Title: Enhancing and disseminating the outputs of the Promoting Effective and Rapid Stroke Care (PEARS) NIHR PGfAR Programme Grant & facilitating thrombectomy implementation in England
Funder: Department of Health and Social Care

Abstract: Background Acute ischaemic stroke (AIS) caused by large arterial occlusion (LAO) is the most devastating form of the condition, with a disproportionately poor outcome compared with stroke overall. Thrombectomy has become established as the gold standard of care in LAO stroke offering major clinical benefit over intravenous thrombolysis (IVT) or &quot;clotbusting&quot; drugs alone. However, the implementation of MT has been slow and disappointing to date in the UK generally - with still Aims and objectives Enhanced dissemination, upgrading and engagement regarding the PEARS Interface for Thrombectomy Economic Modelling and outcomeS in stroke (ITEMS) webtool Establish the state of Thrombectomy implementation in England in Q1 of 2021, categorise current best practice, identify and highlight barriers to thrombectomy implementation along the pathway Examine and understand public and stroke survivor acceptability (or otherwise) of ambulance redirection (bypass) to facilitate thrombectomy Perform secondary data analysis on PEARS Programme data to establish optimum sensitivity/specificity level for &ldquo;ideal diagnostic tools&rdquo; to inform a policy of ambulance bypass and to inform our Patient, Carer and Public Engagement and Involvement (PCPEI) work in this area Develop a community of practice for all thrombectomy centres to promote optimum MT implementation working in partnership with other influential organisations, including the Stroke Association (SA); aided by establishing a virtual international advisory panel to advise on overcoming barriers to thrombectomy. Work plan ITEMS webtool upgraded to incorporate effects of ambulance redirection and hosted in an enhanced and more user friendly format Secondary data analysis on PEARS ambulance redirection data to inform both ITEMS upgrade and PCPEI activity PCPEI activity with LCRN/SA Stroke Patient and Carer panels around ambulance redirection Dissemination of ITEMS to commissioners/stroke networks Development of a &ldquo;Thrombectomy Community of Practice&rdquo; - via survey/SSNAP data analyses of baseline thrombectomy implementation Q1 2021; barriers advice tendered by virtual international expert panel; then hosting an implementation and facilitatory meeting of Thrombectomy units delivered in conjunction with relevant partners with ongoing support after the meeting to build the community of practice concept Anticipated impact and dissemination An enhanced decision support tool for commissioners of stroke services &ndash; particularly aimed at the new integrated stroke care networks, which did not exist when the PEARS programme was running. Establish PCPEI perceptions around ambulance redirection (bypass) in stroke care to inform commissioning and the webtool enhancements. Facilitate knowledge round best practice in thrombectomy along the care pathway for LAO stroke patients and develop improved knowledge sharing and indeed service networking by developing a thrombectomy community of practice. Demonstrate acceleration in thrombectomy rates whilst maintaining standards of performance (technical, process and outcome). Open access publications around the above activities.

Lay abstract: Background: The most devastating form of stroke, accounting for 1/3 of strokes, is caused by blockage of a large brain artery. &quot;Clotbusting&quot; drugs given intravenously have limited effectiveness in this stroke type. Removal of the blockage via a fine tube passed through an artery in the groin and guided using X-Rays to the blocked artery- known as thrombectomy- has become established as the best treatment for this type of stroke. In previous research, Promoting Effective And Rapid Stroke care (PEARS), we confirmed its' effectiveness and safety. We calculated the numbers eligible and modelled the best way of providing thrombectomy nationally. We developed an online tool for healthcare commissioners to aid decision-making around stroke services. This is called the PEARS Interface for Thrombectomy Economic Modelling and outcomeS in stroke (ITEMS) webtool. Whilst PEARS work has influenced commissioning of thrombectomy services, delivery of thrombectomy has been disappointing in the UK so far. Up to 12% of stroke patients are eligible, yet fewer than 1 in 8 of those receive thrombectomy. Aims Undertake extra analysis on earlier research to clarify if ambulance redirection might improve provision of thrombectomy for stroke. We will explore the views of stroke survivors on this. Ambulance redirection means that an ambulance takes a patient direct to a hospital that can deliver all stroke treatments, even if that means bypassing a nearer hospital. Improve our webtool. Clarify barriers to delivering thrombectomy. Organise a meeting of thrombectomy units to review problems, present solutions, to promote better networking and thrombectomy services. Work Plan Make ITEMS webtool more accessible and easier to use; incorporate effects of ambulance redirection into it. Demonstrate webtool to commissioners/providers. Perform additional analysis on PEARS data to complete aim 1 and to facilitate PCPEI consultation on ambulance redirection. Assess extent of, and barriers to, thrombectomy delivery in England Identify how barriers to thrombectomy are addressed internationally; learn from their experience Investigate stroke survivors/carers opinions of ambulance redirection (by focus groups). Bring thrombectomy units together to present survey findings and to promote best practice. Mr Burgess, a stroke carer, involved with PEARS since 2014, has an enhanced role in this project. The Stroke Association and lay members from Intercollegiate Stroke Working Party will be involved in supporting several parts of this project. Outcomes Gain clear understanding of the impact of ambulance redirection on thrombectomy provision. Provision of improved (ITEMS) webtool. Identification of patient/carer perceptions around ambulance redirection in stroke to inform service commissioning and provision. Identify barriers to thrombectomy provision; learn lessons from international experience in how to overcome them. Promote best practice & facilitation of networking by thrombectomy units developed into a &quot;Community of Practice&quot; to improve thrombectomy provision. Open access publications reporting work.

Research activity codes: 8.1 ORGANISATION AND DELIVERY OF SERVICES
Health categories: STROKE