Rotterdam Stroke Service: audits for the quality of integrated care

Abstract

Introduction: The Rotterdam Stroke Service (RSS) in the Netherlands, is a stroke service network of hospitals, nursing homes, rehabilitation centers and community care organizations, collaborating to provide an optimal quality of care after stroke for patients in the acute, rehabilitation and chronic phase. The aim of the RSS is to realize an optimal treatment and outcomes for every stroke patient, according to the most recent (scientific) standards. Policy Context and objective: Audits should make it possible to check on quality of care, although it is a challenge to judge if the care process and quality of collaboration in an integrated care network is sufficient. Therefore a unique instrument for auditing the quality of collaboration was developed. Targeted population: The Stroke Knowledge Network Netherlands (SKNN) developed a unique audit instrument derived from the Development Model for Integrated Care (DMIC) (1). The DMIC consists of nine clusters in which is described what is necessary to realize good quality of care. Also, the indicators from the Dutch Institute for clinical auditing and care standard CVA/TIA were integrated in the audit instrument. The instrument exists of 2 main parts: self-evaluation and care standard (38 norms) and benchmark (4 norms). The actual working methods are compared with regulations, evidence based guidelines, norms/indicators and regional agreement/commitment. The audit focusses particularly on collaboration with integrated care partners and that is what makes the audit instrument unique. In 2017, an audit team from SKNN visited the RSS and used the new audit instrument. The audit team studied documentation and information beforehand: i.e. (transfer of) medical files, documentation about (the education of) the personnel/workforce, agreements and guidelines. During the audit they made a tour in the organizations and interviewed numerus health care workers. After the audit, they reported on their findings. High lights (innovation, impact and outcomes): Seven stroke services received a report on their best practices and points of improvement. The audit team complimented the RSS for their clear information and the comprehensive commitment of all the integrated care partners. The organization and quality of education and research were rated very positive. There was also much appreciation for the "stroke after-care" method that was developed in the RSS. Points of improvement were the interdisciplinary collaboration, exchange of patient information via ICT and involvement of informal caregivers. Furthermore, results of new projects were not always sufficiently disseminated between the organizations and the collaboration between the integrated care partners and general practitioners was not always satisfactory. Comments on transferability: To be able to work on the points of improvement, the RSS organized a meeting with the organizations. Input of all the representatives have been translated in an improvement plan for 2018 and 2019. Innovative cure and care in the RSS creates a better treatment and rehabilitation environment, resulting in an increasing area of support among professionals in the stroke service. This seems to manifest itself in better communication, better data collection and a better quality of delivered stroke care.