How do patients pass through stroke services? Identifying stroke care pathways using national audit data.

This is routine audit data, not a randomised comparison, so differences between pathways cannot prove that one service configuration caused better outcomes. Patients who died, were discharged or transferred for palliative care within three days were excluded, so the pathways do not represent all stroke patients. Stroke team type and community care were classified from audit variables, and the authors note possible misclassification. Missing data made ethnicity and social deprivation differences difficult to interpret. Data were collected during a period of service reorganisation, so some stroke teams may have changed classification. Costs were average reference costs and cannot show patient-level variation or prove cost-effectiveness. The study describes service pathways and therapy volumes, not the effectiveness of any therapy.

Funding was from the National Institute for Health Research. The authors declared links to SSNAP: A.B. was until 2016 a member of the Intercollegiate Stroke Working Party that produces SSNAP and had university salary part-funded by a personal award from Stroke Association; S.T. is currently a member of that working party; and B.B. and L.P. were employed by SSNAP at the time of the analysis.

Do not read these pathways as evidence that one stroke service configuration causes better recovery or lower cost. The study is observational, patients differed in stroke severity and premorbid disability, and the authors state that causation and cost-effectiveness cannot be inferred.