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      The population-based measurement of quality indicators for secondary prevention of stroke in Saskatchewan

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      Gerein_Janelle_2010.pdf (5.798Mb)
      Date
      2010-07
      Author
      Gerein, Janelle Ann
      Type
      Thesis
      Degree Level
      Masters
      Metadata
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      Abstract
      In Saskatchewan, stroke is the third leading cause of death as well was the major cause of adult disability. Once a person suffers a stroke or transient ischemic attack (TIA), they are at high risk for having a secondary (or recurrent) stroke. Despite this knowledge, secondary stroke prevention is often overlooked in the care of stroke/TIA patients. With the vision of decreasing the incidence and impact of stroke in Saskatchewan, the Saskatchewan Integrated Stroke Strategy (SISS) was recently implemented. The purpose of this study is to begin the development of an evaluation measurement system for the SISS based on the guidelines and measures from the Canadian Stroke Strategy (CSS) specifically pertaining to secondary stroke prevention. This multi-year cross-sectional study is an analysis of de-identified health data derived from linkage of administrative and laboratory data. Select indicators from the CSS Performance Measurement Manual involving medications use for secondary stroke prevention (antihypertensives, antilipidemics, anticoagulants) and intermediate health outcomes (serum LDL cholesterol, INR) are calculated. Regression is used to quantify the association of patient demographic and socioeconomic characteristics and geographic location of care with receipt of guideline-recommended secondary stroke prevention. The target population is Saskatchewan residents who have been hospitalized for a stroke or TIA between April 1, 2001 and March 31, 2008. The results of this study indicated that secondary stroke prevention in Saskatchewan is sub-optimal in the management of hypertension, dyslipidemia, and atrial fibrillation. Although there has been some improvement over the time period, a significant number of patients are not taking the recommended medications at discharge from acute care. Similarly, a considerable number of patients are not receiving the appropriate laboratory tests within the year following their stroke event. Through regression analysis it was revealed that a number of correlates (ie. age, income, on medication before the stroke event) were significantly associated with receiving these specific elements of secondary stroke prevention, suggesting potential differences in provision of care. Finally, regional differences in secondary stroke prevention were found for a number of the outcomes, which may indicate differences in care throughout the province. The findings of this study serve as a baseline for evaluation of the impact of the Saskatchewan Integrated Stroke Strategy in the area of secondary stroke prevention. The results make apparent the fact that secondary stroke prevention in Saskatchewan can be improved, and that there is much opportunity for future research in this area.
      Degree
      Master of Science (M.Sc.)
      Department
      Community Health and Epidemiology
      Program
      Community Health and Epidemiology
      Supervisor
      Teare, Gary F.; Muhajarine, Nazeem
      Committee
      Neufeld, Anne; Janzen, Bonnie L.; Ward, Heather
      Copyright Date
      July 2010
      URI
      http://hdl.handle.net/10388/etd-08312010-101914
      Subject
      Saskatchewan
      secondary stroke prevention
      Saskatchewan Integrated Stroke Strategy
      quality indicators
      secondary stroke
      recurrent stroke
      Collections
      • Graduate Theses and Dissertations

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