1. Wisconsin Coverdell Stroke Program Wisconsin Stroke Coalition Kalahari Resort & Convention Center March 21, 2013 Dot Bluma, RN MetaStar, QI Stroke Specialist

2. Objectives Overview of Coverdell Define the objectives, benefits and goals of Coverdell participation in Wisconsin Describe baseline data, Coverdell vs WI Hospitals

3. Coverdell’s History 2001 Paul Coverdell National Acute Stroke Registry (PCNASR) was established by the CDC Georgia Senator died while serving in Congress Initial three-year pilot study showed large gaps between national recommended guidelines and hospital practices. 2004 Four states chosen to implement state-wide stroke registries (GA, IL, MA, NC) 2007 Increased number of participating states to six: (GA, MA, NC, MI, MN, OH) Increased funding cycle from three years to five years Collaborated with The Joint Commission & American Heart Association to adopt standardized stroke measure set. Sep. 2012 Wisconsin chosen to receive funding. Eleven states participating in registry

4. Coverdell Objectives Coverdell focuses on the continuum of patient care: Measure, track, and improve the quality of care and access to care for stroke patients from onset of stroke symptoms through rehabilitation and recovery. Decrease rate of premature death and disability from acute stroke. Eliminate disparities in care. Support development of stroke systems of care that emphasize quality of care. Improve access to rehabilitation and opportunities for recovery after stroke. Increase the workforce capacity and scientific knowledge for stroke surveillance within stroke systems of care.

5. Coverdell goals for Wisconsin 2013 Year 1 strategies: Infrastructure and Development Hired Stroke QI Specialist staff contracted through MetaStar Interviewing EMS QI Specialist Hospital recruitment efforts for participation in QI Project. Current recruitment of 27 participating or interested hospitals with a goal of 30. Continuation of Stroke Coordinator of Wisconsin meeting Identify Coverdell baseline data to devise a quality improvement plan for the state. EMS QI participation will target those EMS providers servicing the participating hospitals Reconvene Wisconsin Stroke Coalition Develop statewide Stroke Systems of Care

6. Current Stroke Quality Improvement Projects in WI Stroke Coordinator group: All WI hospital stroke coordinators are invited to attend quarterly meetings Wisconsin Hospital Association: Publically reporting of stroke quality measures on Checkpoint Office of Rural Health Stroke Quality Improvement Project EMS: 98.6% of all WI EMS runs are entered into the WARDS Systems, little data analysis is currently completed.

7. Stroke Quality Improvement Goals Stroke QI Specialist to develop chart reabstraction process to ensure abstraction reliability. State Coordinator Committee meetings which: – Provide the ability to participate in performance improvement collaboratives which help to focus on a topic and share challenges and solutions with other hospitals in a safe, neutral environment. – Ability to get connected with other hospitals and share informally how to address common challenges.

8. Stroke Quality Improvement Goals (continued) Educational offerings in collaboration with participating Coverdell states. Free access to technical assistance (data analysis, educational resources, and other QI support) from the Wisconsin Department of Health, American Heart Association and MetaStar

9. Benefits of Joining Wisconsin Stroke Coverdell Registry Additional QI support for ongoing hospital projects Dedicated project leadership Improved outcomes Increased collaboration with EMS providers and referring hospitals Participation in development of stroke systems of care in Wisconsin Funding support: Participating hospitals by June 30, 2013 will receive a one time $1000 stipend Educational opportunities

10. Standardized Stroke Measure Set IV rt-PA Arrive by 2 Hour, Treat by 3 Hour Early Antithrombotics VTE Prophylaxis Antithrombotics Anticoag for AFib/Aflutter Smoking Cessation LDL 100 or ND - Statin Dysphagia Screen Stroke Education Rehabilitation Considered

11. IV rt-PA Arrive by 2 Hour, Treat by 3 Hour

12. Early Antithrombotics

13. VTE Prophylaxis

14. Antithrombotics

15. Anticoag for AFib/AFlutter

16. Smoking Cessation

17. LDL 100 or ND - Statin

18. Dysphagia Screen

19. Stroke Education

20. Rehabilitation Considered

21. Questions? Thank you