Improving access and efficiency of ischemic stroke treatment across four Canadian provinces using a stepped wedge trial: Methodology
Introduction Ischemic stroke is treatable with thrombolysis and/or endovascular treatment. Both treatments are highly time dependent, as faster treatment results in better outcomes. Utilization of both of these treatments is less than optimal, and treatment times continue to exceed the recommended b...
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crfrontiers:10.3389/fstro.2022.1014480 2024-10-13T14:09:10+00:00 Improving access and efficiency of ischemic stroke treatment across four Canadian provinces using a stepped wedge trial: Methodology Kamal, Noreen Aljendi, Shadi Carter, Alix Cora, Elena A. Chandler, Tania Clift, Fraser Fok, Patrick T. Goldstein, Judah Gubitz, Gordon Hill, Michael D. Menon, Bijoy K. Metcalfe, Brian Mrklas, Kelly J. Phillips, Stephen Theriault, Scott Van Der Linde, Etienne Volders, David Williams, Heather Canadian Institutes of Health Research 2022 http://dx.doi.org/10.3389/fstro.2022.1014480 https://www.frontiersin.org/articles/10.3389/fstro.2022.1014480/full unknown Frontiers Media SA https://creativecommons.org/licenses/by/4.0/ Frontiers in Stroke volume 1 ISSN 2813-3056 journal-article 2022 crfrontiers https://doi.org/10.3389/fstro.2022.1014480 2024-09-24T04:03:47Z Introduction Ischemic stroke is treatable with thrombolysis and/or endovascular treatment. Both treatments are highly time dependent, as faster treatment results in better outcomes. Utilization of both of these treatments is less than optimal, and treatment times continue to exceed the recommended benchmarks. An improvement intervention was launched across Atlantic Canada, which has four provinces: Nova Scotia (NS), New Brunswick (NB), Prince Edward Island (PEI), and Newfoundland and Labrador (NL). The intervention was conducted through the ACTEAST (Atlantic Canada Together Enhancing Acute Stroke Treatment) Project, which aimed to improve access and efficiency of treatment for acute ischemic stroke patients. Intervention and methods The improvement intervention was a 6-month virtual Improvement Collaborative that consisted of each stroke center assembling an interdisciplinary team, 2 full-day Learning Sessions, five to six 1-h webinars, and a site visit for each team. The Improvement Collaborative intervention was implemented using a stepped-wedge trial design, where the intervention was delivered in 3 phases. The Improvement Collaborative was initially conducted with NS, followed by NB and PEI, and the final phase was with NL. The number of participants enrolled across all 34 hospitals were 98, 86, and 72 for NS, NB-PEI, and NL, respectively. The attendance at the Learning Sessions ranged from 43 to 81 across all 3 clusters. The attendance at webinars had a mean of 29.0 (SD 6.8), 26.0 (SD 6.3), and 19.0 (SD 8.5) for the NS, NB-PEI, and NL clusters respectively. (Anticipated) Results We anticipate that an additional 3–5% of ischemic stroke patients will receive thrombolysis, EVT, or both. Additionally, we anticipate a reduction of 10–15 min in door-to-needle times across the region. This will translate to an increase in the proportion of ischemic stroke patients that will be discharged home from acute care. Discussion High level of engagement is possible in an Improvement Collaborative Intervention when ... Article in Journal/Newspaper Newfoundland Prince Edward Island Frontiers (Publisher) Canada Newfoundland Frontiers in Stroke 1 |
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Frontiers (Publisher) |
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crfrontiers |
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unknown |
description |
Introduction Ischemic stroke is treatable with thrombolysis and/or endovascular treatment. Both treatments are highly time dependent, as faster treatment results in better outcomes. Utilization of both of these treatments is less than optimal, and treatment times continue to exceed the recommended benchmarks. An improvement intervention was launched across Atlantic Canada, which has four provinces: Nova Scotia (NS), New Brunswick (NB), Prince Edward Island (PEI), and Newfoundland and Labrador (NL). The intervention was conducted through the ACTEAST (Atlantic Canada Together Enhancing Acute Stroke Treatment) Project, which aimed to improve access and efficiency of treatment for acute ischemic stroke patients. Intervention and methods The improvement intervention was a 6-month virtual Improvement Collaborative that consisted of each stroke center assembling an interdisciplinary team, 2 full-day Learning Sessions, five to six 1-h webinars, and a site visit for each team. The Improvement Collaborative intervention was implemented using a stepped-wedge trial design, where the intervention was delivered in 3 phases. The Improvement Collaborative was initially conducted with NS, followed by NB and PEI, and the final phase was with NL. The number of participants enrolled across all 34 hospitals were 98, 86, and 72 for NS, NB-PEI, and NL, respectively. The attendance at the Learning Sessions ranged from 43 to 81 across all 3 clusters. The attendance at webinars had a mean of 29.0 (SD 6.8), 26.0 (SD 6.3), and 19.0 (SD 8.5) for the NS, NB-PEI, and NL clusters respectively. (Anticipated) Results We anticipate that an additional 3–5% of ischemic stroke patients will receive thrombolysis, EVT, or both. Additionally, we anticipate a reduction of 10–15 min in door-to-needle times across the region. This will translate to an increase in the proportion of ischemic stroke patients that will be discharged home from acute care. Discussion High level of engagement is possible in an Improvement Collaborative Intervention when ... |
author2 |
Canadian Institutes of Health Research |
format |
Article in Journal/Newspaper |
author |
Kamal, Noreen Aljendi, Shadi Carter, Alix Cora, Elena A. Chandler, Tania Clift, Fraser Fok, Patrick T. Goldstein, Judah Gubitz, Gordon Hill, Michael D. Menon, Bijoy K. Metcalfe, Brian Mrklas, Kelly J. Phillips, Stephen Theriault, Scott Van Der Linde, Etienne Volders, David Williams, Heather |
spellingShingle |
Kamal, Noreen Aljendi, Shadi Carter, Alix Cora, Elena A. Chandler, Tania Clift, Fraser Fok, Patrick T. Goldstein, Judah Gubitz, Gordon Hill, Michael D. Menon, Bijoy K. Metcalfe, Brian Mrklas, Kelly J. Phillips, Stephen Theriault, Scott Van Der Linde, Etienne Volders, David Williams, Heather Improving access and efficiency of ischemic stroke treatment across four Canadian provinces using a stepped wedge trial: Methodology |
author_facet |
Kamal, Noreen Aljendi, Shadi Carter, Alix Cora, Elena A. Chandler, Tania Clift, Fraser Fok, Patrick T. Goldstein, Judah Gubitz, Gordon Hill, Michael D. Menon, Bijoy K. Metcalfe, Brian Mrklas, Kelly J. Phillips, Stephen Theriault, Scott Van Der Linde, Etienne Volders, David Williams, Heather |
author_sort |
Kamal, Noreen |
title |
Improving access and efficiency of ischemic stroke treatment across four Canadian provinces using a stepped wedge trial: Methodology |
title_short |
Improving access and efficiency of ischemic stroke treatment across four Canadian provinces using a stepped wedge trial: Methodology |
title_full |
Improving access and efficiency of ischemic stroke treatment across four Canadian provinces using a stepped wedge trial: Methodology |
title_fullStr |
Improving access and efficiency of ischemic stroke treatment across four Canadian provinces using a stepped wedge trial: Methodology |
title_full_unstemmed |
Improving access and efficiency of ischemic stroke treatment across four Canadian provinces using a stepped wedge trial: Methodology |
title_sort |
improving access and efficiency of ischemic stroke treatment across four canadian provinces using a stepped wedge trial: methodology |
publisher |
Frontiers Media SA |
publishDate |
2022 |
url |
http://dx.doi.org/10.3389/fstro.2022.1014480 https://www.frontiersin.org/articles/10.3389/fstro.2022.1014480/full |
geographic |
Canada Newfoundland |
geographic_facet |
Canada Newfoundland |
genre |
Newfoundland Prince Edward Island |
genre_facet |
Newfoundland Prince Edward Island |
op_source |
Frontiers in Stroke volume 1 ISSN 2813-3056 |
op_rights |
https://creativecommons.org/licenses/by/4.0/ |
op_doi |
https://doi.org/10.3389/fstro.2022.1014480 |
container_title |
Frontiers in Stroke |
container_volume |
1 |
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1812816018612944896 |