Ontario Stroke Network, Strategy for Patient Oriented Research, Quality-Based Practices

In the current stroke system, there exists significant burden of disease and variation in care. Stroke costs the Ontario economy almost $1 billion annually and the total acute inpatient cost has been estimated at $191.4 million (1.36% of hospital global budget allocations). Furthermore, there exists wide variation across the province in terms of acute length of stay, days per patient, and in-hospital mortality rate following stroke. Changes to health system funding, including linking funding to evidence-based care and practices, are an attempt to reduce this burden and both standardize and increase the quality of stroke care in Ontario.


The Excellent Care for All Act (ECFAA) was passed into law in Ontario June 2010 and is part of a broad strategy that aims to improve the quality of health care delivery in Ontario. The ECFAA has resulted in health system funding reforms, including Quality-based Procedures (QBPs). This approach reimburses health care providers for the types and quantities of patients they treat, using evidence-informed rates that are associated with the quality of care of delivered. Thus, it is believed that implementing evidence-informed pricing for targeted QBPs, including stroke, will encourage health care providers to adopt best practices in their care delivery models and maximize their efficiency and effectiveness. The adoption of this approach, including the adoption of evidence-informed practices as well as these practice changes, has the potential to improve the clinical outcomes and the overall patient experience and help create a sustainable model for health care delivery.


We are evaluating the Ontario stroke QBP because, as a key component of the health care system, interventions such as this should be evaluated to determine not only their effectiveness, but also to determine if there are unintended consequences to the intervention. In order to determine specific details of implementation of the stroke QBP, we will be conducting a broad-reaching survey to establish overall opinions, and will supplement that data with interviews that will provide in depth responses to specific questions. This will provide detailed information on managerial and front-line clinician’s opinions and experiences to elicit an accurate portrayal of the state of stroke care.

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Date : 15 Mar 2016