Published Online
on May 13, 2004

A more recent version of this article appeared on July 1, 2004

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Submitted on October 6, 2003
Revised on March 4, 2004
Accepted on March 22, 2004

Stroke Care Delivery in Institutions Participating in the Registry of the Canadian Stroke Network

Moira K. Kapral MD, MSc^*; Andreas Laupacis MD, MSc; Stephen J. Phillips MD; Frank L. Silver MD; Michael D. Hill MD, MSc; Jiming Fang PhD; Janice Richards RN; Jack V. Tu MD, PhD; for the Investigators of the Registry of the Canadian Stroke Network

From the Institute for Clinical Evaluative Sciences (M.K.K., A.L., J.F., J.R., J.V.T.), Toronto, Ontario, Canada; Division of General Internal Medicine and Clinical Epidemiology and Women’s Health Program (M.K.K), University Health Network, Toronto, Ontario, Canada; Clinical Epidemiology and Health Care Research Program and Division of General Internal Medicine (A.L., J.V.T.), Sunnybrook and Women’s College Health Sciences Centre, Toronto, Ontario, Canada; Division of Neurology (F.L.S.), University Health Network, Toronto, Ontario, Canada; Department of Medicine (M.K.K., A.L., F.L.S., J.V.T.), University of Toronto, Toronto, Ontario, Canada; Department of Public Health Sciences (M.K.K., A.L., J.V.T.), University of Toronto, Toronto, Ontario, Canada; Division of Neurology (S.J.P.), Dalhousie University and Queen Elizabeth II Health Sciences Centre, Halifax, Nova Scotia, Canada; Department of Clinical Neurosciences and Department of Medicine and Department of Community Health Sciences (M.D.H.), University of Calgary, Calgary, Alberta, Canada.

^* To whom correspondence should be addressed. E-mail: moira.kapral{at}uhn.on.ca.

Background and Purpose--Guidelines and performance indicators have been established for acute stroke care. However, little is known about the process of stroke care delivery in Canada.

Methods--The Registry of the Canadian Stroke Network (RCSN) captured detailed clinical data on patients with stroke and transient ischemic attack seen at 21 acute care institutions across Canada. Data from phase 1 of the RCSN (June 2001 to February 2002) were used to determine the use of evidence-based acute stroke care interventions in participating institutions.

Results--Overall, 4439 patients were seen during the study time frame and 1701 (38%) consented to full data collection. Thirty-one percent received care on a stroke unit or from a mobile stroke team. Among patients with ischemic stroke, 7% received thrombolysis, 80% underwent carotid imaging, 89% received antithrombotic agents, and 54% of those with atrial fibrillation received warfarin. There were significant intersite variations in the delivery of all of these interventions except for the use of antithrombotic agents, and these persisted after adjustment for age, sex, stroke type, and other comorbid conditions.

Conclusions--Patients in institutions participating in the RCSN received high-quality stroke care based on a number of performance measures. However, gaps exist in the provision of other elements of stroke care, particularly organized inpatient stroke care and warfarin for atrial fibrillation. Future research should explore explanations for these findings and focus on solutions to deficiencies in care.

Key words: stroke • quality of health care

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