ABSTRACT
Background & Aims: Young stroke survivors (YSS) report unmet needs related to age and life stage that stroke services often overlook. Researchers, advisers with lived experience, and clinicians collaborated to develop the "Young Stroke Unmet Needs Screening Tool". Method(s): Mixed-method codesign project conducted in three phases: 1. Literature review conducted and workshop held with 12 advisers (8 YSS, 4 clinicians) to develop initial tool content. 2. Online survey conducted to examine YSS preferences for methods of meeting needs, and gain feedback on tool's usability and content. 3. A version was then developed for people with communication or cognitive impairment using Principles of Supported Conversation for Adults with Aphasia, and cognitive strategies. Semi-structured interviews and focus groups held to further develop and test both versions. Result(s): 171 online survey responses (68% female, mean age 45 years, IQR 36-51). Respondents' demographic and stroke-related characteristics influenced preferences for methods of meeting needs, including face-to-face contact with professionals, peer support and succinct tip sheets. Interviews and focus groups were held online due to COVID, with 20 YSS (age 24-53yrs, 60% reported cognitive impairments and 80% had mild to moderate-severe language limitation), and 10 family members. Recruitment of people with more severe language limitations required personal invitation rather than advertising via social media or stroke groups. The tools include six domains (Body and Mind, Emotions, Information, Daily Life, Relationships, Social) covering 53 potential needs. Also included is a distress thermometer. Use of the tool was strongly endorsed for both versions. Conclusion(s): These new unmet needs screening tools could be used to identify service needs for young stroke survivors, including those with cognitive and/or communication difficulties. The tools are now being used in a large study to identify care pathway requirements, to inform the development of a bespoke health service for young stroke survivors.
ABSTRACT
Background and aims: National clinical quality registries facilitate reliable monitoring of stroke care by providing local hospital teams with data on their performance compared to national benchmarks. We aimed to assess changes in stroke care over time from public hospitals participating in the Australian Stroke Clinical Registry (AuSCR). Methods: AuSCR stroke quality care indicators were compared between 2017 and 2020, using a matched-hospital design. Analyses were limited to adults with stroke or transient ischaemic attack admitted to hospitals contributing ≥30 episodes each year during the study period. Descriptive statistics and linear tests for trend were used to assess changes in quality indicators across years. Results: Among 47 eligible hospitals, admissions increased from 13,508 (2017) to 18,139 (2020). Overall, half were aged ≥75 years, 45% were female, and 59% had a severe stroke (no differences by year). Between 2017 and 2020, improvements were observed for: endovascular retrieval (+8%;P<0.001), hyperacute antithrombotics (+6%;P<0.001), mobilisation during admission (+3%;P<0.001), swallow screen/assessment within 4 hours (+12%;P<0.001), discharge care planning (+11%;P<0.001), and discharge secondary prevention medications (+10%;P<0.001). However, delivery of thrombolysis remained unchanged (-1%;P=0.07), door-toneedle within 60 minutes decreased (-6%;P=0.008), and access to stroke unit care declined in 2020 (76% 2019 vs 72% 2020;P<0.001). Conclusion: Improvements in many indicators of quality stroke care have been observed within Australian hospitals participating in a national registry. Declines in timeliness to thrombolysis and access to stroke units in 2020 represent a likely consequence of the COVID-19 pandemic that requires national action.