title: The characteristics of stroke units in Ontario: a pan-provincial survey.
abstract: Previous studies have demonstrated that organized, multidisciplinary care is the cornerstone of current strategies to reduce the death and disability caused by stroke. Identification of stroke units and an understanding of their composition and operation would provide insight for the further actions required to improve stroke care. The objective of this study was to identify and survey stroke units in Canada's largest province, Ontario (population of 13 million) in order to describe availability, structure, staffing, processes of care, and type of population stroke units serve.
  
  
  
  The Ontario Stroke Network (2011) list of stroke units and snowball sampling was used to identify all stroke units. During 2013 - 2014 an interviewer conducted telephone surveys with the stroke unit managers using closed and semi-open ended questions. Descriptive statistics were used to summarize survey responses.
  
  
  
  The survey identified 32 stroke units, and a respondent from every stroke unit (100% response rate) was interviewed. Twenty one were acute stroke units, 10 were integrated stroke units and one was classified as a rehabilitation stroke unit. Stroke units were available in all 14 Local Health Integration Networks except Central West. The estimated average number of stroke patients served per stroke unit was 604 with six-fold variation (242 to 1480) across the province. The typical population served in stroke units were patients with either ischemic or hemorrhagic stroke. Data consistently reported on the processes of stroke care, including the availability of multidisciplinary staff, specific diagnostic imaging, use of validated assessment tools, and the delivery of patient education. Details about the core components of stoke care were provided by 16 stroke units (50%).
  
  
  
  This study demonstrates the heterogeneous structure of stroke units in Ontario and signaled potential disparity in access to stroke units. Many core components are in place, but half of the stroke units in Ontario do not meet all criteria. Areas for potential improvement include stroke care training for the multidisciplinary team, provision of individualized rehabilitation plans, and early discharge assessment.
authors.affiliation: Toronto Health Economics and Technology Assessment (THETA) Collaborative, Toronto General Research Institute, Toronto General Hospital, University Health Network, University of Toronto, Toronto, ON, Canada. valeria.rac@theta.utoronto.ca.|Institute of Health Policy, Management and Evaluation (IHPME), University of Toronto, Toronto, ON, Canada. valeria.rac@theta.utoronto.ca.
authors.forename: Valeria E
authors.initials: VE
authors.lastname: Rac
authors.affiliation: Toronto Health Economics and Technology Assessment (THETA) Collaborative, Toronto General Research Institute, Toronto General Hospital, University Health Network, University of Toronto, Toronto, ON, Canada.
authors.forename: Yeva
authors.initials: Y
authors.lastname: Sahakyan
authors.affiliation: Toronto Health Economics and Technology Assessment (THETA) Collaborative, Toronto General Research Institute, Toronto General Hospital, University Health Network, University of Toronto, Toronto, ON, Canada.
authors.forename: Iris
authors.initials: I
authors.lastname: Fan
authors.affiliation: Cancer Care Ontario, Toronto, ON, Canada.
authors.forename: Luciano
authors.initials: L
authors.lastname: Ieraci
authors.affiliation: Institute of Health Policy, Management and Evaluation (IHPME), University of Toronto, Toronto, ON, Canada.|Institute for Clinical Evaluative Sciences (ICES), Toronto, ON, Canada.|Ontario Stroke Network, Toronto, ON, Canada.
authors.forename: Ruth
authors.initials: R
authors.lastname: Hall
authors.affiliation: Ontario Stroke Network, Toronto, ON, Canada.
authors.forename: Linda
authors.initials: L
authors.lastname: Kelloway
authors.affiliation: Toronto Health Economics and Technology Assessment (THETA) Collaborative, Toronto General Research Institute, Toronto General Hospital, University Health Network, University of Toronto, Toronto, ON, Canada.|Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada.
authors.forename: Gabrielle
authors.initials: G
authors.lastname: van der Velde
authors.affiliation: Institute of Health Policy, Management and Evaluation (IHPME), University of Toronto, Toronto, ON, Canada.|Institute for Clinical Evaluative Sciences (ICES), Toronto, ON, Canada.|Toronto General Hospital, University Health Network, University of Toronto, Toronto, ON, Canada.|Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
authors.forename: Moira K
authors.initials: MK
authors.lastname: Kapral
authors.affiliation: Institute of Health Policy, Management and Evaluation (IHPME), University of Toronto, Toronto, ON, Canada.|Institute for Clinical Evaluative Sciences (ICES), Toronto, ON, Canada.|Faculty of Medicine, University of Toronto, Toronto, ON, Canada.|Toronto Rehab Foundations, University Health Network, Toronto, ON, Canada.
authors.forename: Mark
authors.initials: M
authors.lastname: Bayley
authors.affiliation: Toronto Health Economics and Technology Assessment (THETA) Collaborative, Toronto General Research Institute, Toronto General Hospital, University Health Network, University of Toronto, Toronto, ON, Canada.|Institute of Health Policy, Management and Evaluation (IHPME), University of Toronto, Toronto, ON, Canada.|Institute for Clinical Evaluative Sciences (ICES), Toronto, ON, Canada.|Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada.|Toronto General Hospital, University Health Network, University of Toronto, Toronto, ON, Canada.|Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
authors.forename: Murray
authors.initials: M
authors.lastname: Krahn
mesh_terms: D003422:Critical Care / Q000458:organization & administration* / Q000592:standards; D019538:Health Care Surveys; D006297:Health Services Accessibility / Q000458:organization & administration* / Q000592:standards; D006301:Health Services Needs and Demand; D006757:Hospital Units / Q000458:organization & administration* / Q000592:standards; D006801:Humans; D009864:Ontario; D010561:Personnel Staffing and Scheduling; D026761:Physical Therapy Specialty / Q000458:organization & administration* / Q000592:standards; D020521:Stroke / Q000628:therapy*; D000071939:Stroke Rehabilitation / Q000592:standards; D000078329:Workforce
keywords: Core component; Environmental scan; Ontario; Stoke units