The Future of Stroke in Your State: Kansas

Janice Sandt MS,BSN,RN,CCM

FINANCIAL DISCLOSURES: NoneUNLABELED/UNAPPROVED USES DISCLOSURE: None

The Future of Stroke in Your State: Kansas• Review regional, statewide initiatives

Stroke Death Rate per 100,000, 35+,All Race, All Gender, 2008-2010

Centers for Disease Control and Prevention http://nccd.cdc.gov

Kansas: Stroke Death Rate per 100,0002008-2010

Centers for Disease Control and Prevention http://nccd.cdc.gov

Kansas: Ischemic Stroke Death Rate per 100,0002008-2010

Centers for Disease Control and Prevention http://nccd.cdc.gov

Kansas: Hemorrhagic Stroke Death Rate per 100,0002008-2010

Centers for Disease Control and Prevention http://nccd.cdc.gov

Kansas: Stroke Hospitalization Rate per 1,000 Medicare Beneficiaries 2008-2010

Centers for Disease Control and Prevention http://nccd.cdc.gov

• Confusion / Trouble Speaking 91.3%• Sudden Numbness / Weakness 95.3%• Sudden Trouble Seeing 76.4%• Sudden Chest Pain / Discomfort 46.2% (incorrect answer)• Trouble walking, dizziness, loss of balance 90.2%• Severe headache with no known cause 63.4%

• Only 22.8% got all questions correct and identified 911 as the correct first response.

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Survey Results (60% of hospita reporting)

Survey results (60% of 129 hospitals reporting):• 43.3% of hospitals stated they were not equipped / staffed to care for stroke• 45.5% of hospitals stated they were interested in participating in telestroke. • 70% of hospitals do not have an ER Physician available 24 x 7• 79.5% of hospitals do not have a stroke team• 41.0% do not have pre-written stroke orders• 68.5% do not have stroke pathways for stroke patients that are admitted. • 17.5% do not have pharmacological thrombolysis available• 25% do not have a set protocol for the use of tPA. • 67.6% are interested in support for Community Stroke Awareness 10

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2012 Task Force Goals

Include the following:

• Air ambulance, fixed wing and ambulance locations

• Neuro-interventional Centers • Primary Stroke Centers• Emergent Stroke Ready Hospitals• Hospitals NOT Stroke Ready

Give all hospitals the opportunity to participate and self-identify.

Support local EMS as they pursue policies / protocols that meet the needs of the regional stroke system of care.

Work in concert with the State Board of EMS

Identify possible gaps in service and solutions for overcoming.

Work with local hospitals to implement a state-wide, stroke signs and symptom campaign with an emphasis on:

Recognizing Symptoms andCalling 911 immediately

The local stroke system of care

Partners providing advanced care.

STROKE CAPABILITY MAP TRANSPORT / TREATMENT GUIDELINES STROKE SIGNS AND SYMPTOMS

64 hospitals (50% of Kansas Hospitals) are participating in KISS in one of 4 categories:

• Emergent Stroke Ready (52), • Primary Stroke Center (9), • 24/7 Neuro-Interventional Center/Primary Stroke Center (2) • Advanced Comprehensive Stroke Center (1)

Lessons Learned

LESSONS LEARNED:• Most small hospitals want to provide the very best stroke care. • The need for stroke focused clinical education is especially important for ESRH’s. This education

is best offered regionally or electronically. The Stroke Champion also wears many other “hats”. • Most common barrier to implementation is Door to CT interpretation within 45 minutes

• CT tech call protocol is too long requiring revision ( one hour too long!)• Contracted provider unable to meet obligation for read time• Changed providers for radiology support

• The most important educational message for EMS to support the ESRH is that Onset of Symptom is not the same as Last Known Well (Normal).

• Physicians who are hesitant to treat can be swayed through physician to physician communication. (Don’t be afraid to address the conflict directly.)

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Door to Needle Time

Door to IV tPA

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The Future of Stroke in Your State: Kansas The Kansas Heart & Stroke Collaborative • A care delivery and payment model to improve rural

Kansans’ heart health and heart attack and stroke outcomes to reduce total cost of care for that population.

• Residents of rural Northwest Kansas counties at risk of or have suffered heart attack or stroke

• Approximately 13,000 Medicare/Medicaid beneficiaries

Kansas Heart and Stroke Collaborative Participants

Anticipated Outcomes

•Reduce total cost of care for target population by $13.8 million (1.9 percent savings)

•Reduce deaths from heart disease and stroke by 20 percent

Kansas Heart and Stroke Collaborative Year 1• Target population: acute care admissions with discharge diagnosis of

heart attack and stroke. • Estimated number of patients: 630• Interventions

• STEMI protocols depending on geographical location• PCI within 90 minutes• Thrombolytic treatment

• Acute ischemic stroke protocols• IV tPA for eligible patients

• Transitional care management (TCM) for secondary prevention: call in 2 days, face to face in 2-4 weeks

• PCP, health coach, patient engagement

The Future of Stroke in Your State: Kansas

Where you live should not determine

whether you live!