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Protocol for an observation and implementation study investigating optimisation of the management of stroke and transient ischaemic attack (TIA)
  1. James Peter Sheppard1,
  2. Ruth Mary Mellor1,
  3. Sheila Marie Bailey1,
  4. Pelham Barton2,
  5. Amunpreet Boyal1,
  6. Sheila Greenfield1,
  7. Sue Jowett2,
  8. Jonathan Mant3,
  9. Tom Quinn4,
  10. Satinder Singh1,
  11. Richard J McManus5,
  12. on behalf of the BBC CLAHRC Investigators*
  1. 1Department of Primary Care Clinical Sciences, University of Birmingham, Birmingham, UK
  2. 2Health Economics Unit, University of Birmingham, Birmingham, UK
  3. 3Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
  4. 4Faculty of Health and Medical Sciences, School of Health and Social Care, University of Surrey, Guildford, UK
  5. 5Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
  1. Correspondence to Professor Richard J McManus; richard.mcmanus{at}


Introduction Patients benefit from early and intensive treatment in both acute ischaemic stroke and transient ischaemic attack. Recent audits of acute stroke/transient ischaemic attack care suggest that although standards have improved, current services still fall short of optimal care. The aim of this study is to establish a database of patients accessing stroke services. Data will be collected and analysed to provide individualised feedback to healthcare professionals who can then use these findings to develop strategies for service improvement.

Methods and analysis This longitudinal observational study will evolve with the ongoing findings from the research output. The project will consist of three phases: assessment of current practice, feedback of findings and evaluation of service change. Consecutive patients will be recruited from participating hospitals, and identifiable data will be collected to link records from the Primary Care, Secondary Care and Emergency Services. As this study focuses on observation of current practice, a sample size calculation is not deemed appropriate. Patients will be sent follow-up questionnaires examining quality of life at 3 and 12 months post-event. Qualitative interviews will examine the care pathway through the experiences of patients, their carers, healthcare personnel and commissioners. Collected data will be used in economic analyses, which will evaluate the impact of current care and service redesign on the NHS costs and patient outcomes (death and quality of life).

Ethics and dissemination Ethical approval for this study has been obtained from the National Research Ethics Committee (reference; 09/H0716/71), and site-specific R&D approval has been acquired from the relevant NHS trusts. All findings will be presented at relevant healthcare/academic conferences and written up for publication in peer-reviewed journals. Results will be fed back to patients and participating trusts through a series of reports and presentations. These will be used to facilitate discussions about service redesign and implementation.

This is an open-access article distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits use, distribution, and reproduction in any medium, provided the original work is properly cited, the use is non commercial and is otherwise in compliance with the license. See: and

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  • * Birmingham and Black Country Collaborations for Leadership in Applied Health Research and Care investigators include: Peter Carr, Heart of England NHS Foundation Trust; Brin Helliwell, Lay member of Steering Group; Cristina Nand, Lay member of Steering Group; Norman Phillips, Lay member of Steering Group; David Sandler, Heart of England NHS Foundation Trust; Don Sims, University Hospitals Birmingham NHS Foundation Trust; Rob Scott, Birmingham and Midland Eye Centre; Matt Ward, West Midlands Ambulance Service NHS Trust.

  • To cite: Sheppard JP, Mellor RM, Bailey SM, et al. Protocol for an observation and implementation study investigating optimisation of the management of stroke and transient ischaemic attack (TIA). BMJ Open 2012;2:e001430. doi:10.1136/bmjopen-2012-001430

  • Contributors RJMcM, JM, SJ and PB had the original idea, gained the funding and wrote the first draft with JPS and RMM. All authors subsequently refined the manuscript and approved the final version. RJMcM is the guarantor.

  • Funding The research was funded by and took place at the National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care based in Birmingham and Black Country. RJMcM holds an NIHR Career Development Fellowship. The views and opinions expressed are those of the authors and do not necessarily reflect those of the NHS, NIHR or the Department of Health. The funders had no involvement in the study design, data collection, management of the project, data analysis, interpretation of data, writing of the article or the decision to submit the article for publication. The corresponding author (RJMcM) has ultimate authority over each of these activities.

  • Competing interests None.

  • Ethics approval Approval for this project has been obtained from the National Research Ethics Service Committee, London—Queen Square (reference; 09/H0716/71).

  • Provenance and peer review Not commissioned; internally peer reviewed.