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