Wisconsin Coverdell Stroke Program (WCSP)

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From 2013 to 2015, the Wisconsin Coverdell Stroke Program (WCSP) achieved significant improvements in the percentage of eligible patients who were given thrombolytic therapy (alteplase) (69% to 86%, P < .05) and who received thrombolytic therapy (alteplase) within 60 minutes of arrival (26% to 55%, P < .001) in 29 participating hospitals through the development of toolkits to support QI activities and educational outreach events for hospital and EMS staff.

History of Stroke Care in Wisconsin

In 2012, the Wisconsin Department of Health Services received Paul Coverdell National Acute Stroke Program funds from CDC. Prior to 2012, the Wisconsin Department of Health Services participated in the 2005–2009 Great Lakes Regional Stroke Network. Through this network, the Wisconsin Department of Health Services developed the Wisconsin Stroke Coalition and a statewide stroke system of care plan. Using 2012–2015 Coverdell funds, WCSP was able to reconvene the coalition and revive partnerships developed through the Great Lakes Regional Stroke Network to improve the transition of care from EMS to hospitals for stroke patients.

Program Implementation for the WCSP from 2012–2015

WCSP’s key QI activities included (1) providing technical assistance to hospital staff through performance reviews and data abstraction training, (2) developing toolkits for hospitals and EMS agencies, and (3) conducting outreach events to facilitate relationship building between EMS agencies and hospitals.

Improving Outcomes Among Wisconsin Stroke Patients

WCSP’s efforts led to practice changes including the development of new protocols and improved data linkages between EMS and hospitals. WCSP worked with the state EMS unit, physician advisory group, and stroke coordinators to develop and distribute a transfer protocol for patients needing thrombolytic therapy (alteplase) to 450 EMS agencies and 127 hospitals in the state. Additionally, WCSP developed a communication form for hospitals to provide feedback to EMS on transitions of care, thereby creating a data feedback loop and overcoming barriers to real-time data access.

Participation in WCSP also contributed to better quality of care for stroke patients. Performance measure data from the state stroke registry of participating hospitals revealed improvements in 7 of the 12 key Coverdell Program quality-of-care measures from 2013 (the first year that data were available) to 2015 (Table 1). The two measures with the greatest improvement over time were the percentages of eligible patients who were given thrombolytic therapy (alteplase) and who received that therapy within 60 minutes of hospital arrival (door-to-needle time), which increased 17% and 29%, 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
Thrombolytic therapy (alteplase) 69% 86% <.05
Assessed for rehabilitation 97% 99% <.0001
Stroke education 90% 95% <.05
Discharged on statin medication 96% 98% <.05
Anticoagulation therapy for atrial fibrillation/flutter 92% 98% <.05
Door-to-needle time ≤ 60 minutes 26% 55% <.001
Recording of NIHSS score 89% 96% <.0001

 Future Directions for Stroke Care in Wisconsin

Using CDC funding, WCSP established itself as a convener and coordinator of the stroke care stakeholders and efforts in the state. To sustain this function, WCSP staff are writing a charter for the Wisconsin Stroke Coalition that will outline organizations’ roles and responsibilities going forward and working to identify a partner with the capacity to coordinate future stroke care activities in the state. WCSP received 2015–2020 Coverdell funding to continue its work in stroke care.

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 arebheartinfo@cdc.gov.