Michigan Links Hospital and Emergency Medical Services Data

Overview

For its most recent Paul Coverdell National Acute Stroke Program cooperative agreement, the Michigan Stroke Program (MiSP) aimed to link information about the treatment stroke patients receive in an ambulance with information about the care they receive when they reach the hospital.

Before this project, emergency medical services (EMS) providers received little or no feedback about whether they had correctly identified that a patient was having a stroke. They also weren’t told what treatment patients received at the hospital or what happened to them. This made it hard for EMS providers to evaluate the quality of their pre-hospital care.

MiSP developed a process for linking patient data using five factors: destination hospital, date of arrival, patient age, date of birth, and gender. MiSP uses this information to produce quarterly reports that allow EMS providers to track patient outcomes. The reports help identify patients whose strokes were missed by EMS providers, as well as patients who were misidentified as having a stroke. This information helps EMS providers improve the quality of their stroke care.

“The success of a stroke system of care rests on the ability of the components of the stroke system to communicate effectively with one another,” said Adrienne Nickles, MPH, the MiSP co-principal investigator and stroke epidemiologist.

Good communication between EMS providers and hospital staff ensures that stroke patients receive the most appropriate and fastest possible treatment once they reach the hospital.

Making sure EMS providers can accurately identify the signs of a stroke is critical. They are often the first medical person to have contact with the patient, and they can begin life-saving treatment in the ambulance on the way to the emergency department. They can also contact the hospital to let them know a potential stroke patient is coming in (prenotification), which gives the hospital time to prepare. Stroke is a medical emergency. Getting treatment quickly can reduce stroke-related brain damage and increase the patient’s chances of survival and recovery.

In addition to linking hospital and EMS data, MiSP also began forming partnerships with EMS agencies across the state. Over the past 6 years, MiSP has partnered with over 170 EMS agencies across Michigan to help create a unified system of stroke care in the state. The program also more than doubled the number of its hospital partners, from 23 to over 50.

“We saw the need to bridge the information gap between EMS agencies and hospitals, so EMS could receive information about their patients’ care and outcomes after handoff.”

Challenge and Approach

MiSP expanded the number of its EMS and hospital partners with the help of the state’s Division of EMS and Trauma and 13 of Michigan’s 59 medical control authorities (MCAs), which supervise and coordinate the EMS agencies in their regions. MCAs use the MiSP reports to identify issues as they arise and target educational interventions for their agencies to provide the highest-quality stroke care.

The 13 participating MCAs oversee more than 170 EMS partner agencies, which transport about 70% of the state’s suspected stroke patients. The 50 hospital partners that are currently submitting data treat more than 65% of Michigan’s stroke patients.

EMS agencies can easily share their data with MiSP because they already submit this information to the state. But for some hospitals, especially smaller facilities with fewer providers, staff shortages and turnover can present challenges for data collection and reporting. In early 2020, these issues were made worse as hospitals shifted their priorities to focus on treating COVID-19 patients. MiSP’s quality systems improvement specialist, Suzanne O’Brien, MSN, RN, said these challenges made it hard for some hospitals to join the MiSP project.

Accomplishments

A key success of the MiSP project is that the quarterly reports have helped EMS providers increase the accuracy of their stroke diagnoses, likely because of better documentation and training. Better documentation of stroke data has also helped improve EMS data quality overall, extending beyond stroke care.

From 2015 to 2021, funding from the Paul Coverdell National Acute Stroke Program allowed MiSP to increase partnerships with EMS agencies from 0 to more than 170 and with hospitals across the state. The original plan was to recruit MCAs and EMS agencies that served MiSP partner hospitals. It became clear that recruitment could also work in reverse: Partner MCAs helped MiSP recruit hospitals.

“We weren’t expecting that, but it was a very effective way to continue to expand MiSP’s reach to new hospitals,” said Nickles.

Lessons Learned

Linking hospital data with EMS data can contribute to better quality of care and help MiSP continue to attract new EMS and hospital partners. Adding partners helps strengthen the continuum of stroke care across the state, ultimately helping improve stroke outcomes.

MCAs are key players in helping MiSP recruit EMS agencies and build cross-agency relationships.

Sharing quarterly performance measure reports with EMS providers and MCAs and providing technical assistance also helps build partnerships. MiSP hosts an annual workshop that provides continuing education hours. The partnerships are successful because all of the partners can benefit.

“We provide a monthly call with the hospitals, so it gives our participating hospitals an opportunity to network and share what they’ve learned with one another,” said O’Brien. “Participants on the call share their experiences and challenges in stroke care, helping everyone learn.”

“There’s a long history in Michigan with the Paul Coverdell-funded stroke program, and it’s well known that we provide good information and take the hospitals’ feedback and input. To be successful, it has to be a two-way street.”

Additional Information

• CDC: Paul Coverdell National Acute Stroke Program
• Michigan Department of Health and Human Services: Michigan Stroke Program (MiSP)
• American Heart Association: Get With The Guidelines^®–Stroke