New stroke quality improvement initiative targets center of the “stroke belt”

February 17, 2017 -The IMPROVE Stroke Care program aims to improve every element of stroke care in North Carolina

A new DCRI-led program is looking for ways to improve systems of stroke care across North Carolina and beyond.

Stroke kills more than 130,000 Americans each year, making it the fifth-leading cause of death in the nation. Every year, more than 795,000 people in the United States have a stroke. Many of these strokes occur in the southeastern United States, in an 11-state region known as “the stroke belt.” North Carolina, which occupies the middle of this region, is sometimes described as the “buckle” of the belt.

In early 2015, the American Heart Association/American Stroke Association (AHA/ASA) updated their guidelines to recommend endovascular therapy in eligible acute ischemic stroke patients. However, for this therapy to be of benefit for the largest number of stroke patients, integrated and coordinated systems of care need to include public stroke awareness and education, patient and family recognition of stroke, and carry through rapid Emergency Medical Services  access and transportation to the appropriate inpatient setting and beyond.

Early action is important for improving outcomes for stroke patients. Patients who arrive at the emergency room within 3 hours of their first symptoms often have less disability three months after a stroke than those who received delayed care. Ensuring rapid care in North Carolina is particularly difficult, however, as there are only four certified comprehensive stroke centers in the state.

The IMPROVE Stroke Care program was created to develop a regional integrated stroke system in North Carolina that identifies, classifies, and treats patients with acute ischemic stroke more rapidly and effectively with reperfusion therapy. Based on similar programs developed to improve systems of care around heart attacks, IMPROVE Stroke Care will develop a network of stroke centers and other hospitals to implement best practices and integrate state of the art technologies into regional systems of stroke care. The DCRI’s System and Implementation Research and Outcomes operations teams will provide expertise in health system engineering and data reports to share across the program to improve process and clinical outcomes.

The initial costs of the program will be funded through a series of philanthropic grants from various sources totaling $3 million. The DCRI’s Bradley Kolls, MD, PhD (pictured left), and Carmelo Graffagnino, MD (pictured right), medical director of the Duke Comprehensive Stroke Center, will serve as principal investigators for the project.

One of IMPROVE Stroke Care’s novel elements is the use of new data capture technologies. Key data elements will be defined, collected, and fed back in real time to drive practice improvement. Participating centers will have real-time feedback on their performance metrics, utilizing novel data capture methods and mobile applications that operate independently of existing electronic health records or primary databases but are able to interact with them. This approach is based on earlier work done by the Duke Telestroke Network, which provides remote consultations for acute stroke diagnosis and treatment recommendations to affiliates across the state.

“We’ve come up with an innovative way of capturing data automatically through the Telestroke Network,” Kolls said. “This is a new strategy for collecting data on the systems of care throughout the state.”

The investigators also noted that stroke care has enormous financial costs; the total direct cost of stroke in the United States is expected to reach $184 billion in 2030. Initiatives such as IMPROVE Stroke Care save millions of dollars through reduced disability, improved functional outcomes, as well as reduced nursing home and re-hospitalization costs.

Ultimately, Graffagnino said, the real value of IMPROVE Stroke Care is in bringing together experts from every field of stroke care to address one of the Stroke Belt’s most serious public health threats.

“This is the whole village getting to solve this problem, not just doctors,” he said. “I think that’s really important.”