What’s up with stroke In georgia ?

1. Ehhh, What’s Up Doc? March 4, 2011 Georgia Organization of Nurse Leaders Trish Westbrook, RN, MSN, FNP-C Stroke Coordinator, Northeast Georgia Medical Center What’s up with stroke In georgia?

2. Where have we been? Where are we going? • Bugs Bunny is now 71 years old ! • Looking good, but increased stroke risk • What are Bugs’ risk factors? • What healthy habits does Bugs have to help prevent stroke?

3. Where have we been? Where are we going? • In the past, only treatment for stroke was supportive care • In 1996 the FDA approved Activase(alteplase) for treatment of acute ischemic stroke • This was a game-changer for the treatment of stroke • Must be given within 3 hours of onset (expanded window now up to 4 ½ hours) • Physicians & hospitals were slow to adopt this treatment

4. But then things began to change • Kickoff of Coverdell Stroke Registry • Sen. Paul Coverdell – died of a massive stroke in 2000 • Coverdell Registry partners with American Heart/Stroke Association’s “Get With the Guidelines” (GWTG) program • Timeline • Pilot began with four states – GA, IL, MA, NC – 2001 • Additional states piloted in 2003 • Georgia began with 26 hospitals in 2005 – now 60 hospitals • State implementation in 2004

5. Building Consensus • Goal was to improve the care of acute stroke in hospitals • Coverdell & GWTG advocate: • Evidence-based guidelines • Use of standardized order sets • Primary and secondary prevention • Ongoing research • Different registries, different measures • Finally AHA, CDC, and TJC agreed on 10 “harmonized measures”

6. “Harmonized “ Stroke Measures • Thrombolytic Therapy Administered • Dysphagia Screening * • DVT / VTE Prophylaxis • Antithrombotic Therapy by Day 2 • Anticoagulation for A-fib/A-flutter • Smoking Cessation * • Stroke Education • Assessed for Rehabilitation Needs • Discharged on Cholesterol Reducing Therapy • Discharged on Antithrombotics *Measures temporarily suspended in 2010

7. “Get With the Guidelines - Stroke” and Outcome Sciences • GWTG-S is a product of American Heart / American Stroke Association • Robust and comprehensive registry & database • Used by researchers for many studies and evidence-based guidelines • As of March 2011 • 1927 hospitals participating • 1.6 million records entered

8. Location of hospitals in Georgia GCASR- Georgia Coverdell Acute Stroke Registry

9. Number of Primary Stroke Centers certified by TJC 31 - 50 1 - 10 11 - 20 21 - 30 51 +

10. Primary Stroke Centers in Georgia • Athens Regional MC • Atlanta Medical Center • Coliseum MC • Doctors Hosp. of Augusta • Emory Eastside MC • Emory University Hosp. • Floyd MC • Grady Memorial Hosp. • Gwinnett MC • Habersham MC • Hamilton MC • MCG Health MC • Memorial Health (Savannah) • North Fulton MC • Northeast Georgia MC  • Northside Hosp, Forsyth • Northside Hosp. • Piedmont Hosp. • Redmond Regional MC • Saint Joseph’s Hosp. • South Fulton MC • Southern Regional MC • Spalding Regional MC • St. Francis Hosp. (Columbus) • St. Joseph’s Hosp. (Savannah) • St. Mary’s HC System • The MC of Central Georgia (Macon) • The Medical Center (Columbus) • WellStar Cobb Hosp • WellStarKennestone Hosp

11. Stroke Systems of Care

12. Georgia is in the “Stroke Belt”

13. Cardiovascular Risk Factors:Georgia in 2007 . . . • 10% - diabetes • 19% - smoke • 30% - high blood pressure • 37% - high cholesterol • 65% - overweight/obese • 75% - no regular exercise Georgia’s stroke death rate is 16% higher than U.S. average!

14. Obesity is a national epidemic But your arteries aren’t !!

15. Other Stroke Projects in Georgia

16. The Coverdell-Murphy Act • Passed by Georgia Legislature in 2008 • Dramatically changed approach of stroke care in GA • Established two-tier system for stroke-ready hospitals • Primary Stroke Centers (certified by TJC) • Remote Treatment Centers (designated by EMS) • Unfortunately no funding provided by the state to finance efforts, so progress has been slow. • Just last week, language in guidelines changed to include DNV and/or other certifying bodies to designate Primary Stroke Centers

17. Georgia Stroke Professional Alliance (Ga-SPA) • Voluntary grass-roots organization • Began with 7 Atlanta Stroke Coordinators in 2008 • Now over 160 members throughout Georgia • Seeking incorporation as a non-profit

18. Georgia Stroke Professional Alliance (Ga-SPA) • Mission is to prevent stroke and optimize stroke care through professional networking and education. • Meet quarterly – rotate sites • Website: http://share.nghs.com/gastroke/ • Activities • Network of stroke professionals • Support peers in developing stroke programs, achieving certification • Promote evidence-based practice • Professional education • Community education, screening • Support legislation to improve stroke care

19. Is All This Effort Working? Yes !! • For the first time in more than 50 years, stroke has decreased in ranking as a cause of death • From 3rd to 4th leading cause of death (switched places with chronic lower respiratory disease) • Remains the leading cause of disabillity in older adults

20. The Future of Stroke in Georgia

21. The Future . . . • Competition - evolving to  collaboration • True “Stroke Systems of Care” • Telemedicine, telestroke • When Coverdell-Murphy network fully established, non-stroke hospitals may be bypassed • Funding for PSC coverage in south Georgia (fingers crossed)

22. Joint Commission • Three tier system • Comprehensive Stroke Centers • Primary Stroke Centers • Acute Stroke Capable Hospitals • Standards development for Comprehensive Centers will begin Q3 CY2011 • Product launch: late 2012

23. That’s All Folks ! Questions?