A study from CaHRU, ‘Influenza vaccination and risk of stroke: self-controlled case-series study‘, recently published in the journal Vaccine, received international coverage in news media. The study of almost 18,000 patients with stroke looked at data from general practices in England using a self-controlled case series analysis, and showed that the risk of suffering a stroke is significantly reduced for up to two months after receiving a flu vaccine.
The lead author was Dr Zahid Asghar, who conducted the research together with Prof Niro Siriwardena (both from CaHRU) and Dr Carol Coupland (from Nottingham University School of Community Health Sciences). This is the fourth in a series of studies over the past 10 years looking at the link between flu vaccination and reduction in risk of heart attack and stroke.
The coverage included articles in The Times, Sun and Scottish Sun newspapers, BBC television and radio and online media outlets in the US, Middle East, Asia, Australasia and South America. The team are now designing future studies to explore the potential for flu vaccination to reduce risk of heart attack and stroke.
The aims of ASCQI were to improve ambulance care for heart attack and stroke across England and specifically:
To improve the delivery of care bundles for AMI from 43% to over 70% within two years of the project
To improve delivery of care bundles for stroke from 83% to over 90% within two years of the project
To increase diffusion of quality improvement methods to frontline staff in ambulance services.
As a result of the collaborative nine out of twelve ambulance trusts showed a significant improvement in either the stroke or AMI care bundle, and seven out of twelve showed significant improvements for both AMI and stroke. Performance for the care bundle for AMI increased from 43 percent to 79 percent, and for stroke 83 percent to 96 percent during the two years of the project and these improvements have been maintained. These results were published in the journal Implementation Science. A secondary aim of the initiative was to begin to develop patient reported experience measures (PREMs) for AMI and stroke. Preliminary qualitative work for development of PREMS for ambulance services was published in the EMJ, and this work is being continued by Fiona Togher of CaHRU through a funded doctoral study.
The website includes a range of resources which were used by ambulance services to deliver the improvements that we saw nationally. The work is now helping to inform similar prehospital improvement initiatives in the Middle East and North America and will be featured in a session on key care pathways in a Web and Action webinar series developed by the Institute for Healthcare Improvement, a world leader in healthcare quality improvement based in the United States, starting in March 2015.
The results of a national Quality Improvement Collaborative study, the Ambulance Services Cardiovascular Quality Initiative (ASCQI) were published this week in the international academic journal Implementation Science. The article entitled The effect of a national quality improvement collaborative on prehospital care for acute myocardial infaction and stroke in Englandshowed large and significant improvements in the quality of care provided by 11 ambulance services (out of 12) in England for people with heart attack and stroke. Members of the CaHRU team involved in the study included Professor Siriwardena, Dr Zowie Davy and Fiona Togher together with visiting fellows at CaHRU who are members of the research team at EMAS including Anne Spaight, Debbie Shaw and Nadya Essam. Professor Michael Dewey, chair in epidemiological statistics in London was the statistician on the project.
The project has been part of a programme of work, Prehospital and Emergency Quality and Outcomes, developed through collaboration between academics from the Community and Health Research Unit and ambulance services across the United Kingdom, particularly East Midlands Ambulance Service NHS Trust (EMAS). This collaboration has enabled a strategic partnership between the University of Lincoln and EMAS to undertake research which is relevant to ambulance services, focusing on health issues of regional and national importance, and conducted with ambulance staff in order to increase the impact of the research by improving prehospital care for emergencies.
The study examined the period between January 2010 and February 2012. Across England overall, the percentage of emergency cases where care bundles (packages of essential care) were delivered in full increased from 43% to 79% for heart attack and from 83% to 96% for stroke. ASCQI supported frontline staff, and their management, to introduce improvements using checklists, aide memoires, individual and group feedback and sharing of information within and between different trusts to improve the reliability of care for people with heart attack and stroke. The project was shortlisted for an HSJ award in 2012.
A study by members of the CaHRU team, Fiona Togher, Dr Zowie Davy and Professor Niroshan Siriwardena, to better understand the elements of care that are most important to patients with stroke and heart attack accessing the ambulance service, has been published in the Emergency Medicine Journal http://emj.bmj.com/cgi/content/full/emermed-2012-201507.
The qualitative study involved interviewing both patients and clinicians about their experiences of either receiving or providing care prehospital care for stroke or heart attack. Four main themes emerged:
treatment of condition
transition from home to hospital.
The technical knowledge and relational skills of clinicians’ together contributed to patients’ perceptions of professionalism in ambulance personnel. We found that the patient experience was enhanced when physical, emotional and social needs were attended to. Effective clinician–patient communication was also found to be a key component of high quality patient care.
Fiona Togher, who was lead author for the study, has recently been awarded a PhD studentship at Lincoln. The findings will be used to inform her doctoral research, which will examine the potential for developing a generic patient reported experience measure (PREM) for routine use in ambulance services in the UK
A further study, published in the Journal of Infectious Diseases, points to a link between influenza as a trigger of cardiovascular events, while presentations given in the past week in Toronto suggest that influenza vaccination might prevent such events.