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Network legacy: Canadian Stroke Network

Funded 2000-14

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Canada ushers in new era for stroke care, prevention and rehabilitation

There’s no question the Canadian Stroke Network has been a catalyst for change. Since 1999, the network has been focused on what matters by investing time and resources on initiatives with the biggest potential gains. Over the years that has meant implementing the Canadian Stroke Strategy, overseeing the development of Canadian Best Practice Recommendations for Stroke Care, building the  Canadian Stroke Congress, conducting the first national audit of stroke care, funding important research, creating a strong national stroke community through conferences and training programs, and influencing policy decisions related to risk-factor management.

Dr. Antoine Hakim

Dr. Antoine Hakim

How does a country succeed—in just 15 years—from being an international laggard in stroke care to a global leader sharing best practices with the United Kingdom, Australia, Brazil, China and the United Nations? In September 1998, one of the world’s most noted neurologists, Dr. Antoine Hakim, didn’t pull any punches when describing the quality of stroke care in Canada.

“With few exceptions, the current Canadian health care system is poorly equipped to deal with stroke… The current state of disorganization that characterizes stroke care in Canada is a shaky, even dangerous, foundation from which to introduce new technologies,” he wrote in an editorial published in the Canadian Medical Association Journal.

About a year later, the federal government announced funding for the Canadian Stroke Network (CSN)—an ambitious national effort to mobilize scientists, healthcare professionals, industry, government and non-profit agencies to reduce the burden of stroke on people and health budgets.

Dr. Hakim is the CSN’s founding CEO and scientific director. In 2012, he was among six medical heroes named to the Canadian Medical Hall of Fame, for his “steely resolve” to change how stroke care is organized and delivered across Canada.

Today, on the eve of the CSN’s sunsetting as an NCE, those changes are saving lives, reducing disability and preventing many strokes from ever happening—a major accomplishment for a disease that had long been viewed as untreatable and impossible to prevent.

"More than 300,000 Canadians live with the effects of stroke, representing a direct cost of $2.8 billion a year to the national economy."

Mobilizing a national movement

Canada’s success isn’t a result of new scientific breakthroughs, or major new investments in healthcare. Much of what needed to be done was already known. What was lacking was a nimble, arms-length organization that could leverage the expertise and resources of formidable grassroots partners—like the Heart and Stroke Foundation of Canada (HSF)—to focus on activities that could produce the biggest gains.

“Research is extremely important, but it also needs to be translated into action. For stroke, that means closing the care gap between what we already know should be done and what is actually done in the health care system. Our mission was to do that within just 10 years,” explains Katie Lafferty, who joined the CSN as executive director in 2001.

The network’s greatest legacy will no doubt be its development and implementation of the Canadian Stroke Strategy—a joint initiative launched by the CSN and the HSF in 2006. It is transforming stroke services by supporting provincial efforts, including providing seed money to improve systems, policies, professional education and best practices at the local level.

That initiative—since adopted by almost every Canadian province—provides evidence-based guidelines for stroke prevention, care and rehabilitation, as well as tools to evaluate and monitor how well hospitals are doing. It also promotes public education and awareness. Within five years of implementing its strategy, Ontario saw stroke patient admissions decrease by 11% and referrals to stroke prevention clinics increase by 34%.

“This isn’t something a network with just a handful of staff in Ottawa could possibly do alone,” says Lafferty. “Yet through the provincial Heart and Stroke Foundations, we were able to mobilize some 300 people on the ground across Canada, including clinicians, volunteers and provincial health authorities, to work on various aspects of the strategy. It was a movement that everyone rallied behind.”

In Nova Scotia, an early adopter of the stroke strategy, rural stroke patients now receive better treatment and are less likely to end up in long-term care facilities than they were before the province’s stroke strategy was rolled out in 2008.

“One of the greatest benefits of the stroke strategy is that the changes didn’t come at a high cost to the province,” says Katie White, stroke consultant with Cardiovascular Health Nova Scotia. “This was more about reorganizing care based on the resources we have with relatively small funding enhancements rather than major new investments in care.”

Caroline Stephenson and Eileen Stewart

Caroline Stephenson and Eileen Stewart, nurses with the Calgary Stroke Program, are among a growing number of healthcare professionals involved in earning national accreditation in stroke care.

Similar results were being achieved at the Foothills Medical Centre in Calgary: 18% more patients received swallowing screens after a stroke (which reduce complications such as pneumonia and dehydration). As well, nearly 100% of stroke patients received a brain scan within an hour of hospital arrival, compared to 22% for most Canadian patients.

Alberta’s stroke strategy also means paramedics are now better trained in emergency stroke protocols. The hospital’s triage unit is contacted immediately and the stroke team mobilized, often beating the patient to the emergency department. Hospitals with a dedicated stroke team and resources have been shown to reduce disability and death from stroke by as much as 30%.

“If someone pages the stroke team, we automatically answer the page within three minutes. That’s the nature of stroke,” says Dr. Andrew Demchuk, director of the Calgary Stroke Program.

Momentum to continue after CSN ends

To ensure high standards, the CSN partnered with Accreditation Canada to develop the Stroke Services Distinction program, which recognizes leadership, clinical excellence and innovation in stroke care. To date, the Stroke Services Distinction designation has been given to two comprehensive stroke programs—the Calgary Stroke Program and Kingston General Hospital, as well as to the Toronto Rehabilitation Institute. Accreditation Canada will continue to operate the program after the CSN sunsets in 2013. This will complete the network’s 14-year term, the maximum allowed under the NCE program.

Meanwhile, the HSF has begun taking over the CSN’s most critical activities, including updating of best practices and quality of care assessments. The foundation is also working with CSN over the next year and beyond to expand the availability of telestroke, which enables real-time assessment and treatment of patients living in rural areas through consultation and evaluation with a stroke neurologist in a major urban stroke centre. Telestroke saves lives, but is not widely used in Canada.

As well, HSF will continue the CSN’s highly successful Canadian Stroke Congress, an annual conference where more than 1,000 professionals learn about the latest research, policy and health-promotion efforts and clinical best practices. This year, it will be held in parallel with three other scientific/professional conferences, bringing together specialists from multiple sectors to examine the links between diseases, disease prevention and management. With some 6,000 delegates expected, it would be one of the largest medical conferences ever held in Canada.

“We have put in place something that is sustainable,” says Dr. Hakim. “The stroke teams, the best practices and the Stroke Distinction program will all live beyond the network and continue to raise the bar for stroke care everywhere.”

“The Canadian Stroke Network is an excellent example of how the NCE program, with a relatively small investment, can yield major results,” adds André Isabelle, the NCE’s Associate Vice-President. “One of NCE’s strengths is its flexibility in allowing experts from across Canada to think outside of the box to come up with creative solutions to old problems—and sometimes in a way not originally envisioned.”