Six-month post-stroke review provision across southwest England: a service evaluation

Abstract

Background/Aims Six-month post-stroke reviews are advocated for all stroke survivors. There is no recommended service model, with many variations in practice. The aim of this service evaluation was to describe and evaluate the 6-month post-stroke review service provision across the South West England Integrated Stroke Delivery Networks. Methods A mixed-methods service evaluation for 10 services was undertaken, consisting of: a stakeholder meeting to define the scope and review criteria; a mapping exercise to define core service features and activity data; a 12-month retrospective Sentinel Stroke National Audit Programme clinical data audit plus a 1-month prospective audit detailing identified unmet needs, actions to address needs and patient satisfaction; service provider and user guided discussions; and options appraisal synthesising data from all sources to inform service development. Results Considerable variations in service configuration, processes and outcomes existed across services. Guided discussions with 40 service users and 20 service providers revealed predominantly positive experiences. There was perceived value in the review, a key ingredient being its person-centred nature. However, some felt that the review was generic and more of a tick-box exercise. Many staff appeared unaware of differing 6-month post-stroke review models across the region and rarely used Sentinel Stroke National Audit Programme data to reflect on service outcomes or inform service development. Sharing of good practice across services appeared limited. Conclusions Data did not support a specific preferred service model. Findings suggested 6-month post-stroke reviews should not be a ‘one size fits all’ model, with flexibility in format and timing to optimise value. A knowledge sharing and evidence-based culture should be encouraged to nurture service development.