Integrated Care for Patients Following Acute Stroke: Evidence Synthesis and Development of a Novel Holistic Approach to Stroke Care

Eustace-Bowman, I ORCID: 0000-0002-2862-9551 (2026) Integrated Care for Patients Following Acute Stroke: Evidence Synthesis and Development of a Novel Holistic Approach to Stroke Care. Doctoral thesis, Liverpool John Moores University.

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Abstract

Background
Integrated care is an emerging concept that improves patient outcomes and satisfaction and reduces healthcare costs and resource utilisation. There is limited evidence on the benefit of integrated care in people with stroke. This study aims to determine what components of integrated care are considered important for patients and HCPs and to use the information gained to generate a new person-centred integrated care pathway.
Methods
This study comprised two distinct work packages. Work package 1 was a systematic review and meta-analysis of published studies on integrated care in stroke. Work package 2 was an innovative mixed methods study comprising two Phases (Phase 1: focus groups to explore stroke survivors’ experiences of stroke recovery; Phase 2: a Delphi survey to gain consensus on which components of care patients and HCPs believe should be included in an integrated stroke pathway.
Results
The systematic review demonstrated that patients receiving integrated stroke care had significant improvements in quality of life and significantly reduced incidence of depression. There were no significant differences in mortality, recurrent stroke or major bleeding.
Four themes were identified in the stroke survivor focus groups through Reflexive Thematic Analysis: 1) Recognising stroke, 2) Loss of identity, 3) Life after stroke – Feeling lucky and 4) Dealing with the past and looking to the future. Based on the findings of the study, a new holistic integrated care pathway for stroke was created (RACE: R – Recognition of stroke and its associated symptoms, A – Acute and appropriate treatment of stroke, C – Control of cardiovascular risk and other comorbidities, and E – Education and training on care in post-stroke life and prevention of subsequent stroke).
Conclusions
The involvement of stroke survivors and HCPs in a novel mixed methods study has allowed the creation of a new holistic integrated care pathway based on clinical evidence and the priorities of patients and clinicians. Future research should focus on testing the RACE pathway and on further characterising the benefits of integrated care in people with stroke.

Item Type:	Thesis (Doctoral)
Uncontrolled Keywords:	Stroke; Integrated care; Systematic review; Meta-analysis; Delphi; Survey; Qualitative; Quantitative; Mixed methods; Focus group; Pathway
Subjects:	R Medicine > RT Nursing
Divisions:	Nursing and Advanced Practice
Date of acceptance:	1 June 2026
Date of first compliant Open Access:	27 May 2026
Date Deposited:	27 May 2026 08:50
Last Modified:	27 May 2026 08:50
Supervisors:	Higginbotham, K, Jones, I, Buckley, B and Lip, G
URI:	https://researchonline.ljmu.ac.uk/id/eprint/28579

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