The Colorado Stroke Alliance, based in Lakewood, is a not-for-profit organization that oversees the operations of the Colorado Stroke Registry. The CSA's mission is to promote quality improvement in stroke care provided in hospitals statewide.
No. 4: Colorado Stroke Alliance
Success with stroke: Program helps Colorado hospitals improve performance measures
Through the use of an Internet-based, Health Insurance Portability and Accountability Act-compliant patient management program, the CSA has witnessed statistically significant improvements in hospital stroke-care performance indicators on a statewide basis.
Participation in the CSA/CSR is voluntary and open to any hospital in Colorado that has an emergency department, regardless of the location, bed count or annual stroke volume. Launched in 2006, the CSA/CSR has 39 hospitals participating that have entered more than 14,000 patient records. Participation includes eight frontier, five rural and 26 urban hospitals that serve more than 21 counties. There are approximately 70 hospitals in Colorado, and it is estimated that the stroke registry data represent at least 80% of the stroke patients treated in Colorado hospitals.
The CSA model is considered to be a best-practice model by local and national private and public stakeholders, including government agencies.
The CSA is a neutral organization that represents all participants equally and does not promote any hospital, healthcare system or provider over another. To support efforts to remain neutral while supporting statewide stroke improvement efforts, the CSA has access to de-identified statewide data through the Internet software program that is used as the stroke registry data collection tool.
The CSA operations have included site visits, educational venues, data committee activities, production of statewide trend reports using aggregate data and supporting public health initiatives. Since 2006, approximately $1.6 million in grant funding has supported all of the CSA's operations. The alliance has minimal infrastructure requirements and operates in a virtual environment with remote contractors, a server for storing business files, and the use of an Internet-based software program that allows for raw data downloads. Because of budgetary restraints, the operating budget for July 2010 to June 2011 is not anticipated to exceed $150,000.
The evidence: The CSA and the stroke registry have evidence of statistically significant improvements in stroke performance measures on a statewide basis. In one analysis of adherence to hospital-based quality indictors, 13 quarters (second quarter 2006 through second quarter 2009) were reviewed. The results demonstrated that for five of seven performance indicators, linear regression showed statistically significant improvement.
Two indicators, anti-coagulation for atrial fibrillation and anti-thrombotic at discharge, did not reflect significant improvement. However, for these two indictors, the initial adherence rates were already above 90%. For the remaining five indicators, the most recent seven quarters were significantly better than the first six quarters. The greatest absolute improvement (about 12%) was noted for giving intravenous tissue plasminogen activator within one hour of arrival for patients presenting within two hours of symptom onset.
The strategy: The CSA has explored the potential of applying for funding from the American Recovery and Reinvestment Act of 2009. In the fall of 2009, the CSA was in contact with the Agency for Healthcare Research and Quality regarding potential funding opportunities. It was recommended that the CSA review and identify grants that appear to be in alignment with the CSA's goals and objectives and to contact AHRQ for additional discussion. The CSA has reviewed a variety of grants, including those available through the stimulus law. The CSA has not been successful in identifying a funding source that appears to be in alignment with the CSA's goals and mission.
The CSA continues to explore potential funding opportunities including private, foundation and public funding sources at the local and national level. The CSA's current funding source is through a grant program run through the public health department in Colorado.
As of May, CSA operations included one site visit per hospital per year, the production of trend reports and the coordination of monthly business meetings, mentor meetings and data committee meetings. From a systems perspective, the CSA is also actively supporting the continued development of a stroke system of care in Colorado.
Paul Murphy is executive director of the Colorado Stroke Alliance, Lakewood. Don Smith is the alliance’s medical adviser.
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