The Future of Stroke in Your State: Kansas
Janice Sandt MS,BSN,RN,CCM
FINANCIAL DISCLOSURES: None
UNLABELED/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 100,000
2008-2010
Centers for Disease Control and Prevention http://nccd.cdc.gov
Kansas: Ischemic Stroke Death Rate per 100,000
2008-2010
Centers for Disease Control and Prevention http://nccd.cdc.gov
Kansas: Hemorrhagic Stroke Death Rate per 100,000
2008-2010
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
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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.
9
Survey Results (60% of hospita
reporting)
Survey results (60% of 129 hospitals reporting):
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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
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2012 Task Force Goals
STROKE CAPABILITY MAP
Include the following:
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Air ambulance, fixed wing and ambulance
locations
Neuro-interventional Centers
Primary Stroke Centers
Emergent Stroke Ready Hospitals
Hospitals NOT Stroke Ready
TRANSPORT / TREATMENT GUIDELINES
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.
STROKE SIGNS AND SYMPTOMS
Work with local hospitals to implement a statewide, stroke signs and symptom campaign with
an emphasis on:
Recognizing Symptoms and
Calling 911 immediately
The local stroke system of care
Partners providing advanced care.
Give all hospitals the opportunity to participate
and self-identify.
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64 hospitals (50% of Kansas Hospitals) are participating in KISS in one of
4 categories:
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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.)
Door to Needle Time
89
89
90
73
80
70
60
Door to IV tPA
50
Minutes
40
30
20
10
0
2012
2013
2014
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!