title: Effect of a provincial system of stroke care delivery on stroke care and outcomes.
abstract: BACKGROUND
  Systems of stroke care delivery have been promoted as a means of improving the quality of stroke care, but little is known about their effectiveness. We assessed the effect of the Ontario Stroke System, a province-wide strategy of regionalized stroke care delivery, on stroke care and outcomes in Ontario, Canada.
  
  
  METHODS
  We used population-based provincial administrative databases to identify all emergency department visits and hospital admissions for acute stroke and transient ischemic attack from Jan. 1, 2001, to Dec. 31, 2010. Using piecewise regression analyses, we assessed the effect of the full implementation of the Ontario Stroke System in 2005 on the proportion of patients who received care at stroke centres, and on rates of discharge to long-term care facilities and 30-day mortality after stroke.
  
  
  RESULTS
  We included 243 287 visits by patients with acute stroke or transient ischemic attack. The full implementation of the Ontario Stroke System in 2005 was associated with an increase in rates of care at stroke centres (before implementation: 40.0%; after implementation: 46.5%), decreased rates of discharge to long-term care facilities (before implementation: 16.9%; after implementation: 14.8%) and decreased 30-day mortality for hemorrhagic (before implementation: 38.3%; after implementation: 34.4%) and ischemic stroke (before implementation: 16.3%; after implementation: 15.7%). The system's implementation was also associated with marked increases in the proportion of patients who received neuroimaging, thrombolytic therapy, care in a stroke unit and antithrombotic therapy.
  
  
  CONCLUSIONS
  The implementation of an organized system of stroke care delivery was associated with improved processes of care and outcomes after stroke.
authors.affiliation: Department of Medicine, University of Toronto, Toronto, Ontario. moira.kapral@uhn.on.ca
authors.forename: Moira K
authors.initials: MK
authors.lastname: Kapral
authors.forename: Jiming
authors.initials: J
authors.lastname: Fang
authors.forename: Frank L
authors.initials: FL
authors.lastname: Silver
authors.forename: Ruth
authors.initials: R
authors.lastname: Hall
authors.forename: Melissa
authors.initials: M
authors.lastname: Stamplecoski
authors.forename: Christina
authors.initials: C
authors.lastname: O'Callaghan
authors.forename: Jack V
authors.initials: JV
authors.lastname: Tu
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002170:Canada; D003695:Delivery of Health Care / Q000379:methods*; D004632:Emergency Medical Services / Q000379:methods*; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D002546:Ischemic Attack, Transient / Q000401:mortality / Q000628:therapy*; D008134:Long-Term Care / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009864:Ontario; D020521:Stroke / Q000401:mortality / Q000628:therapy*; D055815:Young Adult