Health Services Research: A randomised controlled trial to evaluate a model of comprehensive stroke care

Primary Research Stream

Health Services & Systems

Full Project Title

Health Services Research: A randomised controlled trial to evaluate a model of comprehensive stroke care.

Project Period

1 Jan 2008 – 31 Dec 2010

Rationale / Background

There is compelling evidence from a systematic review for the provision of organised hospital care for stroke patients, specifically, admission to a stroke unit has been shown to reduce death and dependency by 30%. Currently, there are two major structures of stroke care services in NSW, namely comprehensive stroke care (CSC) provided in combined or co-located acute and rehabilitation stroke units; and dislocated stroke care (DSC) provided in geographically separated acute stroke units and rehabilitation services. Of the 22 NSW greater metropolitan stroke units all but two (those located at Bankstown and Blacktown Hospitals) operate under the DSC model. Although the components contributing to effective stroke unit care have previously been identified, the optimum stroke unit model to deliver this care remains unknown. A key question of international significance is – “What is the ideal design model for future stroke unit development or for enhancement of existing stroke units?

Aim and Objectives

Primary aim: To compare the total hospital LOS and change in FIM score (at admission compared to discharge) for stroke patients who received CSC with those who received DSC.
Secondary aim: To compare functional independence, mortality, complication rates and institutionalisation rates of stroke patients who receive CSC and those who received DSC.

Method and Study Design

This will be a prospective randomised controlled trial of two alternative pathways of care for stroke patients. Eligible patients will be randomised if a bed is available in rehabilitation unit after they are admitted to the acute stroke unit at the participating hospitals to either usual care (i.e., acute and rehabilitation phases occurring in separate units with separate multidisciplinary teams) or comprehensive stroke care (acute and rehabilitation phases occurring in single unit with single multidisciplinary team). It is a 36 month project consists of three major phases. Phase I: All hospitals providing stroke unit care will be invited to participate. Once selected, a combined acute and rehabilitation service will be established in addition to existing usual stroke care (e.g., dislocated acute and rehabilitation stroke unit of care). Phase II: Acute stroke patients admitted to these participating hospitals will be randomised to either models of care in the emergency department. Baseline data collected including patient characteristics, stroke type and severity, clinical outcomes, discharge information and length of stay. Phase III: Each patient will be followed up 90 days post-stroke for clinical outcome. Evaluation of the efficiency of CSC and DSC will be performed by comparing the patient clinical outcomes and hospital length of stay, after adjusting for any confounding factors.

Key Findings (to Date)

Publications and Resources