Improving Quality in the Rotterdam Stroke Service By Using the Development Model for Integrated Care

Background

In the Rotterdam Stroke Service (RSS) in the Netherlands, hospitals, nursing homes, rehabilitation centers and community care organizations collaborate to provide the best quality of care for stroke patients in the acute, rehabilitation and chronically phase. The RSS exists of eight stroke services, all operating in the Rotterdam area. The aim of the RSS is to realize a high quality of life for every stroke patient in the Rotterdam area, according to the most recent (scientific) standards. In the last decade, the professionals in the collaborating organizations initiated various activities in the field of education, practice and research, to fulfill the aims of the RSS.  The results of the self-assessment instrument for integrated care offered input for those actions.

Methods

A web based self-assessment instrument, derived from the Development Model for Integrated Care (DMIC) (1) was used to collect data on stroke services. This four phases model consists of nine clusters in which is described what is necessary to realize good quality of care. The development of a stroke service is represented in the four phases. The coordinators of the stroke services filled in the questionnaire together with key persons in their stroke service. The instrument consisted of 89 multiple choice questions (distributed over the nine clusters) concerning the organization of the stroke service. This self-assessment instrument was used in 2012 and 2015. The results of the DMIC questionnaire has to be shown in a specific for that purpose developed radar diagram.

Results

Fifty-three out of 80 stroke services in the Netherlands and six out of eight RSS stroke services filled in the web based questionnaire both in 2012 and 2015. The Dutch stroke services each are admitting a mean of 475 patients a year. They all have a stroke service coordinator, and a collaboration with approximately seven care organizations. The stroke services in the Netherlands exist for a mean of 12 years. How older the stroke service, the higher the phase it is positioned in. The RSS started in 1997, and from then the stroke services collaborated in the RSS. The RSS stroke services all showed development from 2012 to 2015, and are now positioned in a next phase (phase three and four). There were a few points that consistently showed up in the results of the Rotterdam stroke services. A lack of: 1) political involvement, 2) involvement of patients in improving services, 3) development of specific care programs, 4) connection of databases, 5) registration of errors and mistakes.

Discussion

Innovative cure and care in the RSS creates a new 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. Nevertheless, there is a lot of work to be done and new aims concerning 1) political involvement, 2) involvement of patients in improving services, 3) development of specific care programs, 4) connection of databases, 5) registration of errors and mistakes, are set for the year 2016.