WHAT’S UP WITH STROKE IN GEORGIA?

March 4, 2011Georgia Organization of Nurse Leaders

Trish Westbrook, RN, MSN, FNP-CStroke Coordinator, Northeast Georgia Medical Center

Ehhh, What’s

Up Doc?

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

31 - 50

51 +21 - 30

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

Emergency Medical Services

Remote Treatment Centers

Primary Stroke Centers

Comprehensive Stroke Centers

Rehabilitation

Community Support & Reintegrati

on

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

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?

For the first time in more than 50 years, stroke has decreased in ranking as a cause of death From 3rd to 4th leading cause of death

(switched places with chronic lower respiratory disease)

Remains the leading cause of disabillity in older adults

Yes !!

The Future of Stroke in Georgia

The Future . . .

Competition - evolving to collaboration

True “Stroke Systems of Care” Telemedicine, telestroke 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

That’s All Folks !

Questions?