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Bridging the quality gap: stroke

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Stroke is a disease that has a marked impact on the length and quality of many people’s lives. In England each year there are more than 110,000 strokes – one quarter of these affect people under the age of 65. About 300,000 people are living in England with moderate to severe stroke disabilities, making stroke the leading cause of severe adult disability. The financial costs of stroke – directly to the healthcare system and indirectly to society as a whole – are significant. Total costs to the National Health Service (NHS) and the economy have been estimated to be £7 billion a year, comprising: • £2.8 billion in direct costs to the NHS • £2.4 billion in informal care costs (for example, the costs of home nursing borne by patients’ families) • £1.8 billion in income lost to productivity and disability (Saka et al, 2005). International comparisons show that quality of stroke care in England could be improved significantly: England lags behind comparator countries for rates of mortality, and there is unevenness in the availability of skilled facilities and in the provision of treatments that have been shown to improve outcomes. This chartbook focuses on quality of stroke care. Quality is broadly defined, encompassing the key domains of effectiveness, access, safety, structural capacity, patient responsiveness and equity. The chartbook comprises three main sections. Section 1 presents epidemiological data and summarises recent policy documents on stroke. The contents of this section may represent familiar territory to many readers, but it is included to provide the context against which quality can be judged. Section 2 presents data on quality of care in stroke and illustrates the gap between actual and achievable performance. It draws on data from disparate sources and highlights deficiencies in stroke services and variation in care across the country. It also provides international benchmarks to help define what level of performance is attainable in stroke services. Section 3 summarises available evidence about how to bridge the quality gap in stroke care. Drawing on systematic reviews of the literature, it illustrates the current state of knowledge about ‘what works’ to improve organisational performance and presents emergent research data on the costs involved in bridging the quality gap.

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