We are a team of researchers based in the University of Oxford, at the Centre for Health Service Economics and Organisation (CHSEO). We are planning to seek funding for a study of post-acute stroke care in England. We understand that early supported discharge, rehabilitation and other forms of care and support after acute care for a stroke is very important for the quality of life of stroke survivors and their families. Yet there is a lack of evidence on post-acute stroke care relative to evidence on acute stroke care.
The Health Foundation is currently inviting research proposals on the use of national clinical audit and patient registries to improve the quality of UK health care. One of three themes on which they are seeking proposals is reducing variation: ‘using national clinical audit and registries to explore variations in metrics of clinical quality to support policies for improvement’.
We plan to investigate:
1. How capacity, workload, waiting times and other characteristics of providers of post-acute stroke care vary by region, deprivation and other characteristics of the areas they serve;
2. How outcomes for providers of post-acute care vary by their characteristics such as the nature of the care they offer, their capacity, their staffing, and their training for stroke survivors and their families;
3. Whether the outcomes for providers of post-acute care are correlated with deprivation and other characteristics of the areas and patients they serve;
4. What factors are correlated with outcomes of post-acute stroke care by commissioner (Clinical Commissioning Group) such as their expenditure on stroke care, access to different forms of post-acute care, and deprivation of the area they serve;
5. The barriers to improving outcomes of post-acute care and changes in policy and practice which could facilitate improved outcomes;
6. What further data on outcomes of post-acute care do providers collect or could they collect for a future audit and/or future research study.
The Sentinel Stroke National Audit Programme (SSNAP) conducted in 2014-15, in addition to its ongoing clinical audit, an organisational audit of post-acute care. This collected data from commissioners (CCGs) on the post-acute stroke care they commission and from providers on the nature, capacity, staffing and other aspects of the services they provide. The clinical audit collects data on the level of disability (modified Rankin score) of individual patients at discharge/transfer from acute care and at 6 months. We plan to treat the change in modified Rankin score between discharge/transfer and 6 months as an indicator of outcomes.
Our study will involve statistical analyses of these SSNAP audit data together with other data, especially Office for National Statistics (ONS) data on local populations. It will also involve Interviews with a sample of around ten providers of post-acute care.
We would be most interested to hear your views on our planned research proposal. We would especially welcome comments on specific issues and questions relating to post-acute stroke care on which you consider it would be particularly helpful for the NHS to have better evidence to inform decisions in the interests of improving patient care and patient experience. We would be happy to receive comments by email, to Raphael.Wittenberg@phc.ox.ac.uk. If you would prefer to give comments on the phone please request this. Responses by 21 July would be especially helpful but responses after that date would also be valuable.