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Regionalization of stroke systems of care in the stroke belt states: The IMPROVE stroke care quality improvement program.

Publication ,  Journal Article
Kolls, BJ; Ehrlich, ME; Monk, L; Shah, S; Roettig, M; Iversen, E; Jollis, JG; Granger, CB; Graffagnino, C ...
Published in: Am Heart J
March 2024

BACKGROUND: Despite guidelines and strong evidence supporting intravenous thrombolysis and endovascular thrombectomy for acute stroke, access to these interventions remains a challenge. The objective of the IMPROVE stroke care program was to accelerate acute stroke care delivery by implementing best practices and improving the regional systems of care within comprehensive stroke networks. METHODS: The IMPROVE Stroke Care program was a prospective quality improvement program based on established models used in acute coronary care. Nine hub hospitals (comprehensive stroke centers), 52 regional/community referral hospitals (spokes), and over 100 emergency medical service agencies participated. Through 6 regional meetings, 49 best practices were chosen for improvement by the participating sites. Over 2 years, progress was tracked and discussed weekly and performance reviews were disseminated quarterly. RESULTS: Data were collected on 21,647 stroke code activations of which 8,502 (39.3%) activations had a final diagnosis of stroke. There were 7,226 (85.0%) ischemic strokes, and thrombolytic therapy was administered 2,814 times (38.9%). There was significant overall improvement in the proportion that received lytic therapy within 45 minutes (baseline of 44.6%-60.4%). The hubs were more frequently achieving this at baseline, but both site types improved. A total of 1,455 (17.1%) thrombectomies were included in the data of which 401 (27.6%) were transferred from a spoke. There was no clinically significant change in door-to-groin times for hub-presenting thrombectomy patients, however, significant improvement occurred for transferred cases, 46 minutes (interquartile range [IQR] 36, 115.5) at baseline to 27 minutes (IQR 10, 59). CONCLUSIONS: The IMPROVE program approach was successful at improving the delivery of thrombolytic intervention across the consortium at both spoke and hub sites through collaborative efforts to operationalize guideline-based care through iterative sharing of performance and best practices for implementation. Our approach allowed identification of both opportunities for improvement and operational best practices providing guidance on how best to create a regional stroke care network and operationalize the published acute stroke care guidelines.

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Published In

Am Heart J

DOI

EISSN

1097-6744

Publication Date

March 2024

Volume

269

Start / End Page

72 / 83

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Time-to-Treatment
  • Thrombolytic Therapy
  • Stroke
  • Quality Improvement
  • Prospective Studies
  • Humans
  • Fibrinolytic Agents
  • Cardiovascular System & Hematology
  • 3201 Cardiovascular medicine and haematology
 

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Kolls, B. J., Ehrlich, M. E., Monk, L., Shah, S., Roettig, M., Iversen, E., … (On behalf of the IMPROVE stroke consortium), . (2024). Regionalization of stroke systems of care in the stroke belt states: The IMPROVE stroke care quality improvement program. Am Heart J, 269, 72–83. https://doi.org/10.1016/j.ahj.2023.11.020
Kolls, Brad J., Matthew E. Ehrlich, Lisa Monk, Shreyansh Shah, Mayme Roettig, Edwin Iversen, James G. Jollis, Christopher B. Granger, Carmelo Graffagnino, and Carmelo (On behalf of the IMPROVE stroke consortium). “Regionalization of stroke systems of care in the stroke belt states: The IMPROVE stroke care quality improvement program.Am Heart J 269 (March 2024): 72–83. https://doi.org/10.1016/j.ahj.2023.11.020.
Kolls BJ, Ehrlich ME, Monk L, Shah S, Roettig M, Iversen E, et al. Regionalization of stroke systems of care in the stroke belt states: The IMPROVE stroke care quality improvement program. Am Heart J. 2024 Mar;269:72–83.
Kolls, Brad J., et al. “Regionalization of stroke systems of care in the stroke belt states: The IMPROVE stroke care quality improvement program.Am Heart J, vol. 269, Mar. 2024, pp. 72–83. Pubmed, doi:10.1016/j.ahj.2023.11.020.
Kolls BJ, Ehrlich ME, Monk L, Shah S, Roettig M, Iversen E, Jollis JG, Granger CB, Graffagnino C, (On behalf of the IMPROVE stroke consortium). Regionalization of stroke systems of care in the stroke belt states: The IMPROVE stroke care quality improvement program. Am Heart J. 2024 Mar;269:72–83.
Journal cover image

Published In

Am Heart J

DOI

EISSN

1097-6744

Publication Date

March 2024

Volume

269

Start / End Page

72 / 83

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Time-to-Treatment
  • Thrombolytic Therapy
  • Stroke
  • Quality Improvement
  • Prospective Studies
  • Humans
  • Fibrinolytic Agents
  • Cardiovascular System & Hematology
  • 3201 Cardiovascular medicine and haematology