Ohio Coverdell Stroke Program

From 2012 to 2015, the Ohio Coverdell Stroke Program achieved significant improvements in the percentage of patients for whom an NIHSS score was recorded (77% to 90%, P < .0001) and who received thrombolytic therapy (alteplase) within 60 minutes of arrival (41% to 59%, P < .0001) in 46 participating hospitals through education, training, and consultation with hospitals based on aggregated data reports.

History of Stroke Care in Ohio

The Ohio Department of Health received Paul Coverdell National Acute Stroke Program funding from CDC in 2007 and in 2012. From 2007 to 2012, the Ohio Coverdell Stroke Program focused on acute care QI initiatives and achieved high levels of in-hospital quality of stroke care. In 2012, the Ohio Coverdell Stroke Program determined that 27 of the 42 participating hospitals were already working toward improving transitions of care, either hospital-wide or for conditions other than stroke, through various federally funded initiatives. Ohio Coverdell established a data collection component within their American Heart Association Get With the Guidelines® (GWTG)—Stroke platform to collect data on follow-up appointment scheduling. This strategically poised the Ohio Coverdell Stroke Program to expand its focus to include improving transitions of care from hospitals to post-hospital facilities using 2012–2015 Coverdell funds.

Program Implementation for the Ohio Coverdell Stroke Program from 2012–2015

The Ohio Coverdell Stroke Program’s main QI activities included (1) providing technical assistance and report development to hospitals for in-hospital and post-hospital stroke care initiatives, and (2) scheduling follow-up appointments for patients discharged home to improve transitions of care from acute care to post-hospital settings.

Improving Outcomes Among Ohio Stroke Patients

Ohio Coverdell Stroke Program activities contributed to practice and systems changes in participating hospitals. For example, scheduling process changes resulted in an increase in the number of follow-up appointments made for patients before discharge, and documenting data in the GWTG tool facilitated QI within partnering hospitals.

Performance measure data from the state stroke registry of participating hospitals revealed improvement in all 12 Coverdell Program quality-of-care performance measures from 2012 to 2015 (Table 1). The two measures with the greatest increase over time were the percentages of eligible patients treated with thrombolytic therapy (alteplase) within 60 minutes of hospital arrival (door-to-needle time) and for whom an initial NIHSS score was recorded, which increased 18% and 13%, respectively.

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

 Future Directions for Stroke Care in Ohio

In the future, the Ohio Coverdell Stroke Program aims to collaborate with hospitals to address contextual factors, such as transportation and caregiver education, that could prevent patients from attending follow-up appointments. Additionally, the Ohio Coverdell Stroke Program plans to sustain its networking activities to ensure that stroke care providers have future opportunities to share information on best practices. The program also plans to develop workforce capacity by providing education, training, clinical consultation, and technical assistance to hospital stroke teams. Further, the program wants to continue providing data reports to participating hospitals. These reports are valuable as stroke coordinators often do not have time to aggregate program data or create reports for administrative and stroke center certification purposes. The Ohio Department of Health received 2015–2020 Coverdell funding to continue its work in stroke care.