How achievement of a stroke care pathway is associated with functional outcome after stroke: a national, register-based study

 

This is the whole problem in stroke enumerated in one word; 'care'; NOT RECOVERY!

If your hospital is touting 'care' it means they are a failure because they are delivering 'care'; NOT RECOVERY! I would never go to a failed hospital!

YOU have to get involved and change this failure mindset of 'care' to 100% RECOVERY! Survivors want RECOVERY, NOT 'CARE'!

I see nothing here that states going for 100% recovery! You need to create EXACT PROTOCOLS FOR THAT!

ASK SURVIVORS WHAT THEY WANT, THEY'LL NEVER RESPOND 'CARE'! This tyranny of low expectations has to be completely rooted out of any stroke conversation! I wouldn't go there because of such incompetency as not having 100% recovery protocols!

RECOVERY IS THE ONLY GOAL IN STROKE! 

GET THERE!'

How achievement of a stroke care pathway is associated with functional outcome after stroke: a national, register-based study

• Elin Bergh, 
• Torunn Askim, 
• Ole Morten Rønning, 
• Stian Lydersen, 
• Hild Fjaertoft & 
• Bente Thommessen 

BMC Health Services Research volume 25, Article number: 874 (2025) Cite this article

Abstract

Background

Care pathways are introduced to ensure adherence to treatment guidelines for several patient groups. In the present study, we aimed to evaluate whether the achievement of key objectives within the recently implemented Norwegian stroke care pathway (SCP) was associated with functional outcome 3 months after stroke and to identify the characteristics of patients who achieved the recommended goals.(The only goal in stroke is 100% recovery!  I'd have any medical 'professional' fired for suggesting less than that!)

Methods

We conducted a register-based study with data from the Norwegian Stroke Registry (NSR). Patients who were registered with acute stroke in 2019, one year after the SCP was introduced, were included. The functional outcome at 3 months was compared between ‘achievement’ and ‘non-achievement’ patients. The modified Rankin scale (mRS) was used to measure functional outcome at 3 months post-stroke, functional independence was defined as an mRS score of 0–2.

Results

Among 2730 patients without missing data on achievement criteria, 272 (10%) were in the achievement group. The probability of being independent(That is the wrong goal right there; your tyranny of low expectations being forced on your patients!) at 3 months post-stroke was significantly greater in the achievement group than in the non-achievement group (odds ratio (OR) 1.35, 95% CI 1.01 to 1.79, p = 0.043). However, subsequent sensitivity analyses did not replicate these findings, showing an average proportion of achievers of 7.2% (average odds ratios 1.12, 95% CI 0.88 to 1.45, p > 0.05). “Achievers” had better pre-stroke function, less likelihood of living alone, more severe strokes upon admission, and in addition, higher thrombolysis rates compared to “non-achievers.”

Conclusion

We concluded that in the early phase after the SCP was implemented, between 7% and 10% reached goal achievement(If that goal achievement was not 100% recovery; THEN YOU'RE DOING IT ALL WRONG! You're fired!). The estimated association between achievement and independence 3 months post-stroke was significant in the primary analysis, but lost significance in sensitivity analyses.

Peer Review reports

Introduction

Stroke is the third leading cause of mortality and the fourth most common contributor to Disability-Adjusted Life Years (DALYs) worldwide [1]. Over the past few decades, revascularization therapies—intravenous thrombolysis and thrombectomy—have significantly improved acute stroke management [2, 3]. As these treatments are highly time-sensitive, international guidelines recommend fast recognition and treatment of acute stroke [4]. One method of adhering to these guidelines while also developing proper and high-quality treatment has been to implement standardized care pathways. These pathways are defined as structured, multidisciplinary plans that outline the optimal sequence and timing of interventions, assessments, and treatments for patients with acute stroke. Their design is based on the best available evidence and clinical guidelines, and their aim is to ensure consistent, high-quality care, improve patient outcomes, enhance efficiency, and reduce variability in treatment across different healthcare providers [5].

In Norway approximately 10,000 patients are hospitalized with acute stroke each year [6]. Despite the establishment of national guidelines for acute stroke treatment in 2010, disparities in care seemed to exist across different regions and hospitals, which is one of the main reasons why Norwegian health authorities introduced a national standardized pathway of stroke care in 2018 [7,8,9]. The pathway is divided into two phases in accordance with key national quality indicators. Phase one covers the pre - and -intrahospital pathway and its time-specific goals are shown in Table 1.

Research has demonstrated that even small reductions in delay to stroke treatment may significantly affect outcomes. One minute of delay to treatment is shown to provide 1.8 extra days of healthy life in those receiving thrombolysis and 4.2 days in those receiving endovascular therapy [10,11,12]. Even for patients who do not receive reperfusion therapy, early arrival at the hospital is associated with a favourable outcome [13, 14]. Treatment within a comprehensive stroke unit increases the likelihood of survival and enhances the probability of being independent and living at home one year after stroke. Additionally, early admission to a stroke unit may further enhance these outcomes [15, 16].

Table 1 The stroke care pathway

Full size table

In a previous study, we evaluated the impact of the introduction of the SCP on functional outcomes after stroke [15]. No change in global function or mortality 3 months post-stroke was found. However, more patients were treated in a stroke unit, and more patients were discharged directly from the acute hospital stay after the introduction of the SCP [17].

Achieving pathway goals is an important measure of pathway effectiveness. Accordingly, we identified four essential goals that apply to all the patients, each of which was defined before conducting the analyses.

The primary aim of the present study was to determine whether achieving these four stroke care pathway goals—designed to reduce diagnostic and treatment delays—was associated with functional outcome three months post-stroke. Secondarily, we wanted to identify the characteristics of patients who achieved these goals.

We hypothesized that patients who achieved all four goals would have significantly better functional outcome at 3 months post-stroke than non-achievers.

More at link.