Methods of Implementation of Evidence-based Stroke Care in Europe: The EIS Collaboration

Background and Purpose-- 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 ten European countries. Methods--A questionnaire was developed and administered through face-to-face interviews with key informants. Implementation strategies were investigated considering three levels (macro, meso, and micro, e.g., policy, organisation, patients/professionals) identified by the framing analysis, and different settings (primary, hospital, specialist) of stroke care. Similarities and differences among countries were evaluated using the Categorical Principal Components Analysis (CATPCA). Results--Implementation methods reported by seven or more countries included non-mandatory 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 six countries at national level; national and regional regulations in four countries. Private financial incentives, reminders, and educational outreach visits were reported only in two countries. At national level, the first principal component of CATPCA 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, while Belgium, Lithuania, Poland, and Scotland showed negative scores. Spain was in an intermediate position. Conclusions--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.