Iowa Coverdell Stroke Program (ICSP)

From 2012 to 2015, the Iowa Coverdell Stroke Program (ICSP) achieved significant improvements in the percentage of patients provided with stroke education (87% to 94%, P < .001) and prescribed anticoagulation therapy for atrial fibrillation/flutter (86% to 93%, P < .05) in 30 participating hospitals by establishing interdisciplinary learning communities and providing education to EMS agencies.

History of Stroke Care in Iowa

In 2008, CDC funded the Iowa Department of Public Health to develop a heart disease and stroke prevention program. The following year, the Iowa Department of Public Health received additional funding from CDC to create the Iowa Stroke Registry, and participating hospitals began collecting data on stroke-related measures on a voluntary basis. The Iowa Department of Public Health received 2012–2015 CDC Paul Coverdell National Acute Stroke Program funds to continue the registry and improve EMS-to-hospital transitions for stroke patients.

Program Implementation for ICSP from 2012–2015

Through a partnership with the Iowa Healthcare Collaborative, the Iowa Department of Public Health engaged 30 hospitals in data-driven QI. ICSP’s two main QI activities included (1) the development of stroke action teams through learning communities and (2) EMS education, including calls, webinars, tutorials, and trainings.

Improving Outcomes Among Iowa Stroke Patients

ICSP’s efforts led to systems changes that improved EMS-to-hospital transitions for stroke patients. With CDC funds, ICSP implemented practice changes such as switching from the standard neurological assessment to a more comprehensive scale, modifying the EMS protocol to ensure that all stroke patients would eventually be transported to a primary stroke center, and increasing the number of stroke-capable facilities in the state.

ICSP’s work also contributed to maintaining and improving quality of stroke care in participating hospitals. Performance measure data from the state stroke registry of participating hospitals revealed improvements in 3 of the 12 key Coverdell Program quality-of-care measures from 2012 to 2015 (Table 1). The two measures that showed the greatest improvements over time were the percentages of patients provided with stroke education and of patients prescribed anticoagulation therapy for atrial fibrillation/flutter; both increased 7%.

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

 Future Directions for Stroke Care in Iowa

ICSP staff reported that future directions for stroke care in Iowa include technology and legislation changes to improve data linkages. In 2015, all EMS providers switched to new software that expands the stroke-related indicators collected by EMS providers. Furthermore, the software is able to transfer information directly into the registry, which could facilitate the use of electronic records and potentially phase out paper records. Stroke care in Iowa may also change if the Iowa Code changes to make stroke a mandatory reportable condition. This change could increase participation in the registry across the state and improve data linkages across the continuum of care.