New York Coverdell Program
From 2012 to 2015, the New York Coverdell Program achieved significant improvements in the percentage of patients who received stroke education (75% to 95%, P < .0001) and who were administered thrombolytic therapy (alteplase) within 60 minutes of hospital arrival (48% to 69%, P < .0001) in 47 participating hospitals through tailored technical assistance to hospitals based on performance measure data and a hospital learning collaborative.
In 2004, the New York State Department of Health developed a voluntary stroke hospital designation program to begin improving the quality of care among suspected stroke patients in the state. Additionally, New York was one of the first states to have a statewide EMS protocol for suspected stroke patients. These programs provided a foundation for improving stroke care in the state. After receiving funding through the 2012–2015 CDC Paul Coverdell National Acute Stroke Program, the health department built upon the existing EMS protocols and hospital designation system to establish the New York Coverdell Stroke Quality Improvement and Registry Program (hereafter called the New York Coverdell Program). With this funding, the New York Coverdell Program expanded its focus from in-hospital stroke care to improving EMS-to-hospital transitions of care for stroke patients.
The New York Coverdell Program engaged in three key QI activities: (1) one-on-one technical assistance with hospitals, (2) best practice calls with stroke coordinators, and (3) learning collaborative webinars with hospitals.
The New York Coverdell Program focused its QI efforts on five priority measures including stroke education, prescription of statins at discharge, dysphagia screening, door-to-needle time within 60 minutes, and arrival to hospital within 2 hours and treatment within 3 hours following stroke onset. Program staff had one-on-one interactions with Coverdell-participating hospitals that were below an 85% performance level on any of the five priority measures, and helped them to develop 3-month, 6-month, and 12-month action plans.
“Teams were most engaged in work around [alteplase] tPA, and the outcomes show that. It is our biggest success.” — Program Staff Member
Additionally, the New York Coverdell Program hosted bi-weekly—and later, monthly—best practice calls with stroke coordinators from participating hospitals. On these calls, hospitals shared strategies and challenges they were facing.
Finally, the New York Coverdell Program held numerous learning collaborative webinars with hospitals. Webinar topics included, but were not limited to, best practices and interventions, data quality, and data re-abstraction.
The New York Coverdell Program supported practice and systems changes in participating hospitals. For example, individual hospitals implemented best practices learned through the collaborative meetings, such as using a tool to provide feedback to EMS and keeping alteplase kits in the CT scanner room to improve the timeliness of alteplase administration.
New York Coverdell Program activities contributed to better quality of care for stroke patients. Performance measure data from the state stroke registry of participating hospitals revealed improvements in 4 of the 12 key Coverdell Program quality-of-care measures from 2012 to 2015 (Table 1). The two measures that made the largest increases over time were the percentages of patients who received stroke education and who received thrombolytic therapy (alteplase) within 60 minutes of arrival (door-to-needle time), which increased 20% and 21%, respectively.
Table 1. Improved Coverdell Program Quality of Stroke Care Measures, 2012–2015
|Venous thromboembolism (VTE) prophylaxis||98%||99%||<.05|
|Door-to-needle time ≤ 60 minutes||48%*||69%||<.0001|
|Recording of NIHSS score||88%||93%||<.0001|
*Data are from 2013 for door-to-needle time only.
Using a foundation of stroke designation and EMS protocols in the state and programmatic activities funded by Coverdell, the New York Coverdell Program was able to bring together partners and stakeholders to improve stroke systems of care. Program leadership lauded their partners for their work and pointed to a common vision as the foundation for their successful partnerships. Success in the 2012–2015 funding cycle leaves the New York Coverdell Program poised to implement further system change efforts across the stroke care continuum. The New York State Department of Health received 2015–2020 Coverdell funds to continue its work in stroke care.
Acronyms Used in the Summaries
CDC: Centers for Disease Control and Prevention
EMS: Emergency Medical Services
NIHSS: National Institutes of Health Stroke Scale
NQF: National Quality Forum
QI: Quality Improvement
Other Terms Defined
Primary Stroke Center: The Joint Commission’s Certificate of Distinction for Primary Stroke CentersExternal recognizes centers that make exceptional efforts to foster better outcomes for stroke care. Achieving certification signifies that the services provided have the critical elements to achieve long-term success in improving outcomes. The certification is based on the Brain Attack Coalition’s “Revised and Updated Recommendations for the Establishment of Primary Stroke CentersExternal” and includes the requirement to report on eight core standardized measures from the Joint Commission.