title: Methods of Implementation of Evidence-Based Stroke Care in Europe: European Implementation Score Collaboration.
abstract: OBJECTIVE
  Differences in stroke care and outcomes reported in Europe may reflect different degrees of implementation of evidence-based interventions. We evaluated strategies for implementing research evidence into stroke care in 10 European countries.
  
  
  METHODS
  A questionnaire was developed and administered through face-to-face interviews with key informants. Implementation strategies were investigated considering 3 levels (macro, meso, and micro, eg, policy, organization, patients/professionals) identified by the framing analysis, and different settings (primary, hospital, and specialist) of stroke care. Similarities and differences among countries were evaluated using the categorical principal components analysis.
  
  
  RESULTS
  Implementation methods reported by ≥7 countries included nonmandatory policies, public financial incentives, continuing professional education, distribution of educational material, educational meetings and campaigns, guidelines, opinion leaders', and stroke patients associations' activities. Audits were present in 6 countries at national level; national and regional regulations in 4 countries. Private financial incentives, reminders, and educational outreach visits were reported only in 2 countries. At national level, the first principal component of categorical principal components analysis separated England, France, Scotland, and Sweden, all with positive object scores, from the other countries. Belgium and Lithuania obtained the lowest scores. At regional level, England, France, Germany, Italy, and Sweden had positive scores in the first principal component, whereas Belgium, Lithuania, Poland, and Scotland showed negative scores. Spain was in an intermediate position.
  
  
  CONCLUSIONS
  We developed a novel method to assess different domains of implementation in stroke care. Clear variations were observed among European countries. The new tool may be used elsewhere for future contributions.
authors.affiliation: From the Institute of Neuroscience, Italian National Research Council, Florence, Italy (A.D.C., D.I.); Department of Emergency, San Camillo-Forlanini Hospital, Rome, Italy (F.R.P.); Department of Management, School of Social Science and Public Policy (A.F., J.B.) and Division of Health and Social Care Research (C.M.K.), King's College, London, United Kingdom; Department of Neurofarba, Neuroscience Section, University of Florence, Italy (F.B., D.I.); Faculty of Health, Social Care and Education, St. George's University of London and Kingston University, London, United Kingdom (A.B.); Institute of Clinical Epidemiology and Biometry (P.H.) and Comprehensive Heart Failure Center (P.H.), University of Würzburg, Würzburg, Germany; Clinical Trial Center Würzburg, University Hospital Würzburg, Würzburg, Germany (P.H.); and National Institute for Health Research (NIHR) Biomedical Research Centre at Guy's and St. Thomas' NHS Foundation Trust and King's College, London, United Kingdom (C.D.A.W.). dicarlo@in.cnr.it.
authors.forename: Antonio
authors.initials: A
authors.lastname: Di Carlo
authors.affiliation: From the Institute of Neuroscience, Italian National Research Council, Florence, Italy (A.D.C., D.I.); Department of Emergency, San Camillo-Forlanini Hospital, Rome, Italy (F.R.P.); Department of Management, School of Social Science and Public Policy (A.F., J.B.) and Division of Health and Social Care Research (C.M.K.), King's College, London, United Kingdom; Department of Neurofarba, Neuroscience Section, University of Florence, Italy (F.B., D.I.); Faculty of Health, Social Care and Education, St. George's University of London and Kingston University, London, United Kingdom (A.B.); Institute of Clinical Epidemiology and Biometry (P.H.) and Comprehensive Heart Failure Center (P.H.), University of Würzburg, Würzburg, Germany; Clinical Trial Center Würzburg, University Hospital Würzburg, Würzburg, Germany (P.H.); and National Institute for Health Research (NIHR) Biomedical Research Centre at Guy's and St. Thomas' NHS Foundation Trust and King's College, London, United Kingdom (C.D.A.W.).
authors.forename: Francesca Romana
authors.initials: FR
authors.lastname: Pezzella
authors.affiliation: From the Institute of Neuroscience, Italian National Research Council, Florence, Italy (A.D.C., D.I.); Department of Emergency, San Camillo-Forlanini Hospital, Rome, Italy (F.R.P.); Department of Management, School of Social Science and Public Policy (A.F., J.B.) and Division of Health and Social Care Research (C.M.K.), King's College, London, United Kingdom; Department of Neurofarba, Neuroscience Section, University of Florence, Italy (F.B., D.I.); Faculty of Health, Social Care and Education, St. George's University of London and Kingston University, London, United Kingdom (A.B.); Institute of Clinical Epidemiology and Biometry (P.H.) and Comprehensive Heart Failure Center (P.H.), University of Würzburg, Würzburg, Germany; Clinical Trial Center Würzburg, University Hospital Würzburg, Würzburg, Germany (P.H.); and National Institute for Health Research (NIHR) Biomedical Research Centre at Guy's and St. Thomas' NHS Foundation Trust and King's College, London, United Kingdom (C.D.A.W.).
authors.forename: Alec
authors.initials: A
authors.lastname: Fraser
authors.affiliation: From the Institute of Neuroscience, Italian National Research Council, Florence, Italy (A.D.C., D.I.); Department of Emergency, San Camillo-Forlanini Hospital, Rome, Italy (F.R.P.); Department of Management, School of Social Science and Public Policy (A.F., J.B.) and Division of Health and Social Care Research (C.M.K.), King's College, London, United Kingdom; Department of Neurofarba, Neuroscience Section, University of Florence, Italy (F.B., D.I.); Faculty of Health, Social Care and Education, St. George's University of London and Kingston University, London, United Kingdom (A.B.); Institute of Clinical Epidemiology and Biometry (P.H.) and Comprehensive Heart Failure Center (P.H.), University of Würzburg, Würzburg, Germany; Clinical Trial Center Würzburg, University Hospital Würzburg, Würzburg, Germany (P.H.); and National Institute for Health Research (NIHR) Biomedical Research Centre at Guy's and St. Thomas' NHS Foundation Trust and King's College, London, United Kingdom (C.D.A.W.).
authors.forename: Francesca
authors.initials: F
authors.lastname: Bovis
authors.affiliation: From the Institute of Neuroscience, Italian National Research Council, Florence, Italy (A.D.C., D.I.); Department of Emergency, San Camillo-Forlanini Hospital, Rome, Italy (F.R.P.); Department of Management, School of Social Science and Public Policy (A.F., J.B.) and Division of Health and Social Care Research (C.M.K.), King's College, London, United Kingdom; Department of Neurofarba, Neuroscience Section, University of Florence, Italy (F.B., D.I.); Faculty of Health, Social Care and Education, St. George's University of London and Kingston University, London, United Kingdom (A.B.); Institute of Clinical Epidemiology and Biometry (P.H.) and Comprehensive Heart Failure Center (P.H.), University of Würzburg, Würzburg, Germany; Clinical Trial Center Würzburg, University Hospital Würzburg, Würzburg, Germany (P.H.); and National Institute for Health Research (NIHR) Biomedical Research Centre at Guy's and St. Thomas' NHS Foundation Trust and King's College, London, United Kingdom (C.D.A.W.).
authors.forename: Juan
authors.initials: J
authors.lastname: Baeza
authors.affiliation: From the Institute of Neuroscience, Italian National Research Council, Florence, Italy (A.D.C., D.I.); Department of Emergency, San Camillo-Forlanini Hospital, Rome, Italy (F.R.P.); Department of Management, School of Social Science and Public Policy (A.F., J.B.) and Division of Health and Social Care Research (C.M.K.), King's College, London, United Kingdom; Department of Neurofarba, Neuroscience Section, University of Florence, Italy (F.B., D.I.); Faculty of Health, Social Care and Education, St. George's University of London and Kingston University, London, United Kingdom (A.B.); Institute of Clinical Epidemiology and Biometry (P.H.) and Comprehensive Heart Failure Center (P.H.), University of Würzburg, Würzburg, Germany; Clinical Trial Center Würzburg, University Hospital Würzburg, Würzburg, Germany (P.H.); and National Institute for Health Research (NIHR) Biomedical Research Centre at Guy's and St. Thomas' NHS Foundation Trust and King's College, London, United Kingdom (C.D.A.W.).
authors.forename: Chris
authors.initials: C
authors.lastname: McKevitt
authors.affiliation: From the Institute of Neuroscience, Italian National Research Council, Florence, Italy (A.D.C., D.I.); Department of Emergency, San Camillo-Forlanini Hospital, Rome, Italy (F.R.P.); Department of Management, School of Social Science and Public Policy (A.F., J.B.) and Division of Health and Social Care Research (C.M.K.), King's College, London, United Kingdom; Department of Neurofarba, Neuroscience Section, University of Florence, Italy (F.B., D.I.); Faculty of Health, Social Care and Education, St. George's University of London and Kingston University, London, United Kingdom (A.B.); Institute of Clinical Epidemiology and Biometry (P.H.) and Comprehensive Heart Failure Center (P.H.), University of Würzburg, Würzburg, Germany; Clinical Trial Center Würzburg, University Hospital Würzburg, Würzburg, Germany (P.H.); and National Institute for Health Research (NIHR) Biomedical Research Centre at Guy's and St. Thomas' NHS Foundation Trust and King's College, London, United Kingdom (C.D.A.W.).
authors.forename: Annette
authors.initials: A
authors.lastname: Boaz
authors.affiliation: From the Institute of Neuroscience, Italian National Research Council, Florence, Italy (A.D.C., D.I.); Department of Emergency, San Camillo-Forlanini Hospital, Rome, Italy (F.R.P.); Department of Management, School of Social Science and Public Policy (A.F., J.B.) and Division of Health and Social Care Research (C.M.K.), King's College, London, United Kingdom; Department of Neurofarba, Neuroscience Section, University of Florence, Italy (F.B., D.I.); Faculty of Health, Social Care and Education, St. George's University of London and Kingston University, London, United Kingdom (A.B.); Institute of Clinical Epidemiology and Biometry (P.H.) and Comprehensive Heart Failure Center (P.H.), University of Würzburg, Würzburg, Germany; Clinical Trial Center Würzburg, University Hospital Würzburg, Würzburg, Germany (P.H.); and National Institute for Health Research (NIHR) Biomedical Research Centre at Guy's and St. Thomas' NHS Foundation Trust and King's College, London, United Kingdom (C.D.A.W.).
authors.forename: Peter
authors.initials: P
authors.lastname: Heuschmann
authors.affiliation: From the Institute of Neuroscience, Italian National Research Council, Florence, Italy (A.D.C., D.I.); Department of Emergency, San Camillo-Forlanini Hospital, Rome, Italy (F.R.P.); Department of Management, School of Social Science and Public Policy (A.F., J.B.) and Division of Health and Social Care Research (C.M.K.), King's College, London, United Kingdom; Department of Neurofarba, Neuroscience Section, University of Florence, Italy (F.B., D.I.); Faculty of Health, Social Care and Education, St. George's University of London and Kingston University, London, United Kingdom (A.B.); Institute of Clinical Epidemiology and Biometry (P.H.) and Comprehensive Heart Failure Center (P.H.), University of Würzburg, Würzburg, Germany; Clinical Trial Center Würzburg, University Hospital Würzburg, Würzburg, Germany (P.H.); and National Institute for Health Research (NIHR) Biomedical Research Centre at Guy's and St. Thomas' NHS Foundation Trust and King's College, London, United Kingdom (C.D.A.W.).
authors.forename: Charles D A
authors.initials: CD
authors.lastname: Wolfe
authors.affiliation: From the Institute of Neuroscience, Italian National Research Council, Florence, Italy (A.D.C., D.I.); Department of Emergency, San Camillo-Forlanini Hospital, Rome, Italy (F.R.P.); Department of Management, School of Social Science and Public Policy (A.F., J.B.) and Division of Health and Social Care Research (C.M.K.), King's College, London, United Kingdom; Department of Neurofarba, Neuroscience Section, University of Florence, Italy (F.B., D.I.); Faculty of Health, Social Care and Education, St. George's University of London and Kingston University, London, United Kingdom (A.B.); Institute of Clinical Epidemiology and Biometry (P.H.) and Comprehensive Heart Failure Center (P.H.), University of Würzburg, Würzburg, Germany; Clinical Trial Center Würzburg, University Hospital Würzburg, Würzburg, Germany (P.H.); and National Institute for Health Research (NIHR) Biomedical Research Centre at Guy's and St. Thomas' NHS Foundation Trust and King's College, London, United Kingdom (C.D.A.W.).
authors.forename: Domenico
authors.initials: D
authors.lastname: Inzitari
mesh_terms: D003299:Cooperative Behavior; D005060:Europe / Q000453:epidemiology; D055317:Evidence-Based Practice / Q000379:methods*; D006284:Health Plan Implementation / Q000379:methods*; D006801:Humans; D010865:Pilot Projects; D012720:Severity of Illness Index; D020521:Stroke / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy*; D011795:Surveys and Questionnaires
keywords: decision making; disease management; health services research; research science; stroke