National Stroke Strategy People who have had strokes and their carers, either living at QM14 (2007) home or in care homes, are offered a review from primary care services of their health and social care status and secondary prevention needs, typically within six weeks of discharge home or to a care home and again six months after leaving hospital. This is followed by an annual health and social care check, which facilitates a clear pathway back to further specialist review, advice, information, support and rehabilitation where required Care Quality Commission Regular reviews after transfer home provide a key opportunity to review on stroke care (2011) ensure people get the support they need. Royal College of Physicians Any patient with residual impairment after the end of initial (RCP) National Clinical rehabilitation should be offered a formal review at least every 6 Guidelines for Stroke (2012) months, to consider whether further interventions are warranted, Fourth Edition 7.1.1C and and should be referred for specialist assessment if: 7.4.1A new problems, not present when last seen by the specialist service, are present the patient’s physical state or social environment has changed Patients and their carers should have their individual practical and emotional support needs identified: before they leave hospital when rehabilitation ends or at 6-month review annually thereafter NICE (CG162) Stroke Review the health and social care needs of people after stroke rehabilitation guideline: and the needs of their carers at 6 months and annually Long term rehabilitation thereafter. These reviews should cover participation and after stroke (2013) community roles to ensure that people's goals are addressed. CCG Outcomes Indicator Domain 3 Helping people to recover from episodes of ill health – Set 2013/14 and 2014/15 or following injury Improving recovery from stroke / People who have had a stroke who receive a follow-up assessment between 4-8 months after initial admission Established in 2010, the Accelerating Stroke Improvement (ASI) programme was a national initiative designed to ensure that maximum implementation of the Quality Markers in the
National Stroke Strategy QM14 (2007) People who have had strokes and their carers, either living at home or in care homes, are offered a review from primary care services of their health and social care status and secondary prevention needs, typically within six weeks of discharge home or to a care home and again six months after leaving hospital. This is followed by an annual health and social care check, which facilitates a clear pathway back to further specialist review, advice, information, support and rehabilitation where required Care Quality Commission review on stroke care (2011) Regular reviews after transfer home provide a key opportunity to ensure people get the support they need. Royal College of Physicians (RCP) National Clinical Guidelines for Stroke (2012) Fourth Edition 7.1.1C and 7.4.1A Any patient with residual impairment after the end of initial rehabilitation should be offered a formal review at least every 6 months, to consider whether further interventions are warranted, and should be referred for specialist assessment if: new problems, not present when last seen by the specialist service, are present the patient’s physical state or social environment has changed Patients and their carers should have their individual practical and emotional support needs identified: before they leave hospital when rehabilitation ends or at 6-month review annually thereafter NICE (CG162) Stroke rehabilitation guideline: Long term rehabilitation after stroke (2013) Review the health and social care needs of people after stroke and the needs of their carers at 6 months and annually thereafter. These reviews should cover participation and community roles to ensure that people's goals are addressed. CCG Outcomes Indicator Set 2013/14 and 2014/15 Domain 3 – Helping people to recover from episodes of ill health or following injury Improving recovery from stroke / People who have had a stroke who receive a follow-up assessment between 4-8 months after initial admission Established in 2010, the Accelerating Stroke Improvement (ASI) programme was a national initiative designed to ensure that maximum implementation of the Quality Markers in the
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