Stefan Pagliuso, Regional Stroke Program Director, Central South Regional Stroke Network
Health System News recently spoke to members of the Central South Regional Stroke Network team. Stefan Pagliuso, Regional Stroke Program Director, and Rhonda Whiteman, Regional Stroke Best Practice, Clinical Nurse Specialist, provided insights into how they leverage the Integrated Decision Support (IDS) data and analytics network to support their work. Located at Hamilton Health Sciences, the Central South Regional Stroke Network works with organizations that provide stroke care across the Central South Region. Its focus is on facilitating stroke best practice implementation across the continuum of care.
IDS is Ontario's most mature and widely used collaborative solution for integrating health services utilization data across health providers, empowering its growing subscriber community with insight-rich, time-saving tools and reports designed by and for Ontario's health care analysts and decision-makers. IDS equips providers and regional health teams with a longitudinal line of sight into patients' care journeys, to enable planning, population health management, program evaluation, quality improvement, and operational benchmarking.
Can you tell us more about what brought you to IDS?
S. Pagliuso: I first heard about IDS in 2013. There was some talk about this wonderful data source where we could actually evaluate patients' journeys outside a hospital's four walls, and that was something really novel to us. So, we were excited to learn more about it. Today, we partner with IDS on many important projects, as well as utilize their dashboards for best practice implementation and quality improvement strategies.
Most recently, we've partnered with IDS to update the Stroke Distinction Dashboards that were developed by the Southwestern Ontario Regional Stroke Network. We worked with our partners in the Southwest and Southeast Ontario Regional Stroke Networks on this automated dashboard that could be utilized to pull the Accreditation Canada Stroke Distinction™ Key Quality Indicators in preparation for the Onsite visit. We were able to incorporate experience from other regions to create a resource that could be utilized provincially by organizations that are undergoing the Accreditation Canada Stroke Distinction™ Program.
Another example is the Regional Stroke Dashboard which is based on the provincial stroke report. We've worked with IDS on the technical specifications using these key indicators and metrics that are now available on the dashboards. This allows all the regions participating in IDS to use the dashboards to view timely and up-to-date progress and performance, which are needed for ongoing quality improvement.
R. Whiteman: IDS has also been used provincially by Ontario Health - CorHealth Branch, the Ontario government's principal advisor on cardiac, stroke and vascular services which drives improvement in access, quality, efficiency, and equity in care. CorHealth utilized IDS as a platform for the Stroke Endovascular Therapy Dashboard to share endovascular metrics by organization and health region to help benchmark, identify opportunities for quality improvement, and track progress.
What was it like before having access to IDS?
S. Pagliuso: Previously, one of our challenges was the time lag in getting relevant data for us to move forward on quality improvement initiatives and make sure we were facilitating those best practice implementation elements. Timeliness of the data is incredibly important with respect to ensuring that the quality improvement we're doing is relevant. Now, we're able to track it much sooner since the data is from the previous quarter. This allows us to really track progress and ensure that the quality improvement strategies we're putting in place are required and effective.
R. Whiteman: Yes, I would agree with Stef that timely data is essential to drive quality improvement. For some of the provincial stroke data, there is a significant time lag which requires you to do a lot of analysis or interpretation to create local reports. IDS gives us a snapshot of some of those key elements – it helps to supplement our work and look at the data in different ways.
Do you have examples of how access to these insights has supported recent projects?
S. Pagliuso: Two came to mind. One was our strategic planning process.
As the Central South Regional Stroke Network, we are responsible for developing a strategic plan to advance best practices within the region. IDS was a very, very helpful tool in establishing current performance metrics in all key areas of stroke care that we could evaluate, determine the need for quality improvement, establish baseline performance, and then track our progress as we “live through" the strategic plan that's currently in place.
We've also done some work very recently with IDS looking at stroke prevalence using population health data. IDS has been tremendous in providing a very detailed and individualized report for our region, looking at stroke prevalence across the Central South region, and the impact of population health. IDS was also able to pull data that compares elements of the Ontario Marginalization Index and stroke prevalence in Central South.
These are just some examples of our work with IDS and finding avenues to improve stroke care across our region.
Can you share specific instances about how your team used those insights to improve care?
S. Pagliuso: A big focus has been the continuum of care. We've looked at key metrics to improve performance across our region. For example, with acute stroke unit access, we've been able to track data across our region consistently over time. Through IDS, we established our benchmark, where we sat when we started our strategic plan, and a reasonable target to achieve. We continue to look at stroke unit access every quarter with all the organizations in our region to ensure we're continuing to drive forward.
R. Whiteman: We utilized the EVT Stroke Dashboard when we were looking to improve access to endovascular therapy. One initiative we undertook was our public awareness campaign which we run twice a year – in June for Stroke Month and October for World Stroke Day. As we saw that some of our patient sub-region areas had a lower proportion of patients who were treated with endovascular therapy (EVT), we focused on building awareness about the warning signs of stroke, the importance of calling 911, not to drive themselves, and that stroke is a medical emergency that can be treated.
How does this data also create efficiencies for your region, in addition to improving patient care and health outcomes?
R. Whiteman: We know that ischemic stroke is treatable and access to thrombolysis and endovascular therapy improves outcomes for our patients. By reviewing our performance in a timely manner through IDS, we can identify quality improvement initiatives to increase access to thrombolysis and endovascular therapy and improve efficiencies, decrease disability after stroke for our patients, and make our system more efficient.
We know access to stroke unit care improves outcomes for our patients. The evidence shows that patients who receive care in stroke units are more likely to be alive, independent, and home in one year. So, by really focusing on improving access to that best practice care, we're improving the quality of care, which improves system efficiency.
S. Pagliuso: If we can recognize gaps, address them, and increase access to best practice stroke care, we know we're doing a great service for our patients. And that's what we want to drive towards.
What advice would you share with other regions that may also benefit from using shared data to collaborate and drive best practices in specific areas of care?
S. Pagliuso: With our partnership with IDS, three things that came to mind.
As I said before, one is the importance of the timeliness of the data when it comes to best practice implementation. Two is the IDS team's real willingness to collaborate. There's a massive benefit to that. I met earlier today with IDS and talked about some of our data strategies and ways we can continue to improve or look for new opportunities for data strategies to further drive best practice implementation. And the third thing is the opportunity for the automated pull of data which is really important because we have limited resources. When we can go to a trusted source that has an automated pull, with access to great data that is already available – this is so beneficial. It makes things very efficient.
R. Whiteman: For me, it's that cross-continuum linkage of patients. So really, you're not looking at acute [care], you're not looking at rehabilitation – you're looking at that cross-continuum, from the emergency department, to acute care, to rehabilitation – to drive system improvement. IDS is also continuing to expand the data available as it is starting to include data from paramedic services, Ontario Health atHome long-term care, and more.
How are you hoping to use IDS in the future?
R. Whiteman: Being able to link and create reports across the continuum that we have not been able to do before. Some of the paramedic services in our region are starting to contribute to IDS. This can allow us to link pre-hospital care, to the emergency department, to acute care to provide feedback about the patients paramedics bring to hospital. For example – did they receive thrombolysis, what were their outcomes, etc.? Right now, we're unable to provide this feedback as it would be a manual process which is very challenging to do with high volumes of patients. We would also be able to identify stroke patients who are discharged from hospital and receive services from Ontario Health atHome or go to long-term care. It's challenging to identify stroke patients in these databases as they don't identify stroke patients in the same way hospitals may.
S. Pagliuso: For me, it's continuing to work with IDS to refine what we have in place, that it remains up-to-date, consistent with technical specifications and data strategies across the regions. This is to ensure the data remains relevant and as accurate as possible, so it continues to be a great source to help us achieve our mandate.