WHAT’S UP WITH STROKE IN GEORGIA?

Ehhh, What’s Up Doc?

March 4, 2011 Georgia Organization of Nurse Leaders Trish Westbrook, RN, MSN, FNP-C Stroke Coordinator, Northeast Georgia Medical Center

Where have we been? Where are we going?

 Bugs Bunny is now 71 years old !

 Looking good, but increased stroke risk  What are Bugs’ risk factors?  What healthy habits does Bugs have to help prevent stroke?

Where have we been? Where are we going?

   In the past, only treatment for stroke was supportive care In 1996 the FDA approved Activase (alteplase) for treatment of acute ischemic stroke  This was a game-changer for the treatment of stroke  Must be given within 3 hours of onset (expanded window now up to 4 ½ hours) Physicians & hospitals were slow to adopt this treatment

But then things began to change

 Kickoff of Coverdell Stroke Registry  Sen. Paul Coverdell – died of a massive stroke in 2000  Coverdell Registry partners with American Heart/Stroke Association’s “Get With the Guidelines” (GWTG) program  Timeline  Pilot began with four states – GA, IL, MA, NC – 2001  Additional states piloted in 2003  Georgia began with 26 hospitals in 2005 – now 60 hospitals  State implementation in 2004

Building Consensus

   Goal was to improve the care of acute stroke in hospitals Coverdell & GWTG advocate:  Evidence-based guidelines  Use of standardized order sets  Primary and secondary prevention  Ongoing research Different registries, different measures  Finally AHA, CDC, and TJC agreed on 10 “harmonized measures”

“Harmonized “ Stroke Measures

          Thrombolytic Therapy Administered Dysphagia Screening * DVT / VTE Prophylaxis Antithrombotic Therapy by Day 2 Anticoagulation for A-fib/A-flutter Smoking Cessation * Stroke Education Assessed for Rehabilitation Needs Discharged on Cholesterol Reducing Therapy Discharged on Antithrombotics *Measures temporarily suspended in 2010

“Get With the Guidelines Stroke” and Outcome Sciences

   GWTG-S is a product of American Heart / American Stroke Association Robust and comprehensive registry & database Used by researchers for many studies and evidence-based guidelines  As of March 2011   1927 hospitals participating 1.6 million records entered

Location of hospitals in Georgia

GCASR- Georgia Coverdell Acute Stroke Registry

Number of Primary Stroke Centers certified by TJC

1 - 10 11 - 20 21 - 30 31 - 50 51 +

Primary Stroke Centers in Georgia

               Athens Regional MC Atlanta Medical Center Coliseum MC Doctors Hosp. of Augusta Emory Eastside MC Emory University Hosp. Floyd MC Grady Memorial Hosp.

Gwinnett MC Habersham MC Hamilton MC MCG Health MC Memorial Health (Savannah) North Fulton MC Northeast Georgia MC                 Northside Hosp, Forsyth Northside Hosp.

Piedmont Hosp. Redmond Regional MC Saint Joseph’s Hosp.

South Fulton MC Southern Regional MC Spalding Regional MC St. Francis Hosp. (Columbus) St. Joseph’s Hosp. (Savannah) St. Mary’s HC System The MC of Central Georgia (Macon) The Medical Center (Columbus) WellStar Cobb Hosp WellStar Kennestone Hosp

Stroke Systems of Care

Community Support & Reintegration Emergency Medical Services Remote Treatment Centers Rehabilitation Comprehensive Stroke Centers Primary Stroke Centers

Georgia is in the “Stroke Belt”

Cardiovascular Risk Factors: Georgia in 2007 . . .

      10% - diabetes 19% - smoke 30% - high blood pressure 37% - high cholesterol 65% - overweight/obese 75% - no regular exercise Georgia’s stroke death rate is 16% higher than U.S. average!

Obesity is a national epidemic

But your arteries aren’t !!

Other Stroke Projects in Georgia

The Coverdell-Murphy Act

     Passed by Georgia Legislature in 2008 Dramatically changed approach of stroke care in GA Established two-tier system for stroke-ready hospitals  Primary Stroke Centers (certified by TJC)  Remote Treatment Centers (designated by EMS) Unfortunately no funding provided by the state to finance efforts, so progress has been slow. Just last week, language in guidelines changed to include DNV and/or other certifying bodies to designate Primary Stroke Centers

Georgia Stroke Professional Alliance (Ga-SPA)

    Voluntary grass-roots organization Began with 7 Atlanta Stroke Coordinators in 2008 Now over 160 members throughout Georgia Seeking incorporation as a non-profit

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Georgia Stroke Professional Alliance (Ga-SPA)

 Mission is to prevent stroke and optimize stroke care through professional networking and education. Meet quarterly – rotate sites Website: http://share.nghs.com/gastroke/ Activities  Network of stroke professionals  Support peers in developing stroke programs, achieving certification  Promote evidence-based practice  Professional education  Community education, screening  Support legislation to improve stroke care

Is All This Effort Working?

Yes !!

 For the first time in more than 50 years, stroke has decreased in ranking as a cause of death  From 3 rd to 4 th leading cause of death (switched places with chronic lower respiratory disease)  Remains the leading cause of disabillity in older adults

The Future of Stroke in Georgia

The Future . . .

    Competition - evolving to Telemedicine, telestroke  collaboration True “Stroke Systems of Care” When Coverdell-Murphy network fully established, non-stroke hospitals may be bypassed  Funding for PSC coverage in south Georgia (fingers crossed)

Joint Commission

 Three tier system  Comprehensive Stroke Centers  Primary Stroke Centers  Acute Stroke Capable Hospitals  Standards development for Comprehensive Centers will begin Q3 CY2011  Product launch: late 2012