The Ontario Stroke Strategy Southeastern Ontario (SEO) Jan 2006 Cally Martin, BScPT, MSc(Rehab) Regional Stroke Coordinator, SEO Tamara Lucas RN, BNSc, Quinte District Stroke Coordinator

Ontario Stroke Strategy Stroke = leading cause of death and disability with high health care and human costs (1994 study: direct and indirect cost of stroke care in Ontario approached $964 million a year) Report of MOH and HSFO: “Towards an Integrated Stroke Strategy for Ontario” May 2000 MOHLTC announced budget for a Provincial Integrated Stroke Strategy

Based on demonstration phase spear-headed by the HSFO 3 components: public awareness professional education systems change

Ontario Stroke Strategy - Funding KGH designated a Regional Stroke Centre with a Stroke Prevention Clinic in 2001 (after 3 year demonstration phase) Community Stroke Prevention Clinics designated in Perth, Brockville, Belleville in 2003 QHC designated a District Stroke Centre in 2004 Funding from MOHLTC Hospitals Branch to hospitals Funding from MOHLTC Health Promotion Branch to promote health - this includes funding to HSFO for BP action plan and public awareness campaign.

System Change, Professional Education, Public Awareness Regional Stroke Centres District Stroke Centres Prevention Clinics Links with Rehab, Community, LTC Links with Health Promotion, Primary Care Access to Best Practice; Build Stroke Expertise / Education

Patient and Family Primary Care Physician Best Practice across the Continuum of Care The Ontario Stroke Strategy Stroke Strategy Principles: Comprehensive Integrated Evidence-based Province-wide Stroke recognition Prevention Prehospital Emergency Acute Rehab Community Transition

Vision To ensure that all Ontarians have access to the best possible quality stroke care, from prevention, through treatment and rehabilitation, to community re-integration.

Comprehensive: entire continuum of care Integrated: linkages built to optimize existing resources Evidence-based: builds on practices supported by scientific evidence or best practice standards Province-wide: access available to all Ontarians irrespective of geography. Principles

Prevention after TIA Rehabilitation Systems and Care Plans Patient and Family Primary Care Physician Regional Acute Stroke Protocol Primary Care Prevention Emergency Medical System Emergency/ Diagnostics Community Re-integration Acute Care Rehabilitation Heart Health Coalition Stroke Survivors Initiatives Across the Continuum of Care Health Promotion HSFO “Recognize and React” HSFO “Living with Stroke” Stroke Support Groups The Ontario Stroke Strategy HSFO Blood Pressure

NORTHUMBERLAND Southeastern Ontario 12,500 miles 2 20,000 km 2 H H H H H H HH H H H

Regional Stroke Steering Committee Full representation: across region across continuum of care Subcommittees

Regional Stroke Team Medical Director Regional Stroke Program Manager District Stroke Coordinator (Quinte) Regional and Community Prevention Clinic Staff (Kingston, Belleville, Brockville, Perth) Regional Advanced Practice Nurse and Case Manger Regional Education Coordinator Administrative support Enhanced KGH Acute Stroke Unit Team Community and Long-term Care Stroke Specialist Regional Tele-stroke Pilot Project Leader Regional Rehabilitation Coordinator

Stroke Prevention

Health Promotion & Stroke Prevention Health Promotion Risk Factor Management in Primary care (e.g. Blood pressure control) Stroke Prevention Clinics –Regional Stroke Centre, KGH –community hospital prevention clinics

Emergency and Acute Stroke Care

Regional Acute Stroke Protocol Southeastern Ontario For those with Signs and Symptoms of Stroke: A Coordinated system response Bypass Protocol Implemented July 1999 Access to thrombolytics within a 3-hour time window

Time from LSN/Stroke Onset to ER Canadian Stroke Registry - July to June SEO time from Last seen normal to ER arrival: 2.9 hrs (N = 401) All sites: 5.5 hrs (N = 4872)

Transport - Percentages of ER patients Canadian Stroke Registry - July to June

tPA - Percentages of ER patients Canadian Stroke Registry - July to June

ER Door to CT & Door to Needle times (mins) Canadian Stroke Registry - July to June

Inpatient Acute Stroke Care Regional Patient Flow Inter-disciplinary teams Organised stroke units Evidence-Based Stroke Care Pathways Regional Acute Stroke CNS/NP

Stroke Rehabilitation

Stroke Rehabilitation Consensus Panel Report (Ontario) Clinicians experienced in stroke should carry out the initial assessment There should be access to specialized, interdisciplinary stroke rehabilitation Stroke survivors should have access to different levels of rehabilitation intensity Caregivers should have stroke rehabilitation support

Stroke Rehabilitation Consensus Panel Report Long-term rehabilitation services should be widely available in nursing facilities, complex continuing care facilities, and in outpatient and community programs Strategies should be developed to prevent the recurrence of stroke Outcome data are required for stroke rehabilitation

6 Ontario Stroke Rehab Pilot projects approved by MOHLTC May 2002 SEO pilot: –transition from rehab unit to own home –Stroke Care Diary Stroke Rehabilitation Pilots

Provincial proposal to MOH: Rehabilitation Assessment Provincial assessment framework Common triage tool Outreach Education and access to consultative expertise (telestroke) Optimal regional referral process and access to service Data collection and information system Awaiting news re funding for a Regional rehabilitation position

Continuing Care

Long Term & Community Issues Sage Report 2001 Need for appropriate resources and incentives, competing priorities, increasing complexity of LTC environment Need for better information at transition points Important role for expert rehabilitation advisors Importance of community programs and supportive networks

Initiatives in Community/Long Term Care Tips and Tools for Everyday Living: A resource for Stroke Caregivers LTC Resource teams work with outreach LTC Specialists Community Care Stroke Service Guidelines Educational opportunities Communication Tool for Acute to LTC: “Transition Information Plan” Building LTC stroke network via “Linkage Luncheons”

Sept 2004: MOHLTC Funding for LTC Stroke Specialists Communication links with LTC and Community agencies Transition management –communication tools –protocols Enhance education and outreach efforts Network with stakeholders

Professional education

Stroke Strategy of SEO Website HSFO Prof Ed Website