MA Paul Coverdell National Acute Stroke Registry

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• MA Paul Coverdell National Acute Stroke Registry
• All-state HDSP Call
• April 6, 2009
• Kathy Foell, MS Laura Coe, MPH
• Director, HSPC Coordinator, SCORE
• MA DPH MA DPH
• kathy.foell_at_state.ma.us laura.coe_at_state.ma.us

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Overview

• History of Coverdell in MA
• Collaboration with AHA
• Integration with HSPC
• Program components of SCORE
• Achievements

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History of Coverdell in MA

• 2001-2003
• Prototype Phase funded through MA QIO (MassPRO)
• 2004 - 2007
• State designation for Primary Stroke Service
  initiated
• DPH HDSP funded 4 states (MA, GA, NC, IL)
• Partnership with AHA to create SCORE
• 2007 - 2012
• MA refunded, 3 initial states refunded, 3 new
  states added (MI, MN,OH)

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Collaboration with AHA

• MDPH partnered with AHA GWTG to form
  Collaborative for PSS hospitals
• Common objective
• Patient Management Tool
• Reduce duplication for hospitals
• Share resources
• Reduce competition
• Provide staff and resources to SCORE

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Integration with HSPC Projects

• Projects across the stroke care continuum
• Blood pressure control
• Signs and symptoms of stroke
• Pre-hospital
• EMS (PoE plan, stroke QI)
• EMD software
• Transitions of care

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Integration with HSPC Staff

• Shared staff link projects and provide input
• Evaluation staff
• Administrative support staff
• Staff meetings - share ideas and brainstorm

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Integration beyond HSPC

• DPH Division of Health Care Quality
• Primary Stroke Service program
• Joint Hospital Stroke Care Advisory Committee

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What is SCORE?

• Continuous QI project focused on 10 measures of
  acute stroke care
• Joint initiative in MA
• 56 of 69 Primary Stroke Service hospitals
• 75 of MA annual stroke volume
• Structure based on the IHI Model for QI
  Collaboratives

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Program Components

• Didactic training sessions
• Quarterly in-person learning sessions
• Data Quality conference calls
• Abstractor training
• Collaborative learning
• Regional meetings
• One-on-one assistance
• Site visits and calls
• Evaluation
• Chart audit
• Website
• Physician leadership series

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Stroke Measures

• Thrombolytic Therapy Administered
• Antithrombotic Therapy by End of Hospital Day 2
• DVT Prophylaxis
• Dysphagia Screening
• Discharged on Cholesterol Reducing Therapy
• Discharged on Antithrombotics
• Pts with A-Fib receiving Anticoagulation Therapy
• Smoking Cessation/Advice/Counseling
• Assessed for Rehabilitation
• Stroke Education

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Results Summary

• Statistically significant increase in improvement
  in 8 of the 10 stroke measures
• Average improvement ranged from 0.71 2.88
  percentage points per quarter
• Stroke Education showed a 9.18 monthly percentage
  change since January 2008
• Treatment with IV tPA within 2 hours was the
  single measure showing a significant downward
  trend.
• small sample size
• considerable change in the definition in 1/08

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Results (2)

• Significant improvement in DVT, antithrombotic by
  day 2, and lipid profile
• Positive feedback on extensive program evaluation
• Dysphagia
• Significant Improvement (50 adherence)
• 21 hospitals 38
• Outstanding improvement (80 adherence)
• 2 hospitals 4
• Association with volume

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Accomplishments

• 81 of PSS hospitals participate in SCORE
• 98 retention rate since 2005 (1 drop out)
• Improved performance on 8 measures
• Sustainable

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In Summary

• SCORE is integrated with several HSPC projects
• SCORE supports ongoing partnership with AHA
• Hospitals receive technical assistance and
  Collaborative support to improve stroke care
• Data shows improvement

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SCORE Staff

• Kathy Foell, MDPH
• Laura Coe, MDPH
• Mirian Barrientos, MDPH
• Joanne LaBelle, MDPH
• June ONeill, MDPH
• Judy Hinchey, MD, St. Elizabeths Tufts
• Lee Schwamm, MD, Mass General Harvard
• Zainab Magdon-Ismail, AHA/ASA
• Nadine Allyn, AHA/ASA
• Elizabeth Pendry, RN, FL Hospital Memorial System