How do patients pass through stroke services? Identifying stroke care pathways using national audit data.

Area of Science:

• Neurology
• Health Services Research
• Public Health

Background:

• Understanding patient flow through stroke services is crucial for optimizing care.
• Existing models may not fully capture the complexity of stroke patient journeys.

Purpose of the Study:

• To map and describe patient pathways through hospital and community stroke services.
• To categorize patient routes and analyze associated characteristics, therapy, outcomes, and costs.

Main Methods:

• Analysis of a national stroke register including 94,905 inpatients admitted between July 2013 and July 2015.
• Identification and categorization of patient routes through iterative consultations with clinical experts.

Main Results:

• Identified 874 distinct patient routes, consolidated into three overlapping pathways: direct discharge (44%), community rehabilitation (47%), and inpatient transfer (19%).
• Pathway allocation varied by stroke severity and therapy needs.
• Direct discharge had lowest costs and highest mortality; community rehabilitation showed best outcomes; inpatient transfers incurred highest costs.

Conclusions:

• Three overarching stroke care pathways were identified, differing in patient profiles, therapy requirements, and outcomes.
• This pathway mapping serves as a benchmark for developing and planning clinical stroke services and future research.