Measuring performance of an Integrated Community Stroke Service model


Why the research is needed

National clinical guidelines recommend that stroke survivors be provided with stroke rehabilitation services when they are transferred from hospital and living back at home. However, provision of care for stroke survivors in the community has not had the attention that hospital based care has received, and so there are areas of the country in which improvements are required.

The Sentinel Stroke National Audit Programme collects and reports data on provision of stroke care across the UK and has been shown to drive improvements in hospital based care. There are plans to expand the audit, so that it includes a more comprehensive account of provision of community based stroke care.

Commissioners, who procure services, need information about how community stroke services should be resourced and how performance should be measured.

What is already known about the subject

There is strong research evidence for the effectiveness of Early Supported Discharge (ESD) services. These are multidisciplinary teams that provide intensive home-based rehabilitation, usually over a six week period. It is now recognised that community based rehabilitation needs to be provided to a wider population of stroke survivors and over a longer term.

Our previous research has informed evidence based guidelines relating to how ESD and community stroke rehabilitation services could be provided in an integrated service model. A National Integrated Community Stroke Service (ICSS) specification has been created to guide implementation. There is now a need to investigate how ICSS models are resourced in the real world, what outcomes are achieved and how performance can be routinely monitored.

Who we will be working with

We will be working with services who have adopted ICSS models.

How patients and the public are involved

We have discussed the provision of care for stroke survivors in their own home with our Nottingham stroke partnership group. The group’s comments have informed our study proposal, a stroke survivor is on our steering group and we will work in partnership as the study progresses. The proposal is also based on patient participation in a previous study in which we investigated what matters most to stroke survivors regarding the impact of stroke rehabilitation in their homes.

What we will do

We will assess how each ICSS model is staffed in terms of speciality, grade and working hours and associated costs. We will then investigate how much rehabilitation was offered by each service and determine how best this should be reported. We will also investigate how to measure patient recovery and whether these ‘outcome’ measurements relate to how much rehabilitation was provided. Finally, we want to understand the impact of the Covid-19 pandemic in terms of rehabilitation delivery and outcomes.

What the benefits will be

This research will benefit patients affected by stroke because it will investigate how to monitor the performance of the services they experience. The research will help us understand how services are resourced and how best to measure rehabilitation delivery. This will be important information for teams across the country, commissioners of services and the national stroke audit programme.

When the findings will be available

The study starts on 1 December 2020 – initial findings in Spring 2022 with final report in December 2023.

How we are planning for implementation

We are working nationally with NHS England and NHS Improvement (NHS E&I) to influence what changes can be made to stroke care across the country.


Niki Chouliara,