Wisconsin Coverdell Stroke Program: Stroke Systems of Care

The American Stroke Association (ASA) describes the following elements as transitions within a stroke survivor’s system of care: “from prehospital to the admitting hospital, from the intensive care unit to the hospital floor, from the hospital to post-acute settings (inpatient rehabilitation, skilled nursing facility, long-term acute care hospital, or home), and from a facility to home.” A key goal of the Wisconsin Coverdell Stroke Program is to create efficiencies in patient care transitions in Wisconsin. To address this priority, the program is partnering with stakeholders to create stroke systems of care guidelines and best practices as illustrated in the graphic below.

Graphic depicting Coverdell Care Continuum

The ASA’s Recommendations for the Establishment of Stroke Systems of Care: A 2019 Update seeks to provide guidance for policymakers and public healthcare agencies to update their stroke systems of care. These revisions should be based on ASA’s comprehensive review of scientific evidence, evaluating current stroke care, and updates to the ASA’s previous recommendations for improvements in stroke systems of care.

Recommendations for improving Stroke Systems of Care

The following areas of focus related to improving care transitions and reducing disparities in stroke care have been identified by the ASA and the Wisconsin Coverdell Stroke Program. Researchers and providers agree that improvement and increased understanding in these areas will lead to improved patient outcomes.

Further advance public knowledge on prevention, risk factors, and signs and symptoms of stroke
Encourage primary prevention with a particular focus on earliest (primordial) risk factors that can lead to stroke
Improve and facilitate acute therapy
Advance secondary prevention and recovery from stroke
Develop stroke programs in a coordinated and collaborative fashion, involving providers and policy makers at the local, state, and national levels

Root causes of ineffective care transitions

In addition to providing the focus areas detailed above, the ASA has identified three primary root causes of ineffective transitions of care. Root causes often differ from one health care organization to another, but those most often described in medical literature and by experts include:

Communication breakdowns
Patient education breakdowns
Accountability breakdowns

More details about these recommendations can be found in Recommendations for the Establishment of Stroke Systems of Care: A 2019 Update by the ASA.

Care continuum

The aims of the WI Coverdell Stroke Program are to support the implementation of comprehensive stroke systems for individuals, both at highest risk for stroke events and for stroke patients, across the continuum of care. The keys to any successful patient transition across the care continuum are establishing partnerships, open communication and assessing accountability. Get With The Guidelines®, the stroke registry into which participating hospitals enter stroke abstracts, has capabilities to capture the care continuum in the pre hospital (Special Initiatives), in hospital, and post discharge (Discharge, Mortality & Readmission) settings. This data infrastructure allows hospitals to (1) measure, track, and assess the quality of stroke care data and (2) implement performance improvement initiatives to ensure seamless transitions of care.

The Wisconsin Coverdell Stroke Program offers support for improving overall stroke care across the care continuum by running data from Get With The Guidelines® and providing quarterly report cards with comparative benchmarks for hospitals to analyze their performance. Coverdell also holds quarterly meetings where we analyze and discuss data across the care continuum. These meetings also allow for networking and best practice sharing.

While not mandatory, Coverdell participants are highly encouraged to consider the benefits and feasibility of entering data into Get With The Guidelines® free Special Initiatives and Discharge, Mortality & Readmission care tabs. This allows for assessment of post-hospital discharge activities for improved, comprehensive care, across the entire continuum.

The following WI Coverdell participating hospitals are entering pre-arrival metrics in the Special Initiatives tab (as of April 1, 2022):

Ascension NE Wisconsin St. Elizabeth Campus
Ascension NE Wisconsin Mercy Campus
Ascension SE Wisconsin Hospital - Elmbrook Campus
Ascension SE Wisconsin Hospital - Franklin Campus
Ascension SE Wisconsin Hospital - St. Joseph Campus
Ascension St. Francis Hospital
Aspirus Grand View Hospital (Ironwood)
Aspirus Iron River Hospital and Clinics
Aspirus Keweenaw Hospital
Aspirus Langlade Hospital (Antigo)
Aspirus Ontonagon Hospital
Aspirus Riverview Hospital and Clinics
Aurora Medical Center Grafton
Aurora Medical Center Oshkosh
Aurora Sheboygan Memorial Medical Center
Aurora St. Luke's Medical Center
Bellin Memorial Hospital
Froedtert & the Medical College of Wisconsin
Froedtert Menomonee Falls
Froedtert West Bend
Gundersen Health System
Marshfield Medical Center-Ladysmith
ProHealth Care Oconomowoc Memorial Hospital
ProHealth Care Waukesha Memorial Hospital
The Richland Hospital, Inc.
ThedaCare Regional Medical Center-Neenah
University of Wisconsin Hospital & Clinics

The following WI Coverdell participating hospitals are entering post discharge metrics in the Discharge, Mortality & Readmission tab (as of April 1, 2022):

Ascension SE Wisconsin Hospital - Elmbrook Campus
Aspirus Langlade Hospital (Antigo)
Aurora St. Luke’s Medical Center
Bellin Memorial Hospital
Froedtert and the Medical College of Wisconsin
ProHealth Oconomowoc Hospital
ProHealth Waukesha Memorial Hospital
SSM Health St. Mary’s Hospital-Madison
University of Wisconsin Hospital & Clinics

The Wisconsin Coverdell Stroke Program partners with various stakeholders, both at the state and national level, to continue to increase the quality and efficiency of patient stroke care across the care continuum.

Additional resources

Articles, guidelines, and webinars

GWTG® Coverdell Post Discharge, Mortality & Readmissions Tab Webinar Recording
Taking an Accurate Blood Pressure Reading – Outpatient Adults. A guide for teaching staff how to take an accurate blood pressure.
Patient Self-Measurement of Blood Pressure. A guide for teaching patients how to self-monitor their blood pressure at home.
Million Hearts® Tobacco Cessation Change Package (TCCP)
ImageTrend Connect: The Value of Data
Social Determinants of Health and Stroke Series

Publications

Website resources

More Information

Dot Bluma, BSN, RN, CPHQ
Stroke Project Specialist, MetaStar
dbluma@metastar.com