Stroke Patient Outcomes

1. Stroke Patient Outcomes State Hospital Review and Planning Council July 22,2010 Anna Colello

2. Stroke Designated Hospitals by Region

4. Outcome Measure – Mortality (Designated vs. Not Designated)

5. Stroke Provider Performance by Provider TypeNew York State Inpatient Hospitalizations2008

6. Stroke Patients by Patient Characteristics and Location of Treatment 2008

7. Stroke Patientsby Patient Characteristics and Location of Treatment2008

8. Stroke Provider Performance by Provider TypetPA Administration2008

9. Stroke Patient CharacteristicsbyProvider TypeInpatient Hospitalizations2008

10. Stroke Patient CharacteristicsbyProvider TypeInpatient Hospitalizations2008

11. Stroke Provider Performance by Provider TypeDischarge Home 2008

12. Stroke Patient Outcomeby Patient Characteristics2008Discharge Disposition

13. The 12 Performance Measures • DVT Prophylaxis • Early Antithrombotics • Anticoagulation for AF • IV t-PA 2 Hour • Antithrombotics at Discharge • LDL > 100 or Not Documented • Dysphagia screening • Stroke Education • Smoking Cessation • Rehabilitation Considered • NIHSS • Discharge Destination

18. Brain Imaging in <25minsPercent of patients who receive brain imaging within 25 mins of arrival *Data from GWTG-Stroke Database

22. Overview of Data from 2008 (from Get With The Guidelines-StrokeSM as of 1/12/10) Nationwide (all hospitals) N=295,132 patients (1664 hospitals nationwide) New York State N=29,426 patients (110 Designated Stroke Centers)

23. IV-tPA Cases (from Get With The Guidelines-StrokeSM as of 1/12/10) Nationwide (all hospitals) 2008: 7421/11629—63.8% 2009: 8704/12064—72.1% New York State 2008: 798/1097—72.7% 2009: 875/1122—78%

24. IV rt-PA Arrive by 2 Hour, Treat by 3 Hour*Percent of acute ischemic stroke patients who arrive at the hospital within 120 minutes (2 hours) of time last known well and for whom IV t-PA was initiated atthis hospital within 180 minutes (3 hours) of time last known well. *Data from GWTG-Stroke Database

25. IV rt-PA Arrive by 2 Hour, Treat by 3 Hour*Percent of acute ischemic stroke patients who arrive at the hospital within 120 minutes (2 hours) of time last known well and for whom IV t-PA was initiated atthis hospital within 180 minutes (3 hours) of time last known well. *Data from GWTG-Stroke Database

26. Dysphagia Screen*Percent of patients with ischemic, or hemorrhagic stroke who undergo screening for dysphagia with an evidenced-based bedside testing protocol approved bythe hospital before being given any food, fluids, or medication by mouth. *Data from GWTG-Stroke Database

27. Dysphagia Screen*Percent of patients with ischemic, or hemorrhagic stroke who undergo screening for dysphagia with an evidenced-based bedside testing protocol approved bythe hospital before being given any food, fluids, or medication by mouth. *Data from GWTG-Stroke Database

28. NIHSS ReportedPercent of Ischemic stroke, TIA, and Stroke not otherwise specified patients with a score reported for NIH Stroke Scale (Initial) *Data from GWTG-Stroke Database

29. NIHSS ReportedPercent of Ischemic stroke, TIA, and Stroke not otherwise specified patients with a score reported for NIH Stroke Scale (Initial) *Data from GWTG-Stroke Database

30. DOH Accomplishments • Medicaid and tPA • Beginning April 1, 2010 Medicaid will reimburse for the administration of tPA in the Emergency Department at a rate more closely aligned with the cost

31. New York City Region Hospitals Designated as Stroke Centers

32. Long Island Region Hospitals Designated as Stroke Centers

33. Hudson Valley Region Hospitals Designated as Stroke Centers

34. Capital Region

35. Central Region

36. Rochester

37. Western Region