Main barriers to effective implementation of stroke care pathways in France: a qualitative study

Kristel Gache, Henri Leleu, Gérard Nitenberg, France Woimant, Marie Ferrua and Etienne Minvielle ()
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Kristel Gache: COMPAQ(HSPT) - U988 - COordination pour la Mesure de la Performance et l'Amélioration de la Qualité ( Hôpital, Patient, Sécurité, Territoire) - IGR - Institut Gustave Roussy - EHESP - École des Hautes Études en Santé Publique [EHESP] - INSERM - Institut National de la Santé et de la Recherche Médicale
Henri Leleu: LEM - Lille - Economie et Management - Université de Lille, Sciences et Technologies - CNRS - Centre National de la Recherche Scientifique, COMPAQ(HSPT) - U988 - COordination pour la Mesure de la Performance et l'Amélioration de la Qualité ( Hôpital, Patient, Sécurité, Territoire) - IGR - Institut Gustave Roussy - EHESP - École des Hautes Études en Santé Publique [EHESP] - INSERM - Institut National de la Santé et de la Recherche Médicale
Gérard Nitenberg: COMPAQ(HSPT) - U988 - COordination pour la Mesure de la Performance et l'Amélioration de la Qualité ( Hôpital, Patient, Sécurité, Territoire) - IGR - Institut Gustave Roussy - EHESP - École des Hautes Études en Santé Publique [EHESP] - INSERM - Institut National de la Santé et de la Recherche Médicale
France Woimant: ARS IDF - Agence Régionale de Santé Ile-de-France [Paris]
Marie Ferrua: COMPAQ(HSPT) - U988 - COordination pour la Mesure de la Performance et l'Amélioration de la Qualité ( Hôpital, Patient, Sécurité, Territoire) - IGR - Institut Gustave Roussy - EHESP - École des Hautes Études en Santé Publique [EHESP] - INSERM - Institut National de la Santé et de la Recherche Médicale, IGR - Institut Gustave Roussy
Etienne Minvielle: COMPAQ(HSPT) - U988 - COordination pour la Mesure de la Performance et l'Amélioration de la Qualité ( Hôpital, Patient, Sécurité, Territoire) - IGR - Institut Gustave Roussy - EHESP - École des Hautes Études en Santé Publique [EHESP] - INSERM - Institut National de la Santé et de la Recherche Médicale, IGR - Institut Gustave Roussy, EA MOS - EA Management des Organisations de Santé - EHESP - École des Hautes Études en Santé Publique [EHESP] - PRES Sorbonne Paris Cité, EHESP - École des Hautes Études en Santé Publique [EHESP]

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Abstract: Background: Stroke Care Pathways (SCPs) aim to improve quality of care by providing better access to stroke units, rehabilitation centres, and home care for dependent patients. The objective of this study was to identify the main barriers to effective implementation of SCPs in France. Methods: We selected 4 types of SCPs currently implemented in France that differed in terms of geographical location, population size, socio-economic conditions, and available health care facilities. We carried out 51 semi-structured interviews of 44 key health professionals involved in these SCPs and used the interview data to (i) create a typology of the organisational barriers to effective SCP implementation by axial coding, (ii) define barrier contents by vertical coding. The typology was validated by a panel of 15 stroke care professionals. Results: Four main barriers to effective SCP implementation were identified: lack of resources (31/44 interviewees), coordination problems among staff (14/44) and among facilities (27/44), suboptimal professional and organisational practices (16/44), and inadequate public education about stroke (13/44). Transposition of the findings onto a generic SCP highlighted alternative care options and identified 10 to 17 barriers that could disrupt continuity of care. Conclusion: Lack of resources was considered to be the chief obstacle to effective SCP implementation. However, the main weakness of existing SCPs was poor communication and cooperation among health professionals and among facilities. We intend to use this knowledge to construct a robust set of quality indicators for use in SCP quality improvement initiatives, in comparisons between SCPs, and in the assessment of the effective implementation of clinical practice guidelines.

Keywords: Implementation barriers; Care coordination; Quality of care; Clinical pathways; Stroke (search for similar items in EconPapers)
Date: 2014
Note: View the original document on HAL open archive server: https://hal.science/hal-01509874
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Citations: View citations in EconPapers (1)

Published in BMC Health Services Research, 2014, 14, pp.95. ⟨10.1186/1472-6963-14-95⟩

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Persistent link: https://EconPapers.repec.org/RePEc:hal:journl:hal-01509874

DOI: 10.1186/1472-6963-14-95

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