Transcript Cost of stroke

Translational research

‘practice based research in health
promotes the study of the process of care,
raises new questions, includes patient
knowledge and preferences - and is the
final common pathway for improving
individual patient care and outcomes ‘
Westfall, Mold, Fagnan 2007
A shift in paradigm?

‘practice-based research provides the
laboratory that will help generate new
knowledge and bridge the chasm between
recommended care and improved health ‘

‘Practice-based research is a crucial scientific
step - between the great advances of the next
25 years and the millions who want to live a
long and healthy life’

Westfall, Mold, Fagnan 2007
Mortality in Stroke survivors at
10 yrs = 82%
Recurrent stroke leads to a
stepwise decline into dependency.
“Risk for stroke recurrence
lowered by 80% if risk factors
are managed correctly”
Hachinski 2002
Management of risk factors
In stroke survivors
Attempts to address problem
CHAMP (cardiac)
PROTECT (stroke)--initiation in hospital
Get with the Guidelines (stroke) --web page
CASPR (stroke)--standardized orders
Can Telemedicine assist in
reaching this goal?
Study Type
Reference
RCT
Mayo NE, et al,
2007
Cohort Study
Bosworth HB, et
al, 2000
Weimar C, et al,
2002
Cohort Study
Comparative
Study
Randomised
Study
Kawas C, et al,
1995
Duncan P, et al
2005
Validation
Study
Kwon S, et al,
2006
T elemedicine Intervention
Telephone calls by nursing care
coordinator over 6 weeks after
discharge, and at 6 months
Telephone interviews at 1, 6
and 12 months
Telephone follow-up at 100
days and 1 year post discharge.
T arget population
190 post-stroke
patients
1073 post-stroke
patients
4264 Post-stroke
patients from 30
hospitals
Use of Telephone and in-person 84 subjects
to test cognitive abilities
Measuring stroke impact using 458 patients with
telephone interviews compared stroke
to mail at 12 weeks post stroke
Measuring stroke impact using 136 post stroke
telephone interviews at 12 and patients from 13
16 weeks post stroke
VA hospitals
Study Type
Reference
T elemedicine Intervention
RCT
Grant JS et al,
2002 *
T elephone contact strategy for
problem solving therapy over
18 months.
RCT
Boter H, 2004 *
Qualitative
study
Pierce 2004
Needs Study
Demeris G,
Shigaki CL,
Schopp LH, 2005
Buckley KM,
Tran BQ,
Prandoni CM,
2004
Lutz BJ,
Chumbler NR,
Roland K, 2007
Outreach care included 3
536 Post Hospital
telephone calls and a home visit Stroke Patients and
within 5 months of discharge.
Infor mal Care
Givers.
Internet based education and
9 Caregivers of
support
patients with
stroke
Assessment of needs for client
43 health
Š oriented rural telehealth
professionals
network by interview
T ele-health nurses use
21 family
videophones to contact
caregivers of
caregivers
stroke patients
Descriptive
Study
Needs Study
Interviews to identify unmet
post-discharge needs for
existing care coordination and
home-telehealth services
Stroke Survivors
and Caregivers
74 Stroke
Survivors and
Caregivers
22 post stroke
patients (3mths to
5 years) and carers
Elements
Integration of hospital and primary care
Surveillance of risk factor management
Long-term sustainability of the process
Track record
GPEP randomized control trial 2000-2005
HARP program 2006
Systolic blood pressure
sBP
138
136
mmHg
134
Treatment
132
Control
130
128
126
Discharge
(mmHg):
Treatment
12 months
5.1
Control
T-test
ANCOVA
6.0
-1.0
p = .07
p = .03
Change scores
-2.1
p = .01
• 12-month target of <140 mmHg: 66/89 (74%) of treatment group, 52/89 (58%) of
control group (p < .05).
Systolic BP
sBP
140
138
136
mm Hg
134
IC
132
SC
130
128
126
124
Discharge
12 months
Change scores: 6.0 (IC) vs –1.8 (SC)
T-test: p = 0.02
ANCOVA (age, sex, Rankin, baseline sBP): p = 0.04
BMI
BMI
30
29
IC
28
SC
27
26
Discharge
12 months
Change scores: 0.5 (IC) vs –0.3 (SC)
T-test: p = 0.04
ANCOVA (age, sex, Rankin, baseline BMI): p = 0.007
Walks
Walks per week
6
5
4
IC
3
SC
2
1
0
Discharge
12 months
Change scores: 0.8 (IC) vs –0.7 (SC)
T-test: p = 0.001
ANCOVA (age, sex, Rankin, baseline walks per week): p < 0.001
Risk factor advice
Patients receiving risk factor advice
100
90
80
70
%
60
IC
SC
50
40
30
20
10
0
BP
Cholesterol
Smoking
Alcohol
Salt
intake/weight
Physical
activity
Blood
glucose
Significant group differences: BP, cholesterol, alcohol, physical activity
and blood glucose.
Depression
Patients depressed at 12 months
100
90
80
70
%
60
IC
50
SC
40
30
20
10
0
12 months
PHQ-9 score of 5 or greater reflected depressive symptoms.
At 12 months, 30/91 (33%) IC patients exhibited depressive symptoms,
compared to 52/95 (55%) SC patients (χ2 = 8.9, p = 0.003).
AQoL
AQoL
31
30
29
28
IC
27
SC
26
25
24
23
Discharge
12 months
Higher score indicates lower quality of life.
Change scores – T-test: p = 0.002
– ANCOVA (age, sex, Rankin, baseline AQoL): p = 0.012
Disability
Rankin
2.5
2
1.5
IC
SC
1
0.5
0
Discharge
12 months
Higher score indicates greater disability.
Change scores – T-test: p = 0.012
– ANCOVA (age, sex, baseline Rankin): p = 0.003
Weight
BMI
30
29
Treatment
28
Control
27
26
Discharge

Change scores (BMI):
12 months
Treatment
0.50
Control
-0.32
T-test
p = .04
ANCOVA p = .03
Depression
Patients with depressive symptoms
100
90
80
70
%
60
Treatment
50
Control
40
30
20
10
0
12 months
Score of 5 or above on PHQ-9:
Treatment
Control
31/92 (34%)
51/94 (54%)
χ2 = 8.0, p < .01
Questions


How can we promote translation of evidence-based
recommendations?
How can we take these items of transferrable
knowledge and make them culturally and health
services appropriate for other systems?

What works and how can we maintain the key
elements?

Diversity--not a problem but an asset.

How can long-term sustainability be promoted?
Adapted, streamlined model
ICARUSS
Integrated Care for Risk
Reduction in Stroke Survivors
ICARUSS
An integrated model of care
The translation of evidence-based
recommendations for secondary stroke
prevention into practice
Traditional model
Dichotomy hospital and primary care system
Defective information flow between two systems
Passive role of patient and carer



Integrated care model ( ICARUSS)




Ongoing information and data transfer between GP,coordinator,
carer and patient, sharing of expertise (Telemedicine)
Propelled by informed carer/patient Ongoing educational aspect
Availability of advice (shared care element)
Sustainability maintained by Chronic Disease Management
Model,
combines
Recommendations commenced in hospital
Protocols for management
Ongoing surveillance
Long-term sustainability
Components of the ICARUSS model

Patient risk profile established in hospital

Identifiction of Carer

Patient and carer education begins in hospital, continuing as groups in community.

Patient and carer assume responsibility role

Telephone tracking ( stratified according to patient profile)

Patient/carer-held document (guidelines, documentation)

Bi-directional information flow (Hospital, coordinator, GP, patient and carer)

Data base entry and surveillance

Clear guidelines for GP ( Flow-chart) mirrored in patient/carer-held document

GP access to telephone advice from specialist ( Shared Care component)

Model of Chronic Disease Management ( Long-term patient and carer support and
involvement, continued data return, surveillance and coordinator contact)
Patient and carer empowerment



Encouraging assumption of
responsibility by patient and/carer
Based on “active” Epilepsy model
Guided by hand-held document
mirroring that of GP
Telephone tracking

According to risk stratification

Semi-structured interview
Educational aspect

3-monthly pre-and post GP visit

relationship)





Structured interview
Data to GP
Post-call --?data faxed
Inexpensive
Outlook
(only if regular GP
Bi-directional information transfer
Traditional model was unidirectional
Integrated care model is bi-directional





Clear directions on flow chart to both patient and primary care
doctor
3 monthly information to GP (if available)
Serial data transfer back to coordinator
Surveillance of data
Reaction to persistent discrepancies
Chronic Disease Management model

Groups (8-10 patients)

Selected on locality/culture/language

Leader ( patient, carer or volunteer)



Structured personal education by coordinator
Telephone contact networking with group
Monthly telephone report to coordinator

Meet as individual group and as part of the educational
sessions run by coordinator

Leader to continue telephone contact and surveillance
during and after exit from one year program

Leader to continue ensuring data return after exit
POST DISCHARGE
HOSPITAL
Stratified telephone tracking related to patient risk profile
High
Medium
Low
CO-ORDINATOR
Coordinator makes
contact with patient or
carer
PATIENT
Patient is discharged
from hospital or
rehabilitation facility.
Pre
Visit
Call
Post
Visit
Call
Pre
Visit
Call
Post
Visit
Call
GP folder, clinical
summary and letters
sent to GP.
Pre
Visit
Call
Post
Visit
Call
Pre
Visit
Call
Home
Visit
v
3-month visit
Randomisation
and baseline data
collection
6-month visit
9-month visit
12-month visit
GENERAL PRACTITIONER
See Fig 2. For
detail.
Ongoing support and medical advice to GP’s
NEUROLOGIST
Discharge information review
and telephone contact with GP
Independent
Patient Review
at Stroke
Follow-up
Clinic
Fig. 1. Diagrammatic Representation of the Integrated Care Model
HOSPITAL
3-MONTH POST
DISCHARGE VISIT
DISCHARGE
CO-ORDINATOR
Stratified telephone
tracking related to
risk factor profile.
Pre
Visit
Call
Data Faxed to
Coordinator
Post
Visit
Call
PATIENT
3-month visit
GENERAL PRACTITIONER
Data Faxed
to GP
Support
to GP
NEUROLOGIST
Fig. 2. Diagrammatic Representation of 3–monthly Visit Flow
EDC Generated
Document Folders
Control Patient 12month Follow-up Letter
Pre-Printed
Risk Factor Brochures
David Jackson
Senior Stroke Research Coordinator
Department of Neurology
The Royal Melbourne Hospital
Parkville VIC 3052
Phone: +61 3 9342 7598
Fax:
+61 3 9342 7444
David Jackson
Senior Stroke Research Coordinator
Department of Neurology
The Royal Melbourne Hospital
Parkville VIC 3052
Phone: +61 3 9342 7598
Fax:
+61 3 9342 7444
Intervention Patient 12month Follow-up Letter
3-month Worksheet
Reducing Risk For Stroke Recurrence By An
Integrated, Multimodal Model Of Care
Reducing Risk For Stroke Recurrence By An
Integrated, Multimodal Model Of Care
The ICARUSS Program
The ICARUSS Program
1/05/2007
31/01/2008
David Jackson
Senior Stroke Research Coordinator
Department of Neurology
The Royal Melbourne Hospital
Parkville VIC 3052
Phone: +61 3 9342 7598
Fax:
+61 3 9342 7444
Dear Dr.
Thank you for agreeing to participate in this study.
The National Ageing Research Institute the Royal Melbourne Hospital and the
National Stroke Research Institute have initiated this research project to address
the benefit of a structured, shared care model in the management of vascular
risk factors and depression for patients discharged from hospital after stroke.
.
Reducing Risk
The process consists of:



Dear Dr.
Thank you for agreeing to participate in this study.
ICARUSS Program



Dear Dr.
It is hoped that this process will facilitate the management and follow-up of stroke patients
with particular reference to modifiable vascular risk factors and post-stroke depression.
Thank you for agreeing to participate in this study.

Attached, please find a clinical summary, which includes a risk factor profile,
medications, plans for management and an ability profile that depicts function in the
areas of:
David Jackson
Senior Stroke Research Coordinator
Department of Neurology
The Royal Melbourne Hospital
Parkville VIC 3052
Phone: +61 3 9342 7598
Fax:
+61 3 9342 7444
An indication of the presence (or not) of depression/anxiety inReducing
the patient
post discharge
Risk For Stroke Recurrence By An
Integrated, Multimodal Model Of Care
If you have any queries, please contact David Jackson at 9342 7598 or fax: 9342 7444
It is hoped that this process will facilitate the management and follow-up of stroke patients
with particular reference to modifiable vascular risk factors and post-stroke depression.
Yours sincerely,
David Jackson Senior Stroke Research Coordinator
Jacques Joubert MB CHB, MRCP, FRACS
6-month
Worksheet
6-month
Worksheet
Incorporation of a patient held risk factor worksheet into follow-up visits by
the general practitioner
Regular telephone tracking of the patient for visits and the appropriate
blood tests
An indication of the presence (or not) of depression/anxiety in the patient
post discharge
It is hoped that this process will facilitate the management and follow-up of stroke patients
with particular reference to modifiable vascular risk factors and post-stroke depression.
Attached, please find a clinical summary, which includes a risk factor profile,
The National Ageing Research Institute the Royal Melbourne Hospital and the
medications, plans for management and an ability profile that depicts function in the
National Stroke Research Institute have initiated this research project to address
areas of:
the benefit of a structured, shared care model in the management of vascular
risk factors and depression for patients discharged from hospital after stroke.

mental status
.

motor function
The process consists of:

verbal expression

understanding

Incorporation of a patient held risk factor worksheet into follow-up visits by

incontinence
the general practitioner

Regular telephone tracking of the patient for visits and the appropriate
The project manager will forward you a patient status report on a regular basis.
blood tests
The study will in no way interfere with your management of the patient.
v
The National Ageing Research Institute the Royal Melbourne Hospital and the
National Stroke Research Institute have initiated this research project to address
the benefit of a structured, shared care model in the management of vascular
risk factors and depression for patients discharged from hospital after stroke.
.
The process consists of:
Control Patient Letter of
Thanks
For Stroke Recurrence By An
Integrated, Multimodal Model Of Care
Incorporation of a patient held risk factor worksheet into follow-up visits by
the general practitioner
The
Regular telephone tracking of the patient for visits and the appropriate
blood tests
1/05/2007
An indication of the presence (or not) of depression/anxiety in the patient
post discharge
The ICARUSS Program
Intervention Patient
Letter of Thanks
Attached, please find a clinical summary, which includes a 1/05/2007
risk factor profile,
medications, plans for management and an ability profile that depicts function in the
areas of:
Dear Dr.

mental status
Thank you for agreeing to participate in this study.

motor function

verbal expression
The National Ageing Research Institute the Royal Melbourne Hospital and the

understanding
National Stroke Research Institute have initiated this research project to address

incontinence
the benefit of a structured, shared care model in the management of vascular
factors
and depression for patients discharged from hospital after stroke.
The project manager will forward you a patient status report onrisk
a regular
basis.
.
The process consists of:
The study will in no way interfere with your management of the patient.
For Stroke Recurrence By An
Multimodal Model Of Care
v
9-month
Worksheet
9-month
Worksheet
Yours sincerely,
v
12-month Worksheet
12-month Worksheet
ICARUSS Program
Attached, please find a clinical summary, which includes a risk factor profile,
medications, plans for management and an ability profile that depicts Dear
function
Dr. in the
areas of:
Thank you for agreeing to participate in this study.
mental status
mental status
motor function
verbal expression
understanding
incontinence
The study will in no way interfere with your management of the patient.
If you have any queries, please contact David Jackson at 9342 7598 or fax: 9342 7444
David Jackson Senior Stroke Research Coordinator
Jacques Joubert MB CHB, MRCP, FRACS
David Jackson
Senior Stroke Research Coordinator
Department of Neurology
The Royal Melbourne Hospital
Parkville VIC 3052
Phone: +61 3 9342 7598
Fax:
+61 3 9342 7444
 7444
Incorporation of a patient held risk factor worksheet into follow-up visits by
If you have any queries, please contact David Jackson at 9342 7598 or fax: 9342
the general practitioner

Regular telephone tracking of the patient for visits and the appropriate
Yours sincerely,
Reducing Risk
blood tests
Integrated,

An indication of the presence (or not) of depression/anxiety in the patient
post discharge
The
David Jackson Senior Stroke Research Coordinator
It is hoped that this process will facilitate the management and follow-up of stroke patients
Jacques Joubert MB CHB, MRCP, FRACS
with particular reference to modifiable vascular risk factors and post-stroke1/05/2007
depression.






The project manager will forward you a patient status report on a regular basis.

motor function
The National Ageing Research Institute the Royal Melbourne Hospital and the

verbal expression
National Stroke Research Institute have initiated this research project to address

understanding
the benefit of a structured, shared care model in the management of vascular

incontinence
risk factors and depression for patients discharged from hospital after stroke.
.
The project manager will forward you a patient status report on a regular
basis.
The process
consists of:
The study will in no way interfere with your management of the patient.
vv

Incorporation of a patient held risk factor worksheet into follow-up visits by
the general practitioner
If you have any queries, please contact David Jackson at 9342 7598 or fax: 9342 7444

Regular telephone tracking of the patient for visits and the appropriate
blood tests
Yours sincerely,

An indication of the presence (or not) of depression/anxiety in the patient
post discharge
It is hoped that this process will facilitate the management and follow-up of stroke patients
with particular reference to modifiable vascular risk factors and post-stroke depression.
David Jackson Senior Stroke Research Coordinator
Jacques Joubert MB CHB, MRCP, FRACS
Attached, please find a clinical summary, which includes a risk factor profile,
medications, plans for management and an ability profile that depicts function in the
areas of:
12-month Follow-up
Letter





mental status
motor function
verbal expression
understanding
incontinence
The project manager will forward you a patient status report on a regular basis.
The study will in no way interfere with your management of the patient.
If you have any queries, please contact David Jackson at 9342 7598 or fax: 9342 7444
Yours sincerely,
David Jackson
Senior Stroke Research Coordinator
Department of Neurology
The Royal Melbourne Hospital
Parkville VIC 3052
Phone: +61 3 9342 7598
Fax:
+61 3 9342 7444
David Jackson Senior Stroke Research Coordinator
Jacques Joubert MB CHB, MRCP, FRACS
Pre-visit Datasheet
Reducing Risk For Stroke Recurrence By An
Integrated, Multimodal Model Of Care
The ICARUSS Program
1/05/2007
Dear Dr.
Thank you for agreeing to participate in this study.
David Jackson
Senior Stroke Research Coordinator
Department of Neurology
The Royal Melbourne Hospital
The National Ageing Research Institute the Royal Melbourne Hospital and the
National Stroke Research Institute have initiated this research project to address
the benefit of a structured, shared care model in the management of vascular
risk factors and depression for patients discharged from hospital after stroke.
.
The process consists of:



Parkville VIC 3052
Phone: +61 3 9342 7598
Fax:
+61 3 9342 7444
Incorporation of a patient held risk factor worksheet into follow-up visits by
the general practitioner
Risk For Stroke Recurrence By An
Regular telephone tracking of the patient for Reducing
visits and the appropriate
blood tests
Integrated, Multimodal Model Of Care
An indication of the presence (or not) of depression/anxiety in the patient
post discharge
The ICARUSS Program
Pre-visit Letter
It is hoped that this process will facilitate the management and follow-up of stroke patients
with particular reference to modifiable vascular risk factors and post-stroke depression.
23/07/2007
Attached, please find a clinical summary, which includes a risk factor profile,
medications, plans for management and an ability profile that depicts function in the
areas of:
Dear Dr Einstein,





mental status
motor function
verbal expression
understanding
incontinence
RE: Jed Carter. 3-month after discharge Integrated Care Visit.
After my telephone conversation with your patient and carer the following have been
determined
Current Problems
The project manager will forward you a patient status report on a regular basis.
Distance walked with ease at one time
The study will in no way interfere with your management of the patient.
= 200m
Times walked per day
If you have any queries, please contact David Jackson at 9342 7598 or fax: 9342 7444
= 2
Reducing Risk For Stroke Recurrence By An
= 7
Integrated, Multimodal Model Of Care
Days walked per week
Yours sincerely,
David Jackson Senior Stroke Research Coordinator
Jacques Joubert MB CHB, MRCP, FRACS
Standard drinks /day / week
= 0
Cigarettes smoked per day
= 40
Clinical Summary
The ICARUSS Program
1/05/2007
Depression
David Jackson
Senior Stroke Research Coordinator
Department of Neurology
The Royal Melbourne Hospital
Parkville VIC 3052
Phone: +61 3 9342 7598
Fax:
+61 3 9342 7444
Dear Dr.
Depression screening assessment (PHQ-9) score:
= 6 to participate in this study.
Thank you for agreeing
According to scoring criteria for the PHQ-9, the
patient
is mildly
moderately
severely
The
National
Ageing
Research
Institute the Royal Melbourne Hospital and the
depressed
National Stroke Research Institute have initiated this research project to address
the benefit of a structured, shared care model in the management of vascular
th
The patient has an appointment with you risk
on 16
April
2007
at 10:00am
factors
and
depression
for patients discharged from hospital after stroke.
.
The process consists of:
Yours sincerely,



Reducing Risk For Stroke Recurrence By An
Integrated, Multimodal Model Of Care
Incorporation of a patient held risk factor worksheet into follow-up visits by
the general practitioner
Regular telephone tracking of the patient for visits and the appropriate
blood tests
An indication of the presence (or not) of depression/anxiety in the patient
CLINICAL
post discharge
The ICARUSS Program
SUMMARY
Patient
Name:
Jed Carter
It is hoped that this process will facilitate the management
and
follow-up
of stroke patients
with particular reference to modifiable vascular risk factors
and post-stroke
depression.
Admission
date: 12/01/2007
Discharge date: 13/01/2007
GP Letter of Thanks
Attached, please find a clinical summary, which includes a risk factor profile,
medications, plans for management and an ability General
profile Practitioner:
that depicts Dr
function
in the
Frank Einstein
areas of:





mental status
motor function
verbal expression
understanding
incontinence
Diagnosis: Left Middle Cerebral Territory Infarction.
Presentation: Awoke with right sided facial droop, slurred speech, sensory changes right
upper and lower limbs, significant weakness right upper and lower limbs
Clinical status on discharge
The project manager will forward you a patient status
report
on Alert
a regular basis.
Conscious
state:
Mental state: Oriented
The study will in no way interfere with your management
of the
patient.
Speech:
Mild
dysarthria
Weakness: Right arm 2/5. Right leg no movement.
Neglect: None
Gait: Impaired in relation to weakness
Continence: Continent
If you have any queries, please contact David Jackson at 9342 7598 or fax: 9342 7444
Yours sincerely,
David Jackson Senior Stroke Research Coordinator
Jacques Joubert MB CHB, MRCP, FRACS
Known risk factors for stroke
Hypertension
Hyperlipidemia
Smoking
Obesity
Social circumstances:
Lives with supportive wife and one adult child.
David Jackson
Senior Stroke Research Coordinator
Department of Neurology
The Royal Melbourne Hospital
Parkville VIC 3052
Phone: +61 3 9342 7598
Fax:
+61 3 9342 7444
Reducing Risk For Stroke Recurrence By An
Integrated, Multimodal Model Of Care
The ICARUSS Program
Relevant Investigations;
CT (Brain): Nil significant abnormalities detected.
1/05/2007
Carotid Doppler study: 75% stenosis left ICA. 0-15% right ICA
Fasting Blood sugar: 7.5mmol/L
Cholesterol: 6 mmol/L
Triglycerides: 4.8 mmol/L
HDLC: 5 mmol/L
LDLC: 6 mmol/L
INR: Not applicable
Discharge medication:
Aspirin 100mg orally daily
Lipitor 40mg orally daily
Atenolol 25 mg orally daily
Frusemide 40 mg orally bd
Dear Dr.
v
Thank you for agreeing to participate in this study.
The National Ageing Research Institute the Royal Melbourne Hospital and the
National Stroke Research Institute have initiated this research project to address
the benefit of a structured, shared care model in the management of vascular
risk factors and depression for patients discharged from hospital after stroke.
.
The process consists of:
Telmisartan 40mg orally daily


Incorporation of a patient held risk factor worksheet into follow-up visits by
the general practitioner
Regular telephone tracking of the patient for visits and the appropriate
Discharge planning: For discharge to Broadmeadows Health Service forblood
approximately
3
tests

Anand
indication
weeks of inpatient rehabilitation. Social work arranging supports for patient
carer. of the presence (or not) of depression/anxiety in the patient
post discharge
It is hoped that this process will facilitate the management and follow-up of stroke patients
with particular reference to modifiable vascular risk factors and post-stroke depression.
Attached, please find a clinical summary, which includes a risk factor profile,
medications, plans for management and an ability profile that depicts function in the
areas of:





mental status
motor function
verbal expression
understanding
incontinence
The project manager will forward you a patient status report on a regular basis.
The study will in no way interfere with your management of the patient.
If you have any queries, please contact David Jackson at 9342 7598 or fax: 9342 7444
Yours sincerely,
David Jackson Senior Stroke Research Coordinator
Jacques Joubert MB CHB, MRCP, FRACS
Fig. 3 . ICARUSS Document Gallery.
v
Login Screen
Acknowledgement of
‘Musee des Beaux-Arts et
de la Dentelle d’Alencon –
France’ for use of the
ICARUSS Logo Image will
appear in Phase 2
Example Patient Details
Screen
Patient fields will be
customised to ICARUSS
Team Requirements
Drop down list of forms available
for each patient, as well as ability
to add forms
The fields shown here will be how the
customised ICARUSS EDC Patient
Fields will be displayed
Research Design
Randomized Controlled Trial
Comparing “usual care” to the
ICARUSS model
Telemedicine features
Telephone contact
(stratified Telephone follow-up, Specialist-GP
contact)
Fax (information to GP)
Web-based EDC
(data surveillance)
(Radiological data transfer)
(Videoconferencing)
Australian collaborators
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Royal Melbourne Hospital
Austin Hospital
Western Hospital
Royal Perth Hospital
Hunter New England Health Area Service
National Ageing Research Institute
National Stroke Research Institute
University of Melbourne
Monash University
National Stroke Foundation
Neuroscience Trials Australia
North Western Division General Practice
Current Participating Sites in Australia
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Royal Melbourne Hospital
Western Hospital
St Vincents
Austin Hospital
John Hunter Hospital
Royal Perth Hospital
Investigators and Scientific Advisory
Committee
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Geoffrey Donnan
Stephen Davis
Graeme Hankey
David Ames
Helen Dewey
Chris Reid
Peter Hand
John Barlow
Sue Hookey
David Jackson
Lynette Joubert
Jacques Joubert
Christine Kilpatrick
Erin Lalor
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Chris Levi
Colin Masters
Michael Murray
Debra O’Connor
Carolyn Searle
Robyn Smith
Christine Walker
Tissa Wijeratne
Bob Williamson
Ingrid Winship
International collaborating centres
France
Singapore
India
Sri Lanka