Case study 2

Needs Assessment for Stroke Services in Ontario, Canada
The Queen’s Health Policy Research Unit (QHPRU) estimated the need for stroke services in Ontario,
Canada using measures of prevalence and incidence of (1) modifiable and nonmodifiable risk factors for
stroke; (2) acute cases of stroke; (3) major sequelae of stroke (Hunter D , 2000 and Hunter D, 2004).
They identified the effective health services that are targeted at each of these three dimensions, and
linked these steps to estimate need for health services. They compared the estimate of need for health
services to compiled measures of levels of stroke-related health services in Eastern Ontario to see if
there was a gap (unmet need) or surplus (overmet need) of these services. The numbers below have
been changed slightly from the original source. (Textbook Case Study 4.3)
Download Case Reports:
http://mcgill.academia.edu/LorieKloda/Papers/78206/Creation_and_pilot_testing_of_StrokEngine_A
_stroke_rehabilitation_intervention_website_for_clinicians_and_families

Case Questions: Answer the case questions, with research from your book, CDC, NIH and other quality
sources to determine answers and solutions. You are to write a 2-3 page paper in APA formatting that
addresses the following questions. Note: A minimum of two references should be used, which should
include your textbook and the CDC, and others that support your responses in your paper. This is a
paper, so your answer should not be numbered, but rather it should use titles and subtitles.
1. Risk factors for stroke include heavy alcohol consumption, atrial fibrillation, diabetes,
hypercholesterolemia, hypertension, obesity, low physical activity, smoking, ischemic heart
disease, transient ischemic attack. Where might QHPRU get estimates of the incidence of these
conditions?
2. For each risk factor, or stroke sequelae, QHPRU listed the kind of intervention that would be
effective, and the proportion of people for whom this intervention would be appropriate.
According to Table 4.3, which three interventions are appropriate for hypercholesterolemia, and
for what proportion of high-risk individuals?
3. The following types of interventions were recommended for acute stroke services: (a) surgical
intervention (carotid endarterectomy); (b) thrombolytic therapy; (c) imaging of the brain, either
computed tomography (CT) or magnetic resonance imaging (MRI); (d) non-invasive imaging of
the vessels (ultrasonography or magnetic resonance angiography); (e) invasive imaging of the
vessels (cerebral angiography); (f) rehabilitation therapy. For what percent of at-risk individuals
are these services recommended?
4. Estimates of people in Eastern Ontario with hypercholesterolemia are as follows: aged 25-44:
30,000 men and 13,000 women; aged 45-64: 33,000 men and 42,500 women; aged 65 and above: 17,000 men and 42,000 women. How many residents in Ontario will need fasting
lipoprotein analysis and dietary and pharmacologic interventions for hypercholesterolemia?
5. It is estimated that Eastern Ontario provides dietary and pharmacologic intervention for
hypercholesterolemia to 66,000 and 15,500 patients respectively. What is the level of unmet
need in terms of the number of patients not receiving each of these two recommended
interventions? What percent of need is not currently being met in Eastern Ontario?
6. The incidence of acute stroke cases was estimated at 3,500 cases, 100 of whom died before
reaching the hospital. The prevalence of chronic stroke cases was estimated to be 4,300. Use
Table 4.4 to estimate the number acute and chronic stroke cases needing core stroke services,
and services for chronic stroke and disability.
7. It is estimated that Eastern Ontario provides thrombolytic therapy and carotid endarterectomy
to 50 and 200 patients respectively. CT and MRI brain imaging is provided to 1,000 and 150
patients respectively. Non-invasive and invasive imaging of the vessels is provided to 425 and
170 patients respectively. Rehabilitation is provided to 1,400 acute stroke survivors, and
homecare services are provided to 1,400 chronic stroke with disability patients. What is the level
of unmet need in terms of the number of patients not receiving each of recommended services
for acute or chronic stroke victims? What percent of need is not currently being met in Eastern
Ontario?