Arkansas Stroke Registry

From 2012 to 2015, the Arkansas Stroke Registry achieved significant improvements in the percentage of stroke patients for whom an NIHSS score was recorded (39% to 69%, P <0.001) and ischemic stroke patients who were given thrombolytic therapy (alteplase) (25% to 71%, P <0.001) in 42 participating hospitals through performance improvement reviews with hospitals and a pilot training program for EMS staff.

History of Stroke Care in Arkansas

In 2005, the Arkansas General Assembly created an Acute Stroke Care Task Force to combat the high prevalence of stroke in the state. The Task Force recommended that Arkansas create a statewide stroke registry and stroke telemedicine program, which later became the AR Stroke Assistance through Virtual Emergency Support (AR SAVES) program. In 2011, the Task Force secured funding to design and implement the Arkansas Stroke Registry. Early work on the stroke registry positioned the Arkansas Department of Health to receive funding from CDC through the 2012–2015 Paul Coverdell National Acute Stroke Program. With these funds, Arkansas focused on improving EMS-to-hospital transitions for stroke patients, and developing a statewide stroke system of care plan.

Program Implementation for the Arkansas Stroke Registry from 2012–2015

The Arkansas Stroke Registry engaged in three key quality improvement (QI) activities: (1) conducting program reviews of performance measures with participating hospitals; (2) providing training and technical assistance for EMS and hospital staff; and (3) establishing a pilot program, Code Stroke, to improve the EMS-to-hospital transition of stroke patients.

Improving Outcomes Among Arkansas Stroke Patients

QI activities and training led to systems changes that improved the transition of stroke patients from EMS agencies to hospitals. The Code Stroke pilot program improved transitions of stroke patients so that they went directly into the CT scanner upon hospital arrival. Participating hospitals also enacted changes such as administering thrombolytic therapy while the patient was in the CT scanner and streamlining the dysphagia screening process.

Arkansas Stroke Registry activities contributed to better quality of care for stroke patients. Performance measure data from the state stroke registry of participating hospitals revealed significant improvements in 9 of the 12 key Coverdell Program quality-of-care measures from 2012 to 2015 (Table 1). The two measures that improved the most over time were the percentages of patients who had an initial NIHSS score recorded and of eligible patients receiving thrombolytic therapy, which improved 30% and 46%, respectively.

Table 1.  Improved Coverdell Program Quality of Stroke Care Measures, 2012–2015

 Future Directions for Stroke Care in Arkansas

Through its established partnerships, the Arkansas Stroke Registry plans to support a new stroke systems of care plan that will promote using a standard of care protocol. Additionally, potential state legislation may change the stroke system of care by mandating stroke center designations recognized by the state health department. The state health department may also establish and implement EMS standard of care protocols and destination protocols for EMS transport.