in the entire province in this regard, and our LHIN was among the best in the province as it relates to the proportion of people receiving tPA. Hamilton Health Sciences' Regional Rehabilitation Centre was also recognized for achieving the greatest improvement in the number of days between stroke onset and admission to inpatient rehabilitation.

Looking at our performance over the past year, there is much to celebrate, especially when one considers that the results on our Stroke Report Card are not just numbers - they represent tangible improvements to the care of those who have had a stroke. We are talking about lives saved, recoveries enabled, outcomes improved and strokes prevented.

Much like the province as a whole, however, within our LHIN there are areas where we could be doing a better job. We are still seeing a high level of alternate level of care (ALC) days as proportion of total days spent in hospital, not enough patients are reaching rehabilitation targets within established timelines, and access to rehabilitation for people with severe strokes is not at the level we would like it to be.

To address these areas of opportunity, we continue to work closely with the Central South Regional Stroke Network (CSRSN) to promote best practices.

A perfect example is the integrated model of stroke care now in place at Brant Community Healthcare System (BCHS). The model, which was developed by BCHS and Norfolk General Hospital in collaboration with CSRSN and the LHIN, pairs an Integrated Stroke Unit with community stroke rehabilitation to deliver better care and outcomes for stroke patients. After receiving evidence-based stroke unit care, patients seamlessly transition from acute and rehabilitative care to the community once they are ready to leave the hospital. Prior to discharge, each patient is assigned to a community stroke coordinator, who reviews their recovery goals and arranges the specialized care they need. This includes 8-12 weeks of individualized treatment through an outpatient therapy program or, for those who live more than 30 minutes away from a rehab centre, referral for in-home community stroke rehabilitation. Following rehabilitation patients are connected with other community services, such as aphasia supportive groups, exercise and mobility classes and adult day programs.

The model has proved so successful that we are working with CSRSN on further integrating stroke care and the expansion of community stroke rehabilitation models into more communities across the LHIN.

Click Here to view or learn more about the Ontario Stroke Network Report Cards.

Click Here to visit the Central South Regional Stroke Network website.

Click Here to learn more about how we are improving stroke care in the HNHB LHIN.

If you or your organization would like to be featured in a future blog or share a patient story in one of our Voices in the Community videos you can reach us through our office, or if you’re on social media via our Twitter handle -@HNHB_LHINgage. Your feedback and questions are always welcome.

P.S. On Thursday, June 2 the bill containing the Patients First Act, 2016 was introduced in the Legislature. If passed, Bill 210 would support access to high quality, integrated care for patients in Ontario, no matter where they live. The introduction of legislation is the next step following the December 2015 release of Patients First: A Proposal to Strengthen Patient-Centred Health Care in Ontario and feedback from thousands of Ontarians informed the development of the Patients First Act.
For a summary of what was heard from Ontarians, what is being proposed, and what will be done you can review Patients First: Reporting Back on the Proposal to Strengthen Patient-Centred Health Care in Ontario.