Each year, stroke-related death and disability affect thousands of stroke patients, their families, employers, and communities in Wisconsin. In 2013, there were over 14,000 stroke-related hospitalizations in Wisconsin.1 Of these hospitalizations, 12.3 percent were readmissions.2 Due to Wisconsin’s efforts to improve stroke triage and treatment, 95 percent of people hospitalized survived their stroke (at the point of discharge from the hospital). However, only slightly more than half (56 percent) were discharged to home. These numbers do not include the thousands of people who experienced transient ischemic attacks (TIAs) but were not admitted to the hospital, and approximately 2,500 persons who died of stroke.3
Stroke is devastating and often results in life-changing and permanent disabilities. Survivors can require intensive rehabilitation and face significant challenges in navigating clinical and community services on the road to recovery.
Background and Prevention
Wisconsin has made great strides in improving stroke triage and treatment, but there is still much more that can be done to improve public awareness of stroke, stroke systems, quality of care, and stroke patient outcomes.
- Optimal stroke care begins with early recognition of stroke signs and symptoms and calling 9-1-1. The Wisconsin Ambulance Run Data System (WARDS) shows 40 percent of stroke patients arrived at the hospital by emergency medical services (EMS) in 2013. Studies have shown that stroke patients who arrive at an Emergency Department (ED) via EMS receive more timely definitive care. Some of their initial triage and assessment has already been completed by EMS, which hastens the care provided by the hospital.
- Wisconsin is fortunate to have 4 Acute Stroke Ready Hospitals, 41 Primary Stroke Centers (PSCs) and 4 Comprehensive Stroke Centers (CSCs); however, much of the northern and central parts of the state are more than 60 minutes from a certified stroke center.4 Feedback from 88 non-specialty, non-stroke certified hospitals revealed strong interest in obtaining resources and technical assistance to improve their stroke readiness.5
There are many ways hospitals and primary care providers can help patients and caregivers navigate post-stroke recovery efforts and facilitate community-clinical linkages. For example, Wisconsin’s network of pharmacists certified in medication therapy management (MTM) could be better utilized to support medication adherence and home blood pressure monitoring during post-stroke recovery. Increasing these efforts will help reduce stroke-related emergency department visits and hospital readmissions.
1 Wisconsin Hospital Inpatient Discharge Database, 2013, Wisconsin Hospital Association.
2 Wisconsin Medicare data, Diagnoses Associated with Frequent Admissions and 30-day Readmissions, July 2013-June 2014 (accessed through MetaStar, Inc.).
3 Wisconsin Interactive Statistics on Health (WISH), Mortality Module (cause of death: Cerebrovascular Diseases), accessed February 19, 2015.
4Drive Time to Certified Stroke Centers in Wisconsin (map), 2015, created by the Wisconsin Department of Health Services.
5 Assessing Wisconsin Hospitals’ Capacity to Treat Stroke: A Report from the Wisconsin Stroke Coalition, 2014; Wisconsin Department of Health Services, Wisconsin Coverdell Stroke Program.