North Carolina Stroke Care Collaborative (NCSCC)

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North Carolina

From 2012 to 2015, the North Carolina Stroke Care Collaborative (NCSCC) achieved significant improvements in the percentage of patients provided with stroke education (75% to 91%, P < .0001) and for whom an NIHSS score was recorded (71% to 80%, P < .0001) in 57 participating hospitals through educational outreach with hospitals and EMS agencies and grant awards for collaborative QI projects.

History of Stroke Care in North Carolina

In 2004, CDC awarded funds to the North Carolina Division of Public Health (NC DPH) through the CDC Paul Coverdell National Acute Stroke Program. This funding helped establish the NCSCC to use data from the registry to drive QI in stroke care. NC DPH received 2012–2015 Coverdell funds to improve EMS-to-hospital transitions of care for stroke patients.

Program Implementation for the NCSCC from 2012–2015

NCSCC’s key QI activities included (1) developing an EMS and hospital data linkage portal; (2) providing educational events and peer-to-peer sharing among hospitals and EMS agencies; and (3) awarding grants for collaborative QI activities.

Improving Outcomes Among North Carolina Stroke Patients

NCSCC’s efforts contributed to stroke care systems and practice changes in participating hospitals. For example, as a result of attending a regional workshop, one participating hospital worked with the local EMS agency to implement a standardized stroke screening process and to develop a better defined transfer of care protocol.

Participation in NCSCC also contributed to better care for stroke patients. Performance measure data from the state stroke registry of participating hospitals revealed significant improvements in 6 of the 12 key Coverdell Program quality-of-care measures from 2012 to 2015 (Table 1). The two measures with the greatest improvement over time were the percentages of patients who received stroke education and for whom an NIHSS score was recorded, which increased 16% and 9%, respectively.

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

Table 1.  Improved Coverdell Program Quality of Stroke Care Measures, 2012–2015
Measure 2012 2015 P
Venous thromboembolism (VTE) prophylaxis 98% 99% <.05
Assessed for rehabilitation 90% 96% <.0001
Stroke education 75% 91% <.0001
Discharged on statin medication 84% 91% <.0001
Anticoagulation therapy for atrial fibrillation/flutter 90% 92% <.01
Recording of NIHSS score 71% 80% <.0001

 Future Directions for Stroke Care in North Carolina

Future proposed directions for stroke care in North Carolina included an expansion of the data linkage pilot program and efforts to raise public awareness of stroke symptoms and the existence of the registry. Through its partnerships, NCSCC aims to raise awareness about stroke prevention, especially in rural parts of the state, and to communicate the value of the registry within the stroke system of care to the public. In addition, NCSCC plans to collaborate with key stakeholders across the state to move across the care continuum to improve transitions of care in the post-discharge stroke care arena.

*The Miami Emergency Neurological Deficit (MEND) exam is a focused neurological assessment that can be used in both the pre-hospital setting and the in-hospital setting.

Additional Information

Acronyms Used in the Summaries

CDC: Centers for Disease Control and Prevention
EMS: Emergency Medical Services
NIHSS: National Institutes of Health Stroke Scale
NQF: National Quality Forum
QI: Quality Improvement

Other Terms Defined

Primary Stroke Center: The Joint Commission’s Certificate of Distinction for Primary Stroke Centers recognizes centers that make exceptional efforts to foster better outcomes for stroke care. Achieving certification signifies that the services provided have the critical elements to achieve long-term success in improving outcomes. The certification is based on the Brain Attack Coalition’s “Revised and Updated Recommendations for the Establishment of Primary Stroke Centers” and includes the requirement to report on eight core standardized measures from the Joint Commission.

For more information on the current program, visit the Paul Coverdell National Acute Stroke Program website.

For questions about the evaluation of the program, e-mail