Canadian Best Practice Recommendations for Stroke Care: 2006 Overview of CSS

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Canadian Best Practice Recommendations for Stroke
Care 2006Overview of CSS
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Todays Discussion

• Canadian Stroke Strategy Overview
• Canadian Stroke Strategy Best Practice
  Recommendations 2006

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Impact of Stroke in Canada
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Canadian Stroke Strategy

• Provides an opportunity to increase consistency
  and standardization across Canada both in
  stroke care delivery and in measurement of care
  delivered.

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The Canadian Stroke System Model

• Decrease burden of stroke
• Improve quality and efficiency of care
• Establish Canada as an international leader

Provincial/Territorial/Regional Implementation of
Best Practice
Prevention Prevention Clinics
Treatment Protocols, Stroke Teams
Rehabilitation Personal Care Plans
Reengagement Coordinated Support
National Platforms to Support Provincial/Territori
al/Regional Strategies
Public Awareness
Best Practice Guidelines and Standards of Care
Professional Development
Information/Evaluation
Coordinated Research
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Your Provincial Model
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Key Provincial Stroke Strategy Resources

• Provincial Coordinators
• Heart and Stroke Foundation Contacts
• Canadian Stroke Strategy Contacts
• Canadian Stroke Network

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National Platforms

• Information and Evaluation
• Focus on data, surveillance, monitoring and
  evaluation
• Development of evidenced based indicators with a
  focus on patient level processes and outcomes
• Evaluation of strategy overall
• Best Practices and Standards
• Development, dissemination and uptake of evidence
  based best practices and guidelines along the
  continuum of care
• Canadian Best Practice Recommendations publicly
  released in November 2006

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National Platforms

• Best Practices and Standards
• Knowledge Translation strategy underway
• Long term goal to synthesize more comprehensive
  list of Canadian best practices and standards
  with focus on effective dissemination and uptake
• Professional Development and Training
• To coordinate and enhance professional
  development and training across the continuum of
  care
• Priorities and recommendations developed

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National Platforms

• Coordinated Research
• Leadership from CSN, HSFC in partnership with
  CIHR, Canadian Stroke Consortium, and others
• To assess current status of stroke research,
  identify and address gaps that exist in the
  evidence base
• Public Awareness
• Leadership from Heart and Stroke Foundation
• Public Awareness to focus on effective ways of
  ensuring that the public knows what a stroke is,
  risk factors, signs and symptoms and the
  appropriate response

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Canadian Stroke Strategy Best Practices
Standards

• The goal of the CSS Best Practices and Standards
  working group was to review available literature
  and recommend best practices in stroke care
  appropriate to the Canadian context.

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Establishing Best Practices for Stroke Care in
CanadaAlignment leads to great things!!
Rehabilitation all disciplines
CIHI
Canadian Stroke Network
HSFC
CFPC
Public Health Agency of Canada
Stroke Survivors
Canadian Stroke System
MOHLTC-JPPC
EBRSR
Canadian Stroke Consortium
CHEP
SCORE
Health Promotion
Community Care
CANN
Primary Care
CSQCS
CAEP
Accreditation
Provincial Initiatives
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Best Practices and Standards Development Process

• Working Group established Fall 2005
• Extensive review of existing guidelines and
  listing of A level evidence
• Small groups reviewed existing recommendations
  developed final recommendations
• External consultation process
• Consensus meeting April 2006
• Final revisions and consultation process
  Spring/Summer 2006

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Experience Around the World
ASA/VADoD
Australian Stroke
CSQCS
SCORE
Guidelines
CHEP
CCORT
RCP
NZ Guidelines
SIGN
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Canadian Best Practice Recommendations 2006

• 24 recommendations
• Public Awareness (1)
• Patient and Caregiver Education (1)
• Stroke Prevention (7)
• Acute Stroke Management (8)
• Stroke Rehabilitation (6)
• Follow-up and Community Re-engagement (1)

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Cross Continuum Recommendations

• 1.0 Public Awareness
• 1.1 Public Awareness and Responsiveness
• 2.0 Patient and Family
• 2.1 Patient and Caregiver Education

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Prevention

• 3.0 Prevention of Stroke
• 3.1 Lifestyle Management
• 3.2 Blood Pressure Management
• 3.3 Lipid Management
• 3.4 Diabetes Management
• 3.5 Antiplatelet Therapy
• 3.6 Anticoagulation in Atrial Fibrillation
• 3.7 Carotid Intervention

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Acute Stroke

• 4.0 Acute Stroke Management
• 4.1 Acute Stroke Unit Care
• 4.2 Brain Imaging
• 4.3 Blood Glucose
• 4.4 Acute Thrombolytic Treatment
• 4.5 Carotid Artery Imaging
• 4.6 Dysphagia Assessment
• 4.7 Acute Aspirin Therapy
• 4.8 Management of Subarachnoid and
  Intracerebral Hemorrhage

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Rehabilitation

• 5.0 Stroke Rehabilitation
• 5.1 Initial Stroke Rehabilitation Assessment
• 5.2 Provision of Inpatient Rehabilitation
• 5.3 Components of Inpatient Stroke
  Rehabilitation
• 5.4 Identification and Management of Post Stroke
  Depression
• 5.5 Shoulder Pain Assessment and Treatment
• 5.6 Community Based Rehabilitation

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Community

• 6.0 Follow-Up and Community Reintegration
• 6.1 Follow-up and Evaluation in the Community

This section will be further developed in 2008
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Recommendation Format
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Best Practice Standards Dissemination

• National release of CSS Stroke Recommendations in
  September 2006
• Web site www.canadianstrokestrategy.ca
• Broad dissemination across provinces, at national
  and international meetings
• Individual consultation within provinces to
  address regional and local issues, challenges and
  strategies for dissemination and uptake
• Consultation with national and provincial
  professional associations and groups

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Generally Effective Strategies

• Educational outreach visits
• Reminders
• Interactive educational meetings
• Multifaceted interventions including two or more
  of
• Audit and feedback
• Reminders
• Local consensus processes
• Social marketing

(Ian Graham, 2006)
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