Enhancing and accelerating stroke treatment in Eastern European region: Methods and achievement of the ESO EAST program

Abstract

Introduction Despite the availability of prevention and therapies of stroke, their implementation in clinical practice, even of low-cost ones, remains poor. In 2015, the European Stroke Organisation (ESO) initiated the ESO Enhancing and Accelerating Stroke Treatment (EAST) program, which aims to improve stroke care quality, primarily in Eastern Europe. Here, we describe its methods and milestones. Patients and methods The ESO EAST program is using an implementation strategy based on a ‘detecting-understanding-reducing disparities’ conceptual framework: stroke care quality is first measured (after developing a platform for data collection), gaps are identified in the current service delivery, and ultimately feedback is provided to participating hospitals, followed by the application of interventions to reduce disparities. The ESO EAST program is carried out by establishing a stroke quality registry, stroke management infrastructure, and creating education and training opportunities for healthcare professionals. Results Program management and leadership infrastructure has been established in 19 countries (Country Representatives in 22 countries, National Steering Committee in 19 countries). A software platform for data collection and analysis: Registry of Stroke Care Quality was developed, and launched in 2016, and has been used to collect data from over 90,000 patients from >750 hospitals and 56 countries between September 2016 and May 2019. Training in thrombolysis, nursing and research skills has been initiated. Discussion ESO EAST is the first pan-Eastern European (and beyond) multifaceted quality improvement intervention putting evidence-informed policies into practice. Continuous monitoring of stroke care quality allows hospital-to-hospital and country-to-country benchmarking and identification of the gaps and needs in health care.

Ischemic stroke mimics: A comprehensive review

“…Ischemic stroke is the leading cause of disability and one of the leading causes of death. Enourmous efforts have been recently made to improve the clinical outcome of stroke patients including testing up comprehensive stroke units and the introducting endovascular procedures [1]. The benefit of revascularisation procedures (both intravenous thrombolysis and endovascular procedures) is time-dependent, therefore shortening door-to-needle time is crucial in the emergency department [2].…”

Establishing Stroke Services in the Republic of Georgia

“…The Georgian stroke initiative is, despite many limitations, a successful result of the ESO initiative at Enhancing and Accelerating Stroke Treatment in the Eastern European Region (ESO EAST) [1,23,24]. A recent survey in 44 European countries discovered disparities in acute stroke treatment in Europe.…”

Nationwide screening for Fabry disease in unselected stroke patients

“…Clinical data were collected in the Registry of Stroke Care Quality (RES-Q), an internet-based registry database used for continuous monitoring of the quality of stroke care by all certified stroke centers in the Czech Republic and the countries participating in European Stroke Organisation Enhancing and Accelerating Stroke Treatment (ESO—EAST) program [ 11 ]. Although RES-Q is primarily designed for monitoring the quality and especially the logistics of acute stroke care, we added a specific database entry on the inclusion in the study during the study periods.…”

“…We collected demographic characteristics (age, gender), type of cerebrovascular event, stroke risk factors (hypertension, atrial fibrillation, carotid stenosis, previous stroke), initial stroke severity (NIHSS stroke scale), and clinical outcome at discharge (mRS scale). The full list of clinical parameters included in the RES-Q database was published in detail previously [ 11 ]. There was no predefined set of required clinical investigations.…”