Abstract 176: Regional Stroke Networks May Fill Gaps for Community and Quality Improvement

Abstract

Introduction: State departments of health (DOH) and professional organizations such as the American Heart Association (AHA) create guidelines that influence many aspects of the stroke systems of care (SSC); however, they do not directly address ongoing quality improvement (QI) efforts and community/professional education (CE) activities. Regional networks such as The NorthEast Cerebrovascular Consortium (NECC) may better liaise with hospitals to fill this gap. We assessed current adherence with recommended stroke improvement activities in the NECC and the attributed source (Joint Commission (JC), hospital QI, AHA, The NECC, and Get With the Guidelines-Stroke [GWTG-S®]) on performing these activities. Methods: Surveys were completed by 37% (172/471) of acute care hospitals in the Northeast region and 100% (8/8) DOH regarding hospital capacity, stroke center designation (SCD), and SSC programs. Respondents used a Likert scale of 1-5 (5=strongly agree) to rate influence of state SC mandates; Joint Commission (JC), hospital QI, AHA, The NECC, and GWTG-S® recommendations on their practices. Results: Over 80% of hospitals offer smoking cessation counseling, blood pressure screening, and rehabilitation, attributing AHA guidelines as most influential for these programs (mean=4.2). Less than 2/3rds of hospitals sponsor outreach programs to community organizations, whereas 83% target emergency medical services. Hospitals with an increase in thrombolytic use over the past 5 years attribute this largely to attending level acute stroke team coverage, again influenced by the AHA (mean=4.0). Among 167 reported SSC areas needing improvement, 56 (34%) identified gaps in QI (compliance, provider education and feedback) and 29 (17%) in CE. Conclusions: Though AHA and DOH guidelines are well incorporated into hospital practice, enforcement of standards, CE and QI processes are needed. Regional organizations such as the NECC are well poised to fill this gap through in-person collaboration and meetings of local stakeholders.