Stroke care delivery in institutions participating in the Registry of the Canadian Stroke Network.
OBJECTIVE
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.
Kapral
Moira K
MK
Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada. moira.kapral@uhn.on.ca.
Laupacis
Andreas
A
Phillips
Stephen J
SJ
Silver
Frank L
FL
Hill
Michael D
MD
Fang
Jiming
J
Richards
Janice
J
Tu
Jack V
JV
D000368:Aged; D002170:Canada; D003695:Delivery of Health Care; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011787:Quality of Health Care; D012042:Registries; D020521:Stroke / Q000628:therapy*