Article type
Year
Abstract
Introduction/Objective: To describe and assess the use of research based information in the planning and delivery of services for strokes, and how the implementation of programmes of clinical effectiveness has affected those services.
Methods: We developed from existing reviews and guidelines a "template" for the evidence-based care of people who have had strokes, and consulted a multidisciplinary panel of UK stroke experts on its comprehensiveness and validity. The template included all aspects of acute care, rehabilitation, secondary prevention, continuing and community care. We used this to assess the provision of services in field visits to health care providers in 7 districts throughout the UK, sampled to maximise geographical spread, the range of quality of stroke services and the level of perceived success in the implementation of clinical effectiveness programmes. We also used the template to construct postal questionnaires to hospital, community, and primary care personnel, as well as to patients' organisations in a total of 13 districts. The visits were supported with a large number of semi-structured telephone interviews with key personnel, face to face interviews, group interviews, document analysis (e.g. the assessment of local clinical guidelines using a validated instrument) and the analysis of routine demographic and healthcare activity data.
Results: At the time of writing, most of the field work has been completed. The project is on schedule within a tight timetable, which requires a final report before September 1997. Final results will therefore be available at the Conference. Preliminary findings suggest that the presence or absence of evidence based services - such as organised stroke teams - has much to do with the local politics and organisation of hospitals and community services, and that clinicians rely more on professional networks and training than on the rigorous use of research data when deciding on clinical policy. There is wide variation in the provision of services of proven effectiveness, and the purchasing authorities have in general had little impact in raising the levels of clinical effectiveness among providers. There is a dearth of evidence about many widely practised aspects stroke care. There is however increasing awareness of the need for evidence based clinical policies.
Discussion: Programmes to implement clinical effectiveness are unlikely to succeed unless they take much more note than they currently do of the motives and barriers in changing professional practice within complex organisations.
Methods: We developed from existing reviews and guidelines a "template" for the evidence-based care of people who have had strokes, and consulted a multidisciplinary panel of UK stroke experts on its comprehensiveness and validity. The template included all aspects of acute care, rehabilitation, secondary prevention, continuing and community care. We used this to assess the provision of services in field visits to health care providers in 7 districts throughout the UK, sampled to maximise geographical spread, the range of quality of stroke services and the level of perceived success in the implementation of clinical effectiveness programmes. We also used the template to construct postal questionnaires to hospital, community, and primary care personnel, as well as to patients' organisations in a total of 13 districts. The visits were supported with a large number of semi-structured telephone interviews with key personnel, face to face interviews, group interviews, document analysis (e.g. the assessment of local clinical guidelines using a validated instrument) and the analysis of routine demographic and healthcare activity data.
Results: At the time of writing, most of the field work has been completed. The project is on schedule within a tight timetable, which requires a final report before September 1997. Final results will therefore be available at the Conference. Preliminary findings suggest that the presence or absence of evidence based services - such as organised stroke teams - has much to do with the local politics and organisation of hospitals and community services, and that clinicians rely more on professional networks and training than on the rigorous use of research data when deciding on clinical policy. There is wide variation in the provision of services of proven effectiveness, and the purchasing authorities have in general had little impact in raising the levels of clinical effectiveness among providers. There is a dearth of evidence about many widely practised aspects stroke care. There is however increasing awareness of the need for evidence based clinical policies.
Discussion: Programmes to implement clinical effectiveness are unlikely to succeed unless they take much more note than they currently do of the motives and barriers in changing professional practice within complex organisations.