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The Ontario Stroke Strategy
Southeastern Ontario (SEO) Jan 2006
Cally Martin, BScPT, MSc(Rehab)Regional Stroke Coordinator, SEO
Tamara Lucas RN, BNSc, Quinte District Stroke Coordinator
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
Based on demonstration phase spear-headed by the HSFO
3 components:
• public awareness
• professional education
• systems change
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.
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
Patient and FamilyPatient and FamilyPrimary Care PhysicianPrimary Care Physician
Best Practice across the Continuum of Care
The Ontario Stroke Strategy
Stroke Strategy Principles:•Comprehensive•Integrated•Evidence-based•Province-wide
Stroke recognition
Prevention
Prehospital
Emergency Acute
Rehab
Community
Transition
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.
• 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.
Principles
Prevention after TIA Rehabilitation Systems and Care Plans
Patient and FamilyPatient and FamilyPrimary Care PhysicianPrimary Care Physician
Regional Acute Stroke Protocol
Primary Care
Prevention
EmergencyMedicalSystem
Emergency/Diagnostics
CommunityRe-integration
AcuteCare
Rehabilitation
Heart Health Coalition
Stroke Survivors
Initiatives Across the Continuum of Care
HealthPromotion
HSFO “Recognize and React”
HSFO “Living with Stroke”Stroke Support Groups
The Ontario Stroke Strategy
HSFO Blood Pressure
NORTHUMBERLAND
Southeastern Ontario
12,500 miles2
20,000 km2
H
H
HH
H
HHH
H
H
H
Regional Stroke Steering Committee
Full representation:
• across region
• across continuum of care
Subcommittees
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
Stroke Prevention
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
Emergency and Acute Stroke Care
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
Inpatient Acute Stroke Care
• Regional Patient Flow
• Inter-disciplinary teams
• Organised stroke units
• Evidence-Based Stroke Care Pathways
• Regional Acute Stroke CNS/NP
Stroke Rehabilitation
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
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
• 6 Ontario Stroke Rehab Pilot projects approved by MOHLTC May 2002
• SEO pilot: – transition from rehab unit to own home– Stroke Care Diary
Stroke Rehabilitation Pilots
Continuing Care
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
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”
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
Professional education
Stroke Strategy of SEO Website
www.heartandstroke.ca/profedHSFO Prof Ed Website
www.strokestrategyseo.ca