How and why do community stakeholders participate in the national stroke audit in England? Findings from a mixed-method online survey.

Abstract

Background: National audit programmes are a recognised means of assessing quality of healthcare by collecting and reporting data in relation to evidence-based standards. The Sentinel Stroke National Audit Programme is a prospective audit of processes and outcomes for all stroke patients in England, Wales and Northern Ireland which has historically focused on hospital-based care. Evidence suggests it has been successful in driving quality improvement. What has yet to be explored is the influence of such a national audit programme on community-based healthcare. The aims of this study were to understand how community stakeholders perceive and participate in the audit.

Methods: The study used a realist approach, being theory driven and informed by collaborators including stroke clinicians and experts in realist and audit methodology. Contextual determinants and mechanisms were identified from the literature as having the potential to influence quality improvement. These were operationalised into 18 survey items, using a combination of 5-point scales and yes / no responses. Free text options offered the opportunity to expand upon responses. The online survey was distributed using social media, clinical networks and professional bodies. Representation was sought from community stroke stakeholders across England and from roles throughout the audit process including administrative, clinical, management and commissioning.

Results: The survey achieved a national sample from a broad range of stakeholders (n=206). Participants reported being engaged in the audit, committing significant resources to participation. National audit feedback was described as being used to support a range of improvement activities, including funding for additional staff and service reorganisation. A number of factors influenced the ability of teams to participate in audit and utilise feedback for quality improvement. These included the online platform, the accuracy of data submitted and leadership support.

Conclusions: Findings highlight the work needed in terms of the data captured, organisational audit support and engagement with feedback if the potential of the audit as a tool for quality improvement in community rehabilitation (as highlighted in acute stroke care) is to be realised.