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State of the MSR Program

State of the MSR Program. Overview. History/Milestones Program Activities Data Vision. History. National program 2001-2004: Pilot 2004-2007: National program launched 2007-2012: Second funding cycle 2012-?: Next funding cycle Minnesota 2007-present. Program Milestones: Enrollment.

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State of the MSR Program

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  1. State of the MSR Program

  2. Overview • History/Milestones • Program Activities • Data • Vision

  3. History • National program • 2001-2004: Pilot • 2004-2007: National program launched • 2007-2012: Second funding cycle • 2012-?: Next funding cycle • Minnesota • 2007-present

  4. Program Milestones: Enrollment

  5. Program Milestones: Abstraction • Minnesota Stroke Registry Tool • Integration w/GWTG (Patient Management Tool) • Chart auditing process • Updates to data elements, algorithms • Stroke Education • VTE Prophylaxis • Evidence of Atherosclerosis • Data dictionary • Case ascertainment guidance • CMS, stroke as a core measure: yes or no?

  6. Program Milestones: Quality Improvement

  7. Ongoing Activities

  8. STK-1: VTE Prophylaxis

  9. STK-2: Discharged on Antithrombotic Therapy

  10. STK-3: Discharged on Anticoagulant (A Fib)

  11. STK-5: Antithrombotic therapy by day 2

  12. STK-6: Discharged on Statin Therapy

  13. STK-9: Smoking Cessation

  14. STK-10: Assessed for Rehabilitation

  15. STK-8: Stroke Education

  16. STK-7: Dysphagia Screening

  17. Dysphagia screening: Flow sheet Patients with acute ischemic or hemorrhagic stroke or stroke not otherwise specified (ill-defined) who were eligible for dysphagia screening Patient screened for dysphagia prior to any oral intake? Results of dysphagia screen Documentation of nosocomial pneumonia? Source: MSR, Q12008-Q32010

  18. STK-4: Thrombolytic Therapy

  19. Thrombolytic therapy: Flow sheet, 2010*includes patients transferred to another acute care facility (drip-and-ship) Time and date last well known documented Came within 2 hours of symptom onset Received IV tPA Documented contraindications Source: MSR, Q12008-Q42010

  20. Improvements in tPA

  21. Thrombolytic therapy: Reasons for nontreatment 528 arrived within 2 hours of symptom onset 199 (38%) received tPA, 329 (62%) did not receive tPA

  22. Vision: “Clinical” Issues • Stroke education (patients/caregivers) • tPA administration • Door-to-Needle Time • Secondary prevention

  23. Patient Demographics: Medical History

  24. Vision: Program • Expansion • Integration with statewide acute stroke system • Stroke conferences • Evaluation: QI → patient health outcomes

  25. Challenges • Funding uncertainties • CDC priorities • Hospitals’ priorities

  26. Our Goal The best care everywhere, for everyone, all the time.

  27. “Quality is never an accident; it is always the result of high intention, sincere effort, intelligent direction and skillful execution; it represents the wise choice of many alternatives.” - William A. Foster

  28. Thank you! Back Row: Mary Jo Mehelich Albert Tsai Front Row: Jacob Zdon Lisa Calhoun Jim Peacock

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