Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Multicenter Study
. 2019 Jan 18;14(1):6.
doi: 10.1186/s13012-018-0849-z.

Hospital organizational context and delivery of evidence-based stroke care: a cross-sectional study

Nadine E Andrew  1   2 , Sandy Middleton  3 , Rohan Grimley  1   4 , Craig S Anderson  5 , Geoffrey A Donnan  6 , Natasha A Lannin  7   8 , Enna Stroil-Salama  9 , Brenda Grabsch  6 , Monique F Kilkenny  1   6 , Janet E Squires  10 , Dominique A Cadilhac  11   12 ; the Stroke123 Investigators
Affiliations
Multicenter Study

Hospital organizational context and delivery of evidence-based stroke care: a cross-sectional study

Nadine E Andrew et al. Implement Sci. .

Erratum in

Abstract

Background: Organizational context is one factor influencing the translation of evidence into practice, but data pertaining to patients with acute stroke are limited. We aimed to determine the associations of organizational context in relation to four important evidence-based stroke care processes.

Methods: This was a mixed methods cross-sectional study. Among 19 hospitals in Queensland, Australia, a survey was conducted of the perceptions of stroke clinicians about their work using the Alberta Context Tool (ACT), a validated measure covering 10 concepts of organizational context, and with additional stroke-specific contextual questions. These data were linked to the Australian Stroke Clinical Registry (AuSCR) to determine the relationship with receipt of evidence-based acute stroke care (acute stroke unit admission, use of thrombolysis for those with acute ischemic stroke, receipt of a written care plan on discharge, and prescription of antihypertensive medications on discharge) using quantile regression. Exploratory cluster analysis was used to categorize hospitals into high and low context groups based on all of the 10 ACT concepts. Differences in adherence to care processes between the two groups were examined.

Results: A total of 215 clinicians completed the survey (50% nurses, 37% allied health staff, 10% medical practitioners), with 81% being in their current role for at least 1 year. There was good reliability (∞ 0.83) within the cohort to allow pooling of professional groups. Greater ACT scores, especially for social capital (μ 9.00, 95% confidence interval [CI] 4.86 to 13.14) and culture (μ 7.33, 95% CI 2.05 to 12.62), were associated with more patients receiving stroke unit care. There was no correlation between ACT concepts and other care processes. Working within higher compared to lower context environments was associated with greater proportions of patients receiving stroke unit care (88.5% vs. 69.0%) and being prescribed antihypertensive medication at discharge (62.5% vs. 52.0%). Staff from higher context hospitals were more likely to value medical and/or nursing leadership and stroke care protocols.

Conclusions: Overall organizational context, and in particular aspects of culture and social capital, are associated with the delivery of some components of evidence-based stroke care, offering insights into potential pathways for improving the implementation of proven therapies.

Keywords: Evidence-based care; Organizational context; Stroke; Stroke unit.

PubMed Disclaimer

Conflict of interest statement

Ethics approval and consent to participate

The study was approved by the Metro South Human Research Ethics Committee (HREC/13/QPAH/31) and Monash University (CF13/1303-2013000641), and each participating hospital provided site governance authorization. Participating clinicians provided implied consent through the anonymous completion of the survey. The AuSCR has ethics approval to use an opt-out method of consent for collection of patient clinical data.

Consent for publication

Not applicable

Competing interests

SM is a member of the Research Committee of National Health and Medical Research Council (NHMRC) of Australia, but her appointment post-dated receipt of funding for this study. All other authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Unit level variations in Alberta Context Tool dimensions. *Excludes units in which < 8 staff provided responses (N = 5)
Fig. 2
Fig. 2
Variations in adherence to care processes by the hospital
Fig. 3
Fig. 3
Alberta Context Tool concept scores by cluster groupings. Asterisk indicates a statistically significant difference between clusters for that concept. ACT, Alberta Context Tool. Cluster 1 = lower context, cluster 2 = higher context
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Feigin VL, Roth GA, Naghavi M, Parmar P, Krishnamurthi R, Chugh S, Mensah GA, Norrving B, Shiue I, Ng M, et al. Global burden of stroke and risk factors in 188 countries, during 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet Neurol. 2016;15(9):913–924. doi: 10.1016/S1474-4422(16)30073-4. - DOI - PubMed
    1. Cadilhac DA, Kim J, Lannin NA, Kapral M, Schwamm LH, Dennis M, Norrving B, Meretoja A. National stroke registries for monitoring and improving the quality of hospital care: a systematic review. Int J Stroke. 2015;11(1):28–40. doi: 10.1177/1747493015607523. - DOI - PubMed
    1. Stroke Foundation . Stroke audit – acute services report. Melbourne: Stroke Foundation; 2017. p. 78.
    1. Stroke Foundation . Clinical guidelines for stroke management 2017. Melbourne: Stroke Foundation; 2017. p. 168.
    1. Cadilhac DA, Andrew NE, Lannin NA, Middleton S, Levi CR, Dewey HM, Grabsch B, Faux S, Hill K, Grimley R, et al. Quality of acute care and long-term quality of life and survival: the Australian Stroke Clinical Registry. Stroke. 2017;48(4):1026–1032. doi: 10.1161/STROKEAHA.116.015714. - DOI - PubMed

Publication types

Substances