Table 1
Characteristics of the study population in 2012, 2015 and 2019.
| 2012 | 2015 | 2019 | |
|---|---|---|---|
| Number of stroke services invited | 72 | 59 | 55 |
| Number of stroke serviced responded (response rate in %) | 67 (93.1) | 53 (89.8) | 47 (85.5) |
| Characteristics of regional stroke services networks | |||
| Age, median (n) | 9 (41)1 | 12 (53) | 15 (46) |
| – Range | 1–16 | 3–20 | 1–24 |
| Number of organisations involved, median (n) | 5 (40) | 6 (53) | 7 (47) |
| – Range | 2–19 | 2–19 | 2–23 |
| – 0–4 organisations, % | 32.5 | 26.4 | 23.4 |
| – 5–7 organisations, % | 42.0 | 41.5 | 31.9 |
| – 8–9 organisations, % | 15.5 | 11.3 | 21.3 |
| – 10 organisations or more, % | 10.0 | 20.8 | 23.4 |
| Volume of stroke patients, median (n) | 364 (41) | 450 (53) | 499 (46) |
| – Min-Max volume | 100–1552 | 79–1650 | 80–1200 |
| – 1–300, % | 34.1 | 20.8 | 21.7 |
| – 301–599, % | 43.9 | 56.6 | 41.3 |
| – 600–899, % | 19.6 | 18.9 | 15.3 |
| – 900 or more, % | 2.4 | 3.8 | 21.7 |
| Coordinator of the regional stroke services network | |||
| – Working hours per week, median (n) | 8.0 (37) | 8.0 (50) | 8.0 (39) |
| – Range hours per week | 1–24 | 1–24 | 3–24 |
| – 1–4 hours per week, % | 27.0 | 18.0 | 25.6 |
| – 5–8 hours per week, % | 27.1 | 45.3 | 38.5 |
| – 9–12 hours per week, % | 24.3 | 17.0 | 12.8 |
| – 13 hours or more per week, % | 21.6 | 15.1 | 23.1 |
| – Appointed (% yes) | 91.6 | 100.0 | 93.5 |
| Working groups (% yes) | 86.6 | 94.3 | 95.7 |
| Formal agreements on cooperation (% yes) | 80.6 | 86.8 | 82.4 |
| Regular meetings with steering group (% yes) | 77.4 | 90.6 | 73.9 |
[i] 1 Because no data were collected in 2012, 26 stroke services did not receive questions on characteristics.
Table 2
Completed activities within the nine clusters of integrated care activities in 2012, 2015 and 20191.
| 2012 | 2015 | 2019 | 2012–2015 | 2015–2019 | 2012–2019 | |
|---|---|---|---|---|---|---|
| mean % (95% CI) | mean % (95% CI) | mean % (95% CI) | mean difference F(df = 1)/p | mean difference F(df = 1)/p | mean difference F(df = 1)/p | |
| n = 67 | n = 53 | n = 47 | n = 120 | n = 100 | n = 114 | |
| Interprofessional teamwork (3 items) | 85.6 (79.7–91.5) | 93.1 (88.9–97.3) | 88.7 (82.8–94.5) | 7.5 F = 3.924 p = 0.050 | –4.4 F = 1.581 p = 0.212 | 3.1 F = 0.518 p = 0.473 |
| Roles and tasks (8 items) | 71.6 (65.6–77.7) | 88.7 (84.4–92.9) | 85.6 (78.8–92.4) | 17.1 F = 19.097 p = 0.000 | –3.1 F = 0.611 p = 0.436 | 14.0 F = 9.255 p = 0.003 |
| Patient-centeredness (10 items) | 59.0 (53.4–64.7) | 71.0 (65.1–76.9) | 71.9 (65.7–78.1) | 12.0 F = 8.518 p = 0.004 | –0.9 F = 0.045 p = 0.842 | 12.9 F = 9.246 p = 0.003 |
| Commitment (12 items) | 58.7 (52.5–65.0) | 75.5 (69.5–81.4) | 69.9 (61.9–77.8) | 16.8 F = 14.515 p = 0.000 | –5.6 F = 1.319 p = 0.254 | 11.2 F = 4.982 p = 0.028 |
| Transparent entrepreneurship (7 items) | 49.5 (42.4–56.6) | 65.0 (59.0–71.0) | 67.2 (59.1–75.2) | 15.5 F = 10.375 p = 0.002 | –2.2 F = 0.202 p = 0.654 | 18.0 F = 10.693 p = 0.001 |
| Result-focused learning(14 items) | 58.5 (52.2–64.8) | 67.1 (61.6–72.6) | 67.4 (61.0–73.8) | 8.6 F = 3.938 p = 0.050 | 0.3 F = 0.005 p = 0.945 | 8.9 F = 3.675 p = 0.058 |
| Quality of care(7 items) | 53.5 (48.5–58.6) | 66.3 (60.7–71.9) | 61.4 (54.5–68.3) | 12.8 F = 11.427 p = 0.001 | 4.9 F = 2.466 p = 0.120 | 7.9 F = 3.585 p = 0.061 |
| Delivery system (18 items) | 54.3 (49.7–59.0) | 67.5 (62.1–72.8) | 60.3 (53.4–67.2) | 13.2 F = 13.962 p = 0.000 | –7.2 F = 2.831 p = 0.096 | 6.0 F = 2.221 p = 0.139 |
| Performance management (18 items) | 52.2 (46.5–57.8) | 67.1 (61.6–72.6) | 58.0 (50.6–65.4) | 14.9 F = 13.723 p = 0.000 | –9.1 F = 4.068 p = 0.046 | 5.8 F = 1.596 p = 0.209 |
[i] 1 Cluster scores were calculated as proportions of the activities implemented.
Table 3
Stroke services per phase of development based on the Development Model for Integrated Care in 2012, 2015 and 20191,2 (in %).
| PHASE OF DEVELOPMENT | 2012 (N = 67) | 2015 (N = 53) | 2019 (N = 47) |
|---|---|---|---|
| Initiative and design phase | 37.3 | 34.0 | 8.5 |
| Experimental and execution phase | 9.0 | 7.5 | 21.3 |
| Expansion and monitoring phase | 35.8 | 35.8 | 48.9 |
| Consolidation and transformation phase | 17.9 | 22.6 | 21.3 |
[i] 1 The phase of development is assessed by having implemented at least seven of the top-ten relevant items for a certain phase of development (see Appendix 2).
2 Pearson’s X2 (6) = 15.669, p = 0.016, n = 167.
Table 4
Regression analysis with forward selection1 on completed integrated activities within the nine clusters and characteristics of integrated stroke services within and over the years (B, CI, p).
| YEAR | R2 | AGE OF REGIONAL STROKE SERVICES NETWORK | ORGANISATIONS INVOLVED | VOLUME OF STROKE PATIENTS, LAST YEAR | |
|---|---|---|---|---|---|
| Inter-professional teamwork (3 items) | All | 0.045 | B = –0.015 –0.028 to –0.003 p = 0.019 | ||
| Roles and tasks (8 items) | 2012 | 0.135 | B = 2.074 0.247 to 3.902 p = 0.027 | ||
| 2019 | 0.140 | B = 0.896 0.144 to 0.165 p = 0.021 | |||
| All | 0.137 | B = 1.387 0.763–2.011 p = 0.000 | |||
| Patient-centeredness (10 items) | 2019 | 0.118 | B = –0.021 –0.041 to –0.002 p = 0.035 | ||
| All | 0.092 | B = 1.005 0.320 to 1.691 p = 0.004 | B = –0.014 –0.027 to –0.001 p = 0.040 | ||
| Commitment (12 items) | 2015 | 0.098 | B = 1.709 0.202 to 3.217 p = 0.27 | ||
| 2019 | 0.227 | B = 1.729 0.652 to 2.806 p = 0.02 | |||
| All | 0.160 | B = 1.625 0.862 to 2.388 p = 0.00 | B = 1.302 0.229 to 2.375 p = 0.018 | ||
| Transparent entrepreneurship(7 items) | 2012 | 0.274 | B = 2.776 0.656 to 4.897 p = 0.012 | B = 3.454 0.605 to 6.304 p = 0.019 | |
| 2015 | 0.085 | B = 1.810 0.684 to 2.935 p = 0.002 | B = 1.588 0.080 to 3.096 p = 0.039 | ||
| 2019 | 0.228 | B = 1.914 1.152 to 2.677 p = 0.00 | B = 1.607 0.534 to 2.680 p = 0.004 | ||
| All | 0.213 | B = 1.914 1.152 to 2.677 p = 0.00 | B = 1.607 0.534 to 2.680 p = 0.004 | ||
| Result-focused learning (14 items) | 2019 | 0.173 | B = 1.344 0.351 to 2.336 p = 0.009 | B = 1.154 0.158 to 2.150 p = 0.024 | |
| All | 0.155 | B = 1.491 0.784 to 2.199 p = 0.004 | |||
| Quality of care (7 items) | 2015 | 0.111 | B = 1.705 0.305 to 3.105 p = 0.018 | ||
| All | 0.035 | B = 1.088 0.071 to 2.106 p = 0.036 | |||
| Delivery system(18 items) | 2019 | 0.204 | B = 1.442 0.478 to 2.406 p = 0.004 | ||
| All | 0.131 | B = 1.402 0.754 to 2.050 p = 0.000 | |||
| Performance management (18 items) | 2019 | 0.294 | B = 1.754 0.836 to 2.673 p = 0.000 | ||
| All | 0.140 | B = 1.495 0.831 to 2.159 p = 0.000 |
[i] 1 Criterion: probability-of-F-to-enter <= 0.050.
2 Only the statistically significant correlations are presented. No correlations with ‘working hours of the coordinator’ were found.