Background

National clinical audit programmes are a recognised means of assessing quality of healthcare delivery by collecting audit data in relation to evidence based standards and reporting performance of healthcare providers. In the UK, the Health Quality Improvement Partnership runs a number of national clinical audit programmes, including the Sentinel Stroke National Audit Programme (SSNAP), informed by evidence based national clinical guidelines for stroke since 1998.

Evidence suggests that the stroke national audit has been successful in driving improvements in hospital based stroke care, by highlighting where clinical practice or service delivery is inconsistent across NHS trusts, and by comparison with accepted national clinical guidelines.

Like many of the national audit programmes, the stroke audit has historically focused on hospital based care. However, in line with a move over the last decade by the NHS to develop community based healthcare (now prioritised in the NHS Long Term Plan), audit programmes such as SSNAP have expanded to cover post-acute care pathways.

What has yet to be explored is the influence of such a national audit programme when focused on community based healthcare.

Approach

A mixed methods observational study with an explanatory sequential design consisting of 3 work packages:

• Part 1: A literature review and evidence synthesis will be used to inform the development of a survey exploring participation and perspectives of the national stroke audit by community stroke team leads with descriptive statistics used for analysis.
• Part 2: Semi-structured interviews with a representative sample of stakeholders (service providers and commissioners) to offer deeper investigation of themes that arise from Part 1.
• Part 3: Historic prospective SSNAP data routinely collected by purposively selected community stroke teams, to investigate variability and associations between data variables relating to delivery of rehabilitation and patient outcomes. Data analysis will include time series and mixed-effects regression analysis designed to investigate changes over time, relationships between patient characteristics, service delivery and patient outcomes.

The overall aim will be to understand how meaningful comparisons between services currently are. Findings will be used to generate recommendations for how national audit data could be optimally used and reported across teams to ensure meaningful comparisons and drive service improvement.