Content area
Full Text
Introduction
Stroke is the second leading cause of morbidity and mortality in the world. Every year, more than five and a half million people die from stroke (Kim et al., 2020). The crude incidence of stroke continues to rise because of an aging Western population and unhealthy lifestyle (GBD, 2018; Gorelick, 2019). Unfortunately, with a “business as usual” approach, the burden of stroke will not decrease in the next decade or beyond (Norrving et al., 2018).
Over the years, the acute treatment of stroke has become more evidence based (Middleton et al., 2011; Wardlaw et al., 2014; Goyal et al., 2016; Langhorne et al., 2020). Also, the prevention of stroke is gaining effect (Rashid et al., 2003; Collins et al., 2004; Collaborative overview, 1994). The latter includes targeting the major risk factors for stroke and cardiovascular disease, such as elevated systolic blood pressure, high body mass index, high blood lipid levels, diabetes mellitus and renal disease and behavior such as physical inactivity, poor diet and smoking. Moreover, according to the European Stroke Action Plan (ESAP) for the years 2018–2030 seven domains will have be put in place: primary prevention, organization of stroke services, management of acute stroke, secondary prevention, rehabilitation, evaluation of stroke outcome and outcome management and (quality of) life after stroke (Norrving et al., 2018).
To organize stroke care, multiple stakeholders currently work closely together in integrated stroke care services (ISCS) and subsequently incorporate the services from hospitals, rehabilitation facilities, nursing homes and community care. The aim of ISCS is to provide person-centered care in all phases after stroke, with coordination of multi-disciplinary collaboration and using the collective expertise. Following from the 69th World Health Assembly in 2016, “integrated care” is the leading paradigm and should optimally lead to improved patient satisfaction, enhanced quality of life and better patient outcomes. An important policy toward integrated care is striving for quality improvement and safety (Sixty Ninht World Assembly, 2016).
However, the heterogeneous outcomes of integration initiatives for people with chronic diseases, including stroke, indicate that multiple challenges exist regarding the design, implementation and evaluation of such initiatives (Ouwens et al., 2005). In the current patient journey, the stroke care process is experienced to be...