Michigan’s Ongoing Stroke Registry to Accelerate Improvement of Care (MOSAIC)

From 2012 to 2015, Michigan’s Ongoing Stroke Registry to Accelerate Improvement of Care (MOSAIC) achieved significant improvements in the percentage of patients for whom an NIHSS score was recorded (82% to 91%, P < .0001) and who were provided with stroke educational materials (86% to 95%, P < .0001) in 26 hospitals through monthly conference calls on best practices and one-to-one technical assistance for hospitals.

History of Stroke Care in Michigan

During 2007–2012, the Michigan Department of Community Health received funding from the CDC Paul Coverdell National Acute Stroke Program to improve care for stroke patients in hospitals participating in MOSAIC. The Michigan Department of Community Health’s experience with in-hospital stroke care and prior pilot work on hospital-to-post-hospital transitions of care provided the program with the organizational capacity needed to receive 2012–2015 Coverdell funds to continue its work.

Program Implementation for MOSAIC from 2012–2015

MOSAIC’s main QI activities were (1) continuing or maintaining improvement on key inpatient stroke care measures and (2) conducting a pilot program of making 30-day follow-up calls for all patients discharged.

Improving Outcomes Among Michigan Stroke Patients

MOSAIC’s QI efforts contributed to systems and practice changes in hospitals participating in the 30-day follow-up call pilot. For example, at one participating hospital, follow-up call data revealed that patients were not meeting lifestyle and medication regimen recommendations. To overcome this challenge, the hospital began providing free medication counseling services that focused on working with the patient and caregiver to set up a medication regimen before discharge.

MOSAIC’s activities also contributed to better quality of care for stroke patients. Performance measure data from the state stroke registry of participating hospitals revealed improvements in 4 of the 12 key Coverdell Program quality-of-care measures from 2012 to 2015 (Table 1). The two measures that made the largest increases over time were the percentages of patients provided with stroke education at discharge and for whom an NIHSS score was recorded, which both improved 9%.

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

 Future Directions for Stroke Care in Michigan

MOSAIC’s future work will focus on continuing the record of success with inpatient and post-hospital stroke care, as well as informing the passage of guidelines to establish a statewide stroke system of care, including hospital designation for primary stroke centers. MOSAIC plans to expand the patient discharge 30-day follow-up call process and resulting system changes to additional Coverdell hospitals; however, they are largely dependent on Coverdell funding for stroke care programming. MOSAIC received 2015–2020 Coverdell funding to continue its work in stroke care.