Hospital Participation and Performance in Stroke Systems of Care - Results from The NorthEast...
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Hospital Participation and Performance in Stroke Systems of Care - Results from The NorthEast Cerebrovascular Consortium (NECC) Region Charles R. Wira III, MD; Zainab Magdon-Ismail, Ed.M, MPH; Shannon Melluzzo, BA; David Day, BS; Louise D. McCullough, MD, PhD; Joel Stein, MD; Lee H. Schwamm, MD; Toby Gropen, MD on behalf of The NorthEast Cerebrovascular Consortium Introduction • Significant regional variations exist in the delivery of healthcare, including the delivery of care for acute ischemic stroke • The Northeast Cerebrovascular Consortium (NECC) was established in 2006 in the Northeast to unite health care providers, public health officials and advocacy organizations in an 8-state region to implement a Stroke Systems of Care Model (SSCM). • The 8 states comprising The NECC are Connecticut, Maine, Massachusetts, New Hampshire, New Jersey, New York, Rhode Island, and Vermont (Figure1). • The NECC SSCM focuses on six stages across the continuum: Primary and Primordial Prevention, Community Education, Notification and Response of EMS, Acute Stroke Treatment, Subacute Care and Secondary Prevention, and Rehabilitation. Methods Objective Conclusions Contact Information For additional information please contact: Shannon Melluzzo, The NECC Project Coordinator [email protected] | (413) 735-2104 | www.thenecc.org • A two-tiered analysis of all ACH/CACs in The NECC region compared: • GWTG-S participation and award trends over time in the pre (2005) and post (2006-11) NECC time periods, and • The NECC region compared to all other US regions from 2005-11. • Analysis used US census data regions stratified as The NECC and Non-NECC regions (PA, South, Midwest, West). • ACH/CACs were obtained from CMS. • AHA data were used for GWTG-S participation and awards (silver or higher defined as more than 1 year of sustained performance on GWTG-S performance measures). • To evaluate if implementation of The NECC has been associated with increased participation in the American Heart Association’s (AHA) Get With the Guidelines ® – Stroke (GWTG-S) and higher performance ratings of acute care hospitals (ACH) and critical access centers (CAC). • Over the study time period (2005-11) the ACH/CACs per year in The NECC and non-NECC regions were 442.1 + 8.2 and 3958.7 + 204.4. • In The NECC region GWTG-S participation increased over time from 22.8% in 2005 to 60.7% in 2011 compared to 10.1% in 2005 and 31.0% in 2011 in non- NECC regions (both analyses p<0.0001, Cochran Armitage Trend test) (Figure 2). • GWTG-S awards increased over time in The NECC from 2.04% in 2005 to 55.02% in 2011 compared to 0.82% in 2005 to 38.7% in 2011 in non-NECC regions (both analyses p<0.0001, Cochran Armitage Trend test). After adjusting for year, significantly more NECC ACH/CACs participated in GWTG-S and received GWTG-S awards than non-NECC ACH/CACs (both analyses p<0.0001, Cochran-Mantel-Haenszel test) (Figure 3). Results • There has been more rapid growth of ACH/CAC participation and achievement in GWTG-S in the Northeast from 2006-11 compared to the South, Mid- West and West Regions. • The NECC may complement and enhance existing regulatory and advocacy initiatives by providing intangibles such as networking and education opportunities. • Further investigation is merited evaluating the effectiveness of regional networks to enhance care. Limitations • Participation in GWTG-S is just one metric used to evaluate the importance of a regional stroke network. • Results may be influenced by unmeasured confounders including but not limited to hospital size, teaching status, stroke center designation status, differences in patient and hospital characteristics, stroke center uptake and stroke systems of care unrelated to The NECC. • Among ACHs only, the trends for increased GWTG-S participation and awards over time as well as the differences between NECC vs. non-NECC regions remained significant (P<0.0001, Cochran Armitage Trend tests; p<0.0001, Cochran-Mantel-Haenszel tests).
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Transcript of Hospital Participation and Performance in Stroke Systems of Care - Results from The NorthEast...
Hospital Participation and Performance in Stroke Systems of Care - Results from The NorthEast Cerebrovascular Consortium (NECC) Region
Charles R. Wira III, MD; Zainab Magdon-Ismail, Ed.M, MPH; Shannon Melluzzo, BA; David Day, BS; Louise D. McCullough, MD, PhD; Joel Stein, MD; Lee H. Schwamm, MD; Toby Gropen, MD on behalf of The NorthEast Cerebrovascular Consortium
Introduction• Significant regional variations exist in the delivery of healthcare,
including the delivery of care for acute ischemic stroke
• The Northeast Cerebrovascular Consortium (NECC) was established in 2006 in the Northeast to unite health care providers, public health officials and advocacy organizations in an 8-state region to implement a Stroke Systems of Care Model (SSCM).
• The 8 states comprising The NECC are Connecticut, Maine, Massachusetts, New Hampshire, New Jersey, New York, Rhode Island, and Vermont (Figure1).
• The NECC SSCM focuses on six stages across the continuum: Primary and Primordial Prevention, Community Education, Notification and Response of EMS, Acute Stroke Treatment, Subacute Care and Secondary Prevention, and Rehabilitation.
Methods
Objective
Conclusions
Contact InformationFor additional information please contact:
Shannon Melluzzo, The NECC Project [email protected] | (413) 735-2104 | www.thenecc.org
• A two-tiered analysis of all ACH/CACs in The NECC region compared: • GWTG-S participation and award trends over time in the pre (2005)
and post (2006-11) NECC time periods, and • The NECC region compared to all other US regions from 2005-11.
• Analysis used US census data regions stratified as The NECC and Non-NECC regions (PA, South, Midwest, West).
• ACH/CACs were obtained from CMS. • AHA data were used for GWTG-S participation and awards (silver or
higher defined as more than 1 year of sustained performance on GWTG-S performance measures).
• To evaluate if implementation of The NECC has been associated with increased participation in the American Heart Association’s (AHA) Get With the Guidelines® – Stroke (GWTG-S) and higher performance ratings of acute care hospitals (ACH) and critical access centers (CAC).
• Over the study time period (2005-11) the ACH/CACs per year in The NECC and non-NECC regions were 442.1 + 8.2 and 3958.7 + 204.4.
• In The NECC region GWTG-S participation increased over time from 22.8% in 2005 to 60.7% in 2011 compared to 10.1% in 2005 and 31.0% in 2011 in non-NECC regions (both analyses p<0.0001, Cochran Armitage Trend test) (Figure 2).
• GWTG-S awards increased over time in The NECC from 2.04% in 2005 to 55.02% in 2011 compared to 0.82% in 2005 to 38.7% in 2011 in non-NECC regions (both analyses p<0.0001, Cochran Armitage Trend test). After adjusting for year, significantly more NECC ACH/CACs participated in GWTG-S and received GWTG-S awards than non-NECC ACH/CACs (both analyses p<0.0001, Cochran-Mantel-Haenszel test) (Figure 3).
Results
• There has been more rapid growth of ACH/CAC participation and achievement in GWTG-S in the Northeast from 2006-11 compared to the South, Mid-West and West Regions.
• The NECC may complement and enhance existing regulatory and advocacy initiatives by providing intangibles such as networking and education opportunities.
• Further investigation is merited evaluating the effectiveness of regional networks to enhance care.
Limitations• Participation in GWTG-S is just one metric used to evaluate the
importance of a regional stroke network.• Results may be influenced by unmeasured confounders including but
not limited to hospital size, teaching status, stroke center designation status, differences in patient and hospital characteristics, stroke center uptake and stroke systems of care unrelated to The NECC.
• Among ACHs only, the trends for increased GWTG-S participation and awards over time as well as the differences between NECC vs. non-NECC regions remained significant (P<0.0001, Cochran Armitage Trend tests; p<0.0001, Cochran-Mantel-Haenszel tests).
