Background

Integrating health care services across regions to improve patient outcomes and experience is a complex process. The literature is clear that receiving stroke care on a designated stroke unit produces improved patient outcomes. St. Joseph’s Healthcare Hamilton (SJHH) and Hamilton Health Sciences (HHS), along with the Central South Regional Stroke Network undertook the challenge of developing an integrated model of stroke care for the city of Hamilton in Ontario, Canada. This integration required the transfer of stroke patient volumes and the reallocation of resources from SJHH to HHS. 


The ultimate result of this integration work was improve access to best practice stroke unit care for every person with stroke throughout Hamilton.

Objective

To describe the integration process and results of the integration to inform similar integration efforts. 


Methods

Integration Process Structure:

•Steering Committee: oversee integration of stroke services


•Volumes and Definition Subcommittee: define patient population 


•Finance Planning Subcommittee: determine transfer of funds 


•People Planning Subcommittee: assess impact to Human Resources 


•Communication Planning Subcommittee: develop and disseminate messages for internal and external stakeholders


•Processes Subcommittee: develop patient flow pathway


•Operations Subcommittee: develop and implement pre-launch education, finalize equipment transfers and establish model evaluation structure 


Evaluation Process:

•Monthly Case Reviews


•Quarterly Data Reviews


•6-month and 1-year fulsome model evaluations


Results

The Integrated model of Stroke Care in Hamilton was launched on January 8, 2018. Early analysis of the model demonstrates appropriate utilization of patient pathways and increased access to stroke unit care. Fulsome data will be available later in 2018.

The Process and Results of Integrating Stroke Services in a Large Urban Setting