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

Nadine E. Andrew, Sandy Middleton, Rohan Grimley, Craig S. Anderson, Geoffrey A. Donnan, Natasha A. Lannin, Enna Striol-Salama, Brenda Grabsch, Monique F. Kilkenny, Janet E. Squires, Dominique A. Cadilhac, On behalf of the Stroke123 Investigators

Research output: Contribution to journalArticleResearchpeer-review

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.

Original languageEnglish
Article number6
Number of pages12
JournalImplementation Science
Volume14
Issue number1
DOIs
Publication statusPublished - 18 Jan 2019

Keywords

  • Evidence-based care
  • Organizational context
  • Stroke
  • Stroke unit

Cite this

Andrew, N. E., Middleton, S., Grimley, R., Anderson, C. S., Donnan, G. A., Lannin, N. A., ... On behalf of the Stroke123 Investigators (2019). Hospital organizational context and delivery of evidence-based stroke care: A cross-sectional study. Implementation Science, 14(1), [6]. https://doi.org/10.1186/s13012-018-0849-z
Andrew, Nadine E. ; Middleton, Sandy ; Grimley, Rohan ; Anderson, Craig S. ; Donnan, Geoffrey A. ; Lannin, Natasha A. ; Striol-Salama, Enna ; Grabsch, Brenda ; Kilkenny, Monique F. ; Squires, Janet E. ; Cadilhac, Dominique A. ; On behalf of the Stroke123 Investigators. / Hospital organizational context and delivery of evidence-based stroke care : A cross-sectional study. In: Implementation Science. 2019 ; Vol. 14, No. 1.
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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",
author = "Andrew, {Nadine E.} and Sandy Middleton and Rohan Grimley and Anderson, {Craig S.} and Donnan, {Geoffrey A.} and Lannin, {Natasha A.} and Enna Striol-Salama and Brenda Grabsch and Kilkenny, {Monique F.} and Squires, {Janet E.} and Cadilhac, {Dominique A.} and {On behalf of the Stroke123 Investigators}",
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Andrew, NE, Middleton, S, Grimley, R, Anderson, CS, Donnan, GA, Lannin, NA, Striol-Salama, E, Grabsch, B, Kilkenny, MF, Squires, JE, Cadilhac, DA & On behalf of the Stroke123 Investigators 2019, 'Hospital organizational context and delivery of evidence-based stroke care: A cross-sectional study' Implementation Science, vol. 14, no. 1, 6. https://doi.org/10.1186/s13012-018-0849-z

Hospital organizational context and delivery of evidence-based stroke care : A cross-sectional study. / Andrew, Nadine E.; Middleton, Sandy; Grimley, Rohan; Anderson, Craig S.; Donnan, Geoffrey A.; Lannin, Natasha A.; Striol-Salama, Enna; Grabsch, Brenda; Kilkenny, Monique F.; Squires, Janet E.; Cadilhac, Dominique A.; On behalf of the Stroke123 Investigators.

In: Implementation Science, Vol. 14, No. 1, 6, 18.01.2019.

Research output: Contribution to journalArticleResearchpeer-review

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T1 - Hospital organizational context and delivery of evidence-based stroke care

T2 - A cross-sectional study

AU - Andrew, Nadine E.

AU - Middleton, Sandy

AU - Grimley, Rohan

AU - Anderson, Craig S.

AU - Donnan, Geoffrey A.

AU - Lannin, Natasha A.

AU - Striol-Salama, Enna

AU - Grabsch, Brenda

AU - Kilkenny, Monique F.

AU - Squires, Janet E.

AU - Cadilhac, Dominique A.

AU - On behalf of the Stroke123 Investigators

PY - 2019/1/18

Y1 - 2019/1/18

N2 - 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.

AB - 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.

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KW - Organizational context

KW - Stroke

KW - Stroke unit

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