2008 Georgia Data Summary: Georgia Coverdell Acute Stroke Registry PROGRAM OVERVIEW HOSPITAL SAMPLING AND PARTICIPATION 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 First established in 2001 as a prototype project involving 46 hospitals in Georgia Full implementation and incorporation into the Georgia Department of Human Resources (DHR), Division of Public Health (DPH) began in 2005 Randomly selected hospitals actively invited to participate and volunteer hospitals also welcomed Hospitals recruited in three stages: -First group (cohort 1) started on 11/1/05 -Second group (cohort 2) started during 10/1/06-3/30/07 -Third group (cohort 3) started during 3/1/08-4/30/08 50 currently participating hospitals, representing over half of stroke admissions in Georgia Partnership between Georgia DHR-DPH, Emory University, American Heart Association/American Stroke Association, Georgia Medical Care Foundation, Georgia Hospital Association, CDC, and participating hospitals GOALS Reduce fatalities and disability due to stroke and the incidence of recurrent stroke in Georgia by monitoring and improving the quality of acute stroke care in hospitals Encourage collaboration between hospitals and between hospitals and other institutions in Georgia relating to 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 Annual meetings to exchange best practices in conjunction with the American Heart Association/American Stoke 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 Data are entered into a Coverdell-modified version of the American Heart Association/American Stroke Association's "Get With the Guidelines" stroke patient management tool 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 Data received for 12,783 stroke hospitalizations during 11/1/05 through 10/31/07 Analysis includes data from 24 cohort 1 hospitals and 21 cohort 2 hospitals Georgia Department of Human Resources, Division of Public Health 2 Peachtree Street, NW Atlanta, GA 30303 (404) 657-3103 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 Administration of tPA Cohort 1 Cohort 2 100 90 80 70 60 50 40 30 20 10 0 Percentage DVT Prophylaxis Cohort 1 Cohort 2 100 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-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 Month Month Dysphagia Screening Cohort 1 Cohort 2 100 90 80 70 60 50 40 30 20 10 0 Percentage Defect-Free Care Cohort 1 Cohort 2 100 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-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 Month Month 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: 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): a medication that can be administered to some acute ischemic stroke patients to help reestablish blood supply to the brain Date updated: July 2008 Publication number: DPH08.218HW Visit http://health.state.ga.us/epi/cdiee/strokeregistry.asp for more information about the Georgia Coverdell Acute Stroke Registry. Georgia Department of Human Resources, Division of Public Health 2 Peachtree Street, NW Atlanta, GA 30303 (404) 657-3103 ga-stroke@dhr.state.ga.us http://health.state.ga.us