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Implement Sci. 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.

Author information

1
Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Level 3, Hudson Institute Building, 27-31 Wright Street, Clayton, VIC, 3168, Australia.
2
Department of Medicine, Peninsula Clinical School, Central Clinical School, Monash University, Melbourne, Australia.
3
Nursing Research Institute, St Vincent's Health Australia (Sydney) and Australian Catholic University, Sydney, Australia.
4
Sunshine Coast Clinical School, The University of Queensland, Birtinya and Statewide Stroke Clinical Network, Queensland Health, Brisbane, Australia.
5
The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, Australia.
6
Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, Australia.
7
Faculty of Health Sciences, La Trobe University, Bundoora, Australia.
8
Occupational Therapy Department, Alfred Health, Melbourne, Australia.
9
Australian Bronchiectasis Registry, Lung Foundation Australia, Brisbane, Australia.
10
School of Nursing, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada.
11
Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Level 3, Hudson Institute Building, 27-31 Wright Street, Clayton, VIC, 3168, Australia. dominique.cadilhac@monash.edu.
12
Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, Australia. dominique.cadilhac@monash.edu.

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

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