Research and Quality Improvement
Research is vital to improving care for persons with stroke and their families/caregivers. In addition to creating new approaches to best practice in stroke care, research enables the testing of new ideas and provides the evidence to support new approaches that can improve health and quality of life and fosters professional development.
This section focuses on research activities, quality improvement initiatives and resources within the Toronto Stroke Networks (TSNs). For a more comprehensive lists of hospital research activities, please refer to the respective hospitals’ websites.
Regional Stroke Centres
- Rehabilitation and Recovery
- Imaging Studies
TSNs Quality Improvement Initiatives
The TSNs regional teams are actively involved in quality improvement initiatives to enhance the health and quality of care of persons with stroke and their families/caregivers. Below is a listing of current and past regional initiatives:
Toronto Stroke Flow Initiative
Stroke Flow is a system-based alignment of stroke services in Toronto to ensure access to stroke best practices.
This initiative includes:
- Access to acute stroke unit care with a dedicated stroke team;
- Earlier access to high intensity rehabilitation;
- Increased access to high intensity rehabilitation for severe stroke patients;
- Enhanced outpatients services for mild stroke patients; and
- Improved functional outcomes across the continuum
Stroke Flow is supported by a comprehensive knowledge translation strategy. To view the Toronto Stroke Flow Education and Knowledge Translation (KT) Implementation Plan, and presentations or posters related to Stroke Flow, please visit the TSNs VCoP website.
Transition Resources for Seamless Care
Between 2010-2014, the Toronto Stroke Networks engaged in an innovative initiative focused on improving the transition experience for persons with stroke and their caregivers. This initiative was known as the Transition Improvement for Continuity of Care (TICC) project, and involved a community of health service providers, persons with stroke and caregivers. During the course of TICC, 3 core resources were created and implemented as a foundation for an improved patient experience through transitions of care after stroke.
These 3 resources include:
- My Guide for Stroke Recovery (formerly known as My Stroke Passport)
- Peers Fostering Hope
- Knowing Each Other’s Work
For a self-guided e-learning overview of these resources and the TICC project, please click the following link: Online Orientation to the Transition Resource for Stroke Care.
To view presentations or posters related to TICC, please visit the TSNs VCoP website.
For more detailed information about these resources, click on the links below.
Guide for Stroke Recovery (GSR)
GSR (formerly known as My Guide for Stroke Recovery) was created to empower people who have had a stroke to take an active role in their own health and recovery. GSR provides information on key topic areas related to stroke, addresses common concerns, and helps to guide discussions with the person’s health care team and family. To access a printable version of GSR and the worksheets within it, please click here. To access resources that can help with the implementation and use of GSR, please click here.
An electronic, mobile friendly version has also been created and includes links to community resources, practical tips and videos to support ongoing recovery. To access this resource, please visit www.strokerecovery.guide.
Peers Fostering Hope (PFH) Program
In partnership with March of Dimes Canada, and other health service providers in the Toronto Stroke Networks, the PFH program is intended to connect persons living with stroke and/or their caregiver with a peer volunteer who has also had a stroke. The PFH program begins in acute care and can continue through rehabilitation and back to home. Through their lived experience of what the recovery journey can be like, peers understand the impact of a stroke and offer hope, reassurance, and emotional support during the recovery process. If you want more information about this program or know of a person with stroke or caregiver who might be interested in volunteering for this program, please email Laura Tomkins at ac.semidfohcramnull@snikmotl
Knowing Each Other’s Work (KEOW)
KEOW includes 2 core initiatives that support healthcare providers to foster learning and meaningful collaboration across the system to know each other’s work in ways that enable delivery of the best seamless, optimistic care possible for persons with stroke. These 2 core initiatives include Essential Professional Conversations for Seamless Care and Stroke Care Observerships. For more information on these initiatives, please see below.
Essential Professional Conversations (EPCs) for Seamless Care
EPCs or ‘warm handovers’ foster enhanced communication, learning and meaningful cross-system collaboration between healthcare providers at times of transition. Verbal exchanges between healthcare providers across facilities can optimize the continuity of care for persons with stroke and their families, and in particular, for persons with complex needs after stroke.
For a self-guided e-learning overview on EPCs or access to other resources, please click on the links below:
- An Orientation to Essential Professional Conversations
- EPCs – Where to Start
- EPCs Tip Sheet
- EPCs Pocket Card – a tool that can guide conversations between healthcare providers.
- Patient Complexity Framework – a resource that can help healthcare providers in identifying which patients have ‘complex needs’ and would benefit from an EPC.
To support conversations between sites, teams have provided healthcare provider contact phone numbers and best times to reach them for an EPC. For instructions on how to access or update these contact lists, please click on the following links:
Stroke Care Observerships (SCOs)
SCOs provide a framework for healthcare providers from different sectors to plan meaningful observerships in each other’s work environments. With tools to support mutual goal setting and reflection, SCOs provide opportunities for in-depth learning about other care settings within the system as well as enhanced relationships and collaboration to support seamless care.
TSN Community Re-engagement Cue to Action Trigger Tool (CRCATT)
This is a multi-site, single-blind randomized control study that evaluated the use of the Community Re-engagement Cue to Action Trigger Tool (CRCATT), a patient-mediated question prompt list, and its impact on self-reported re-engagement in valued activities post stroke.
To view the tool, please click on the following link: Community Re-engagement Cue to Action Trigger Tool (CRCATT)
For a copy of the final report, please click here.
Collaborative Interprofessional Stroke Care in Community Re-engagement (CISCCoR)
This research project evaluated the impact of an innovative educational intervention (integrating concepts of interprofessional collaborative patient-centered care and community re-engagement) on health care providers’ delivery of best practice based care to persons living with stroke.
For a copy of the final report, please click here.
Heart and Stroke Foundation Canadian Partnership for Stroke Recovery
The Heart and Stroke Foundation Canadian Partnership for Stroke Recovery is a multi-disciplinary, multi-site research centre that was formed to enable leading scientists to collaborate research efforts to enhance and accelerate recovery after stroke. The three key strategic research areas of interest are:
- Exercise Interventions to Improve Stroke Recovery and Brain Health
- Exploring the Relationship Between Small Vessel Disease, Cognitive Function, Covert Stroke and Alzheimer’s Disease: Development of Therapeutic Interventions
- Regenerative Approaches to Stroke Recovery and Brain Health
To learn more, please go to http://www.canadianstroke.ca/en/about-us/.
University of Toronto Stroke Program (UTSP)
The UTSP is a collaborative university-wide program comprised of neurologists and other representatives interested in stroke care from the three Toronto Regional Stroke Centres: St. Michael’s Hospital, Sunnybrook Health Sciences Centre, and Toronto Western Hospital. The UTSP combines the resources, strengths, and patient populations to further advance research, education and clinical practices in stroke care. Through dedication and strong leadership, UTSP has become one of the largest stroke academic programs in North America.
Other Research Links