Wisconsin Coverdell Stroke Program (WCSP)
From 2013 to 2015, the Wisconsin Coverdell Stroke Program (WCSP) achieved significant improvements in the percentage of eligible patients who were given thrombolytic therapy (alteplase) (69% to 86%, P < .05) and who received thrombolytic therapy (alteplase) within 60 minutes of arrival (26% to 55%, P < .001) in 29 participating hospitals through the development of toolkits to support QI activities and educational outreach events for hospital and EMS staff.
In 2012, the Wisconsin Department of Health Services received Paul Coverdell National Acute Stroke Program funds from CDC. Prior to 2012, the Wisconsin Department of Health Services participated in the 2005–2009 Great Lakes Regional Stroke Network. Through this network, the Wisconsin Department of Health Services developed the Wisconsin Stroke Coalition and a statewide stroke system of care plan. Using 2012–2015 Coverdell funds, WCSP was able to reconvene the coalition and revive partnerships developed through the Great Lakes Regional Stroke Network to improve the transition of care from EMS to hospitals for stroke patients.
WCSP’s key QI activities included (1) providing technical assistance to hospital staff through performance reviews and data abstraction training, (2) developing toolkits for hospitals and EMS agencies, and (3) conducting outreach events to facilitate relationship building between EMS agencies and hospitals.
WCSP provided training on data abstraction to 29 hospitals participating in Coverdell, along with a quarterly QI report on the re-abstracted data. To help hospitals identify target goals and develop action plans, WCSP used performance data from the registry.
WCSP developed two toolkits to support QI efforts: the Building Blocks toolkit and the EMS toolkit. The Building Blocks toolkit is a compilation of recommendations for hospitals on how to build a stroke program. The EMS toolkit provides resources, including video recordings of presentations about best practices from educational outreach events.
“Over [the] course of 2 years working with this grant, the movement that has happened has been significant. We’ve had success in the outreach, in bringing hospital and EMS together so they know each other and understand how to work together… now the relationship is there and it will be easier to make changes.” — Program Staff Member
WCSP hosted several types of educational events to meet the needs of different stakeholder groups. Together with the American Heart Association/American Stroke Association, WCSP organized five half-day regional stroke conferences to bring certified stroke centers, referral hospitals, and EMS agencies together. WCSP also hosted 17 educational outreach events with hospital and EMS staff across the state. At these events, program staff presented best practices and participants provided solutions to overcoming barriers in establishing stroke systems of care. To meet the needs of smaller, rural hospitals, WCSP collaborated with the Wisconsin Office of Rural Health to provide free online stroke education to critical access hospitals.
WCSP’s efforts led to practice changes including the development of new protocols and improved data linkages between EMS and hospitals. WCSP worked with the state EMS unit, physician advisory group, and stroke coordinators to develop and distribute a transfer protocol for patients needing thrombolytic therapy (alteplase) to 450 EMS agencies and 127 hospitals in the state. Additionally, WCSP developed a communication form for hospitals to provide feedback to EMS on transitions of care, thereby creating a data feedback loop and overcoming barriers to real-time data access.
Participation in WCSP also contributed to better quality of care for stroke patients. Performance measure data from the state stroke registry of participating hospitals revealed improvements in 7 of the 12 key Coverdell Program quality-of-care measures from 2013 (the first year that data were available) to 2015 (Table 1). The two measures with the greatest improvement over time were the percentages of eligible patients who were given thrombolytic therapy (alteplase) and who received that therapy within 60 minutes of hospital arrival (door-to-needle time), which increased 17% and 29%, respectively.
Table 1. Improved Coverdell Program Quality of Stroke Care Measures, 2012–2015
|Thrombolytic therapy (alteplase)||69%||86%||<.05|
|Assessed for rehabilitation||97%||99%||<.0001|
|Discharged on statin medication||96%||98%||<.05|
|Anticoagulation therapy for atrial fibrillation/flutter||92%||98%||<.05|
|Door-to-needle time ≤ 60 minutes||26%||55%||<.001|
|Recording of NIHSS score||89%||96%||<.0001|
Using CDC funding, WCSP established itself as a convener and coordinator of the stroke care stakeholders and efforts in the state. To sustain this function, WCSP staff are writing a charter for the Wisconsin Stroke Coalition that will outline organizations’ roles and responsibilities going forward and working to identify a partner with the capacity to coordinate future stroke care activities in the state. WCSP received 2015–2020 Coverdell funding 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.