Abstract W P262: Using Scarce Stroke Care Resources for the Greatest Impact: Examining Ontario’S Stroke Report Card 2011/12

Background: In 2011 the Ontario Stroke Evaluation and Quality Committee created Ontario’s Stroke Report Card, consisting of twenty indicators with potential to influence system performance and flow of stroke patients across the care continuum. Anecdotal evidence demonstrates clinical connections between indicators. Objective: To determine statistical relationships among indicators to inform system planning and improvement. Methods: Using the FY 2011/12 regional stroke report cards, we performed Pearson correlation analysis, reporting statistical significance at <0.05 for clinically relevant associations among indicators. Eight indicators used FY2010/11 Ontario Stroke Audit data and ten used FY2011/12 Canadian Institute for Health Information administrative databases and one used the Ontario Home Care Database, FY 2010/11. Results: Nine of nineteen indicators had statistically significant correlations with other indicators, specifically: 1) arrival to hospital within 3.5 hours of symptom onset is associated with fewer patients going directly to long-term care (LTC) (r=-0.53, p=0.05) in the subsequent year; 2) acute inpatient admissions are associated with an increased proportion of acute Alternative Level of Care (ALC) days (r=0.55, p=0.04); 3) proportion of acute ALC days are associated with an increase in proportion of rehab ALC days (r=0.55, p=0.04); 4) admission to inpatient rehab has an inverse relationship with proportion of severe stroke patients in inpatient rehab (r=-0.84, p=0.0002), and 5) with proportion of stroke patients going from acute to LTC (r=-0.68, p=0.008); and 6) higher Functional Independence Measure® efficiency is associated with shorter time to admission into rehab (r=-0.81, p=0.0004). Conclusion: Correlations between report card indicators identified opportunities to plan, allocate resources, and improve stroke system care. By focusing efforts on key areas, there is a potential for broader impact on multiple indicators. Although strong correlations were observed between indicator performance, future research will examine change in performance to assess whether the associations remain over time.