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PCNASP History

Paul Coverdell National Acute Stroke Program

In 2001, Congress charged CDC with implementing state-based registries that measure and track acute stroke care and to use data from the registries in efforts to improve the quality of that care. Congress further directed that this project be named the Paul Coverdell National Acute Stroke Registry, after the late U.S. Senator Paul Coverdell of Georgia, who suffered a fatal stroke in 2000 while serving in Congress.

CDC, in consultation with stroke experts and organizations, piloted eight prototype registry projects, led by academic and medical institutions across the country, to test models for measuring the quality of care delivered to stroke patients. "Wave I" projects, funded in 2001, were located in Georgia, Massachusetts, Michigan, and Ohio. "Wave II" projects, funded in 2002, were located in California, Illinois, North Carolina, and Oregon. These prototype projects gathered data concerning each step of emergency and hospital care for stroke patients, from emergency response to the patients' eventual discharge from a hospital. At the end of the 3–year pilot period, the results showed that large gaps existed between generally recommended guidelines for treating stroke patients and actual hospital practices. Intensive quality improvement efforts are needed to close those gaps.

In June 2004, CDC provided funds to the state health departments of Georgia, Illinois, Massachusetts, and North Carolina to establish statewide Coverdell stroke registries for acute care hospitals in their states. The purpose of these registries was to develop and implement systems for collecting data on acute stroke care provided to patients, analyzing the collected data, and using the results of those analyses to guide quality improvement interventions at the hospital level through partnerships with hospital doctors, stroke-care teams, and administrators. All acute care hospitals serving the general population in participating states were eligible for the program.

In the first year of program activities, states established partnerships with leading medical experts, various hospital associations, local affiliates of the American Hospital Association, and other groups interested in improving health care for stroke patients; developed strategies for identifying and recruiting eligible hospitals; selected and implemented customized Web-based data collection systems for hospital use; and recruited hospitals to participate in the registry. In the second and third years, states reviewed collected data to identify specific areas of need for quality improvement, worked with hospitals to implement quality improvement interventions to improve care, and evaluated progress toward improving statewide acute stroke care and promoting long-term systemic changes in how that care is provided. By the end of the 2004–2007 project period, more than 180 hospitals were participating in a stroke registry and the percentages of total statewide stroke admissions treated by participating hospitals ranged from 40% to 79% among the four states.

In July 2007, CDC expanded funding to six state health departments in Georgia, Massachusetts, Michigan, Minnesota, Ohio, and North Carolina for the Paul Coverdell National Acute Stroke Registry for a new 5-year funding period. Illinois will continue to participate in stroke quality improvement activities and provide information to CDC on its progress. In 2007, CDC also came to an agreement with The Joint Commission’s Primary Stroke Center Certification program and with the American Heart Association/American Stroke Association’s Get With The Guidelines-Stroke program to jointly release a set of standardized stroke performance measures for use by all three programs. This effort helped reduce duplication, increase collaboration, and encouraged hospitals to participate in one or more of the programs. The National Quality Forum endorsed eight of these performance measures in 2008.

In July 2012, CDC expanded to 11 state health departments in Arkansas, California, Georgia, Iowa, Massachusetts, Michigan, Minnesota, New York, North Carolina, Ohio, and Wisconsin. Through the 3-year cooperative agreement, which ended in June 2015, states focused on improving the care given to stroke patients from the time they had a stroke. Select states piloted working with emergency medical services (EMS) agencies to improve EMS care for suspected cases of stroke, the transition from EMS to hospital care, hospital care, and the transition from hospital to the next care setting.

In July 2015, CDC funded 9 state health departments in California, Georgia, Massachusetts, Michigan, Minnesota, New York, Ohio, Washington, and Wisconsin. Through this new 5-year cooperative agreement, funded states are working to develop comprehensive stroke systems to improve the quality of care for patients from the time they have a stroke until after they are discharged from the hospital and reintegrated with their primary care doctor. The goals of the new awards are to focus on pre-hospital quality of care as well as the post-hospital transition of care from hospital to home and the next care provider. All grantees will develop robust quality improvement programs for EMS that improve stroke diagnosis in the field and improve the transition from EMS to hospital emergency departments.