Does an integrated care pathway improve processes of care in stroke rehabilitation? A randomized controlled trial.

OBJECTIVE to evaluate whether integrated care pathways improve the processes of care in stroke rehabilitation. DESIGN comparison of processes of care data collected in a randomized controlled trial. PARTICIPANTS acute stroke patients undergoing rehabilitation randomized to receive integrated care pathways management (n=76) or conventional multidisciplinary care (n=76). MEASUREMENTS proportion of patients meeting recommended standards for processes of care using a validated stroke audit tool. RESULTS integrated care pathways methodology was associated with higher frequency of stroke specific assessments, notably testing for inattention (84% versus 60%; P=0.015) and nutritional assessment (74% versus 22%, P<0.001). Documentation of provision of certain information to patients/carers (89% versus 70%; P=0.024) and early discharge notification to general practitioners (80% versus 45%; P<0.001) were also more common in this group. There were no significant differences in the processes of interdisciplinary co-ordination and patient management between the integrated care pathways group and the control group. CONCLUSION integrated care pathways may improve assessment and communication, even in specialist stroke settings.