2009 Georgia data summary: Georgia Coverdell Acute Stroke Registry [July 2009]

2009 Georgia Data Summary:
Georgia Coverdell Acute Stroke Registry

PROGRAM OVERVIEW
Funded by the Centers for Disease Control and Prevention (CDC) as part of the Paul Coverdell National Acute Stroke Registry
Named in honor of the late Senator Paul Coverdell of Georgia who died of a massive stroke in 2000
Partnership between Georgia Department of Community Health's Division of Public Health, Emory University, American Heart Association/American Stroke Association, Georgia Medical Care Foundation, Georgia Hospital Association, CDC and participating hospitals

HOSPITAL PARTICIPATION
Hospitals actively recruited in three stages: - Cohort 1 started in November 2005 - Cohort 2 started in October 2006 - Cohort 3 started in March 2008
Other hospitals continued to join the registry, and the next recruitment is planned for late 2009
52 currently participating hospitals, representing over half of stroke admissions in Georgia

GOALS
Reduce fatalities and disability due to stroke and the incidence of recurrent stroke in Georgia by o monitoring and improving the quality of acute
stroke care in hospitals; and o encouraging collaboration between hospitals and
between hospitals and other institutions in Georgia concerned with stroke care quality improvement.

QUALITY IMPROVEMENT ACTIVITIES
Individualized stroke care quality improvement consultation for participating hospitals

Monthly registry-wide telephone conference calls and bimonthly newsletters sharing best practices between hospitals

Note: Dots represent location and may represent more than one facility

Annual meetings to exchange best practices in conjunction with the American Heart Association/American Stroke Association
Acute Stroke Life Support training using curriculum from the University of Miami
Focus of participating hospitals' quality improvement efforts during first two years was on deep vein thrombosis (DVT) prophylaxis, and is now on dysphagia screening
DATA COLLECTION
Data on stroke patient characteristics and care received during the hospital stay are collected by participating hospitals for patients admitted with an acute stroke or transient ischemic attack
The purpose of data collection is to monitor the quality of stroke care delivered at hospitals in the state and to guide quality improvement efforts

REGISTRY STROKE CASE DATA
Analysis included data from 22,737 patients admitted from November 2005 to October 2008
The majority (58%) had a discharge diagnosis of ischemic stroke, followed by hemorrhagic stroke and transient ischemic attack, at 19% each
For ischemic stroke, prompt treatment (thrombolysis) is critical for good recovery
o Of patients admitted with a presumptive diagnosis of ischemic stroke, 19% arrived at the emergency department within 2 hours from the last time they were known to be well
o Among these, only 52% of eligible patients received thrombolytic treatment within 3 hours after symptom onset

Georgia Department of Community Health, Division of Public Health 2 Peachtree Street, NW Atlanta, GA 30303 (404) 657-2578 ga-stroke@dhr.state.ga.us http://health.state.ga.us

QUALITY INDICATORS

Care received by patients is compared with quality indicators that identify care processes that have been shown to be

beneficial to stroke patients, and have been included in clinical recommendations

Quality indicator calculations include identification of patients for whom a care process would have been recommended,

and a determination of how many of those patients received the recommended care

The 10 registry quality indicators during the first two years of operation were:

Administration of tPA

Delivery of stroke education

Dysphagia screening

Smoking cessation counseling or treatment

Administration of antithrombotic medication

Rehabilitation assessment

within 48 hours

Prescription of antithrombotic medication at

DVT prophylaxis

discharge

Lipid profile measurement

Prescription of anticoagulant medication for patients

with atrial fibrillation

Defect-free care is defined as the delivery of care meeting all quality indicators for which a patient is eligible

TRENDS IN SELECTED QUALITY INDICATORS

Percentage

Nov-05 Dec-05 Jan-06 Feb-06 Mar-06 Apr-06 May-06 Jun-06 Jul-06 Aug-06 Sep-06 Oct-06 Nov-06 Dec-06 Jan-07 Feb-07 Mar-07 Apr-07 May-07 Jun-07 Jul-07 Aug-07 Sep-07 Oct-07 Nov-07 Dec-07 Jan-08 Feb-08 Mar-08 Apr-08 May-08 Jun-08 Jul-08 Aug-08 Sep-08 Oct-08

Administration of tPA

Cohort 1

Cohort 2

Cohort 3

100 90 80 70 60 50 40 30 20 10 0

Month

Percentage

Dysphagia Screening

Cohort 1

Cohort 2

Cohort 3

100 90 80 70 60 50 40 30 20 10 0

Month

Nov-05 Dec-05 Jan-06 Feb-06 Mar-06 Apr-06 May-06 Jun-06 Jul-06 Aug-06 Sep-06 Oct-06 Nov-06 Dec-06 Jan-07 Feb-07 Mar-07 Apr-07 May-07 Jun-07 Jul-07 Aug-07 Sep-07 Oct-07 Nov-07 Dec-07 Jan-08 Feb-08 Mar-08 Apr-08 May-08 Jun-08 Jul-08 Aug-08 Sep-08 Oct-08

DVT Prophylaxis

Cohort 1

Cohort 2

Cohort 3

100

90 80

70 60

50

40

30

20

10

0

Percentage

Defect-Free Care

Cohort 1

Cohort 2

Cohort 3

100

90

80

70

60

50

40

30

20

10

0

Percentage

Nov-05 Dec-05 Jan-06 Feb-06 Mar-06 Apr-06 May-06 Jun-06 Jul-06 Aug-06 Sep-06 Oct-06 Nov-06 Dec-06 Jan-07 Feb-07 Mar-07 Apr-07 May-07 Jun-07 Jul-07 Aug-07 Sep-07 Oct-07 Nov-07 Dec-07 Jan-08 Feb-08 Mar-08 Apr-08 May-08 Jun-08 Jul-08 Aug-08 Sep-08 Oct-08

Nov-05 Dec-05 Jan-06 Feb-06 Mar-06 Apr-06 May-06 Jun-06 Jul-06 Aug-06 Sep-06 Oct-06 Nov-06 Dec-06 Jan-07 Feb-07 Mar-07 Apr-07 May-07 Jun-07 Jul-07 Aug-07 Sep-07 Oct-07 Nov-07 Dec-07 Jan-08 Feb-08 Mar-08 Apr-08 May-08 Jun-08 Jul-08 Aug-08 Sep-08 Oct-08

M onth

M onth

Notes:

23 hospitals comprised Cohort 1, 16 hospitals comprised Cohort 2, and 9 hospitals comprised Cohort 3 Definitions of some of the variables comprising the defect free care indicator have changed over time

DEFINITIONS
Stroke: brain tissue death; can be the result of a thrombus (blocked artery) or a hemorrhage (ruptured artery) which prevents blood flow to the brain Transient ischemic attack (TIA): temporary blockage of cerebral blood flow that causes a short-lived neurological deficit Deep Vein Thrombosis (DVT): blood clot located in a large vein; a potential complication of stroke.

Dysphagia: problems swallowing; a potential complication of stroke that can lead to pneumonia Antithrombotic: medication administered to prevent platelets or clotting factors in the blood from forming a blood clot Anticoagulation: administration of medications to prevent clotting of the blood Tissue plasminogen activator (tPA): medication that can be administered to some acute ischemic stroke patients to help reestablish blood supply to the brain

Date updated: July 2009 Publication number: Visit http://health.state.ga.us/epi/cdiee/strokeregistry.asp for more information about the Georgia Coverdell Acute Stroke Registry.
Georgia Department of Community Health, Division of Public Health 2 Peachtree Street, NW Atlanta, GA 30303 (404) 657-2578 ga-stroke@dhr.state.ga.us http://health.state.ga.us