title: From prevention to nursing home care: a comprehensive national audit of stroke care.
abstract: BACKGROUND
  Many countries are developing national audits of stroke care. However, these typically focus on stroke care from acute event to hospital discharge rather than the full spectrum from prevention to long-term care. We report on a comprehensive national audit of stroke care in the community and hospitals in the Republic of Ireland. The findings provide insights into the wider needs of people with stroke and their families, a basis for developing stroke-appropriate health strategies, and a global model for the evaluation of stroke services.
  
  
  METHODS
  Six national surveys were completed: general practitioners (prevention and primary care), hospital organisational and clinical audit of 2,570 consecutive stroke admissions (acute and hospital care), allied health professionals and public health nurses (discharge to community care), nursing homes (needs of patients discharged to long-term care), and patient and carers (post-hospital phase of rehabilitation and ongoing care).
  
  
  RESULTS
  The audit identified substantial deficits in a number of areas including primary prevention, emergency assessment/investigation and treatment in hospital, discharge planning, rehabilitation and ongoing secondary prevention, and communication with patients and families. There was a lack of coordination and communication between the acute and community services, with a dearth of therapy services in both home and nursing home settings.
  
  
  CONCLUSIONS
  This multi-faceted national stroke audit facilitated multiple perspectives on the continuum of stroke prevention and care. An overall synthesis of surveys supports the development of a multidisciplinary perspective in planning the development of comprehensive stroke services at the national level, and may assist in regional and global development of stroke strategies.
authors: School of Physiotherapy, Royal College of Surgeons in Ireland, Dublin, Ireland. fhorgan@rcsi.ie
authors: Frances
authors: F
authors: Horgan
authors: Hannah
authors: H
authors: McGee
authors: Anne
authors: A
authors: Hickey
authors: David L
authors: DL
authors: Whitford
authors: Sean
authors: S
authors: Murphy
authors: Maeve
authors: M
authors: Royston
authors: Seamus
authors: S
authors: Cowman
authors: Emer
authors: E
authors: Shelley
authors: Ronan M
authors: RM
authors: Conroy
authors: Miriam
authors: M
authors: Wiley
authors: Desmond
authors: D
authors: O'Neill
mesh_terms: D003266:Continuity of Patient Care / Q000592:standards*; D003625:Data Collection; D006760:Hospitalization; D006801:Humans; D007494:Ireland; D008485:Medical Audit; D009735:Nursing Homes; D010351:Patient Discharge / Q000592:standards; D011320:Primary Health Care / Q000592:standards; D055502:Secondary Prevention / Q000592:standards; D020521:Stroke / Q000517:prevention & control* / Q000628:therapy; D000071939:Stroke Rehabilitation; D016896:Treatment Outcome