Methods of Implementation of Evidence-Based Stroke Care in Europe: European Implementation Score Collaboration.

Di Carlo, A; Pezzella, FR; Fraser, A; Bovis, F; Baeza, J; McKevitt, C; Boaz, A; Heuschmann, P; Wolfe, CD; Inzitari, D; European Implementation Score Collaboration Study Group, ; , COLLABORATORS; Thijs, V; Rudd, A; Boaz, A; Giroud, M; Bejot, Y; Wiedmann, S; Hermanek, P; Wagner, M; Baldereschi, M; Lamassa, M; Romani, I; Nencini, P; Rastenyte, D; Ryglewicz, D; Czlonkowska, A; Niewada, M; Dennis, M; Gallofré, M; Abilleira, S; Masjuan, J; Norrving, B; Asplund, K; (2015) Methods of Implementation of Evidence-Based Stroke Care in Europe: European Implementation Score Collaboration. Stroke; a journal of cerebral circulation, 46 (8). pp. 2252-9. ISSN 0039-2499 DOI:

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Differences in stroke care and outcomes reported in Europe may reflect different degrees of implementation of evidence-based interventions. We evaluated strategies for implementing research evidence into stroke care in 10 European countries. A questionnaire was developed and administered through face-to-face interviews with key informants. Implementation strategies were investigated considering 3 levels (macro, meso, and micro, eg, policy, organization, patients/professionals) identified by the framing analysis, and different settings (primary, hospital, and specialist) of stroke care. Similarities and differences among countries were evaluated using the categorical principal components analysis. Implementation methods reported by ≥7 countries included nonmandatory policies, public financial incentives, continuing professional education, distribution of educational material, educational meetings and campaigns, guidelines, opinion leaders', and stroke patients associations' activities. Audits were present in 6 countries at national level; national and regional regulations in 4 countries. Private financial incentives, reminders, and educational outreach visits were reported only in 2 countries. At national level, the first principal component of categorical principal components analysis separated England, France, Scotland, and Sweden, all with positive object scores, from the other countries. Belgium and Lithuania obtained the lowest scores. At regional level, England, France, Germany, Italy, and Sweden had positive scores in the first principal component, whereas Belgium, Lithuania, Poland, and Scotland showed negative scores. Spain was in an intermediate position. We developed a novel method to assess different domains of implementation in stroke care. Clear variations were observed among European countries. The new tool may be used elsewhere for future contributions.

Item Type: Article
Faculty and Department: Faculty of Public Health and Policy > Dept of Health Services Research and Policy
PubMed ID: 26111887
Web of Science ID: 359972200050


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