ESO East Supplement 2023 - 41

Kõrv et al.
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Figure 5. The timeline of developments of stroke care quality in Estonia from 2003 to 2021 (ESO-EAST: European Stroke
Organisation - Enhancing and Accelerating Stroke Treatments project; IVT: intravenous thrombolysis; MT: mechanical
thrombectomy; RES-Q: Registry of Stroke Care Quality; SITS: Safe Implementation of Treatments in Stroke).
using uniform protocols in all stroke-ready hospitals.19 The
registering of fever, blood sugar, swallowing data has also
been incorporated into the new collection form of RES-Q
and thereby enabling monitoring and analysing these basic
principles of stroke unit care.
Rehabilitation and secondary prevention
The availability of inpatient post-stroke rehabilitation after
stroke has been a general problem in Estonia. Although the
proportion of patients receiving rehabilitation is slowly
increasing, it has somewhat decreased during the COVID19
pandemic. However, after the recognition of the shortcoming
by the stakeholders, there have been some
improvements also on the availability of outpatient rehabilitation
and the early supported discharge will be the main
focus in the future.
The proportion of patients receiving antiplatelets in secondary
stroke prevention is good according to the RES-Q
data. However, as aspirin is purchased without prescription,
the adherence to treatment cannot be monitored after the
ischemic stroke.
At discharge, nearly all patients are prescribed anticoagulants
according to RES-Q data, but after 1 year following
stroke approximately 50% receive the treatment. This
could reflect a treatment adherence issue. All direct OACs
are available and are reimbursed to the patients by 75%-
90%. However, part of the low proportion could be related
to data collection methodology. The RES-Q evaluates the
time of discharge from the hospital and the national quality
indicator is evaluated 1 year after stroke. Moreover, the
national indicators reflect the proportion from all patients
having the prescription not only surviving patients.
Life after stroke
In 2020, an innovation project funded by the EHIF focusing
on improving life after stroke - rehabilitation, social support,
returning to work, and patient's quality of life was initiated
and is ongoing in four hospitals.20
The aim of the project is to improve patients' quality of
life through developing more integrated care pathway from
the patient's perspective. The project contains three activities:
(1) The development projects at the hospitals. The
development projects in 4/6 hospitals providing acute
stroke care get extra funding from the EHIF's innovation
and the participating hospitals use different solutions and
collaboration with the aim to improve stroke pathway and
life after stroke. The patients' representatives are also a
member of the steering committee; (2) Collecting outcomes
to understand the patients' wellbeing and to improve their
health outcomes using stroke standard set including patientreported
outcome measures.21 Benchmarking enables to
detect and learn from best practices. After the pilot the
measuring can be extended to other hospitals and conditions;
(3) Changing the payment into a bundled payment
model: testing a new, bundled payment model for the whole
stroke care pathway.
While data collection and monitoring mostly show the
level of stroke care, there are several important aspects that
lead to these results and contribute to the constant improvement
in care quality (Figure 5).
Estonian Stroke Initiative (ESI)
For 13 years, ESI has contributed to the education of stroke
neurologists in Estonia and it has helped to achieve equal
quality results at a national level. Educating also other
members of the stroke care team will be given more attention
in the future. ESI and ENNS have also been the primary
partners for collaborations with governmental
authorities and have continuously enhanced the improvement
of stroke care quality in Estonia.
Stroke action plan
Estonia is actively participating in the Stroke Action Plan in
Europe initiative.22 We have compiled a comprehensive
group of different organizations (societies of medical professionals,
patient organization, governmental institutions)

ESO East Supplement 2023

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