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									Stroke Systems of
Jacqueline Carter MD MBA
Chair, Wisconsin Stroke Committee
Stroke Director, Columbia St. Mary’s Health
System, Milwaukee
Learning Objectives
• Increased knowledge of stroke
  systems of care
  – Defining stroke systems of care
  – Components of stroke systems of
  – Benefits of stroke systems of care
  – Primary Stroke Center certification
  – Wisconsin Stroke Committee
Stroke Systems of Care – Making
the Case
• Burden of stroke
  – Est. 700,000 US residents each year
    have a new or recurrent stroke
       About 163,000 of them die.
  – Est. 5.4 million Americans are stroke
  – Stroke is a leading cause of serious,
    long-term disability (AHA).
Defining Stroke Systems of Care
• A stroke system approach involves
  coordination of stroke care along
  the entire continuum from
  primordial and primary prevention
  through rehabilitation and
Essential Components of a
Coordinated System of Stroke
Care (Stroke, 2005)
• Primordial and Primary Prevention
• Notification and Response to EMS
  for Stroke
• Acute Treatment for Stroke
• Sub-Acute Stroke Care and
  Secondary Prevention for Stroke
• Rehabilitation of Stroke Patients
• Continuous Quality Improvement
Overarching Systems
Coordination (WSC)
Moving from                 Ideal State
• No coordination          • Coordination &
• No leadership               collaboration
• No assessment            • Leadership
• No monitoring            • Baseline assessment
• “Politics” vs. patient   • Monitoring
  interests                • Patient interests
Primary Prevention
Moving from             Ideal State
• No support tools or   • Support/tools exist
  mechanisms exist      • Targeted educational
• No targeted             programs exist
  educational           • Stakeholders
  programs                cooperate and
• No stakeholder          coordinate efforts
  cooperation and
Notification/Response of EMS
Moving from               Ideal State
• No process for rapid    • Processes exist for
  access to EMS             rapid EMS access
• Inadequate EMS          • Protocols match
  dispatch                  current
• Acute stroke patients     recommendations
  not take to PSC         • Transport to PSC is
• EMS personnel can’t       norm
  assess/screen           • EMS personnel can
Acute Treatment for Stroke
Moving from                Ideal State
• No inventory of          • Hospitals identified
  hospital status exists     as PSC or other
• Roles of non-stroke        status
  centers are ill          • Roles of all hospitals
  defined                    are defined
• No strategies exist      • Resources are
  for non-stroke             available for non-
  centers                    stroke centers
Sub-Acute & 2ndary Prevention
Moving from             Ideal State
• No organized          • Organized
  approach to care        approaches to care
• No 2nd prev             exist
  strategies            • 2ndary prev
  implemented             strategies
• No post-stroke educ     implemented
  on risk, warning      • Post-stroke educ on
  signs                   risk, warning signs
• No connection         • Smooth transitions
  between in/out-         from in/out-patient
  patient care            care
Rehabilitation of Stroke Patients
Moving from              Ideal State
• No consistent rehab    • Patients evaluated
  evaluation               for rehab
• No evaluation of       • Rehab service levels
  levels of rehab          periodically
  services                 evaluated
• No consistent stroke   • Appropriate referrals
  survivor referral to     to rehab exist
  rehab                  • Support systems are
• No support systems       offered
Why the Stroke Systems of Care
(SSC) Approach Is the Standard?
• De-Fragmentation
  – SSC will provide each patient seamless
    transitions from one stage of care to the next
    with the highest quality at each step
        Including the ability to overcome boundaries that
         might interfere with stroke care.
  – Stroke expertise and support can be
    delivered in all communities through a
    systems approach and with coordination
    (incl telemedicine) boundaries of time and
    distance can be overcome.
Why the Stroke Systems of Care
(SSC) Approach Is the Standard?
• Time Sensitive Action
  – SSC will improve each link in the
    chain of survival and recovery
       by assuring patients have access to the
        most advanced treatment in facilities best
        equipped to deal with critical and time-
        sensitive needs of stroke patients.
Why the Stroke Systems of Care
(SSC) Approach Is the Standard?
• Leveraging Opportunities
  – A coordinated system of care driven
    by all healthcare providers in the
    stroke team will promote greater
    efficiency of care and the most
    effective application of acute
    treatment, secondary prevention and
Why the Stroke Systems of Care
(SSC) Approach the Standard?
• Improving Outcomes
  – The development of SSC can
    significantly increase the proportion
    of patients who receive improved
    stroke care.
  – Dedicated stroke units can reduce a
    patient’s risk of death by 40%.
Primary Stroke Centers
The Need for Primary Stroke
• In 2000 the Brain Attack Coalition
  published its recommendations for PSC
  – Based on those criteria some institutions
    marketed themselves as PSCs because
    there was no independent survey that
    validated the designation.
• In 2003 the ASA and The Joint
  Commission collaborated to implement
  care quality guidelines and establish a
  formal PSC certification program.
  – Launched December 2003
“…the process of applying for disease-specific
certification is one important way Bay Medical has
moved forward with three important goals: creating
high-quality clinical programs; improving its clinical
reputation among prospective patients; and fostering
teamwork among physicians, hospital employees, and
TJC PSC Certification Program
• First “advanced” certification program
• Over 420 in US
• Leading states: Florida and California
  (25% of certified Primary Stroke Centers
  are in these two states)
• Vast majority of states are using TJC
  certification program for PSC
Wisconsin Stroke Committee
    Wisconsin Stroke Committee
•    A network of organizations partnering to
     establish stroke systems of care in
     –   Provide overarching systems coordination
         across stroke care areas
     –   Implement recommendations from the white
         paper “Recommendations for the
         Establishment of Stroke Systems of Care”
         Stroke, March 2005
Wisconsin Stroke Committee
• Launched in Oct 04
• Stroke Systems of Care Plan
  completed in May 05
• Two state-wide stroke conferences
  held (2005 & 2007)
• Implementation actions underway
• To join the roster: contact Victoria

         Thank you

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