Impact of a Statewide Telestroke. IHI Triple Aim
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1 Impact of a Statewide Telestroke Network in Oregon: Meeting The IHI Triple Aim Nicholas J. Okon, DO Stroke Neurologist Medical Director Providence Telestroke Network CEO and Founder Northwest Stroke Solutions, PLLC
2 Rural-Urban Stroke Care Gap in US Stroke remains the #1 cause of disability in the US Alteplase (tpa) has been shown to significantly reduce disability and was approved in the US in1996 Recent study of all Medicare stroke patients admitted to 4750 US hospitals from showed that - < 2.4% of stroke patients received tpa - 66% of US hospitals gave no tpa - primarily located in rural areas where 40% of US population resides. Reasons patients don t receive tpa in rural facilities primarily includes rural provider s lack of experience in use of tpa and reluctance to provide therapy without access to specialty consultations by neurologists.
3 Use of tpa for Treatment of Acute Stroke in the Northwest US <4% Source: Northwest Regional Stroke Network Fact Sheet 2010
4 Rural-Urban Stroke Care Gap in Oregon Oregon has the highest stroke death rate in the NW and ranks 13th in US after Stroke Belt states for highest death rate (TN,AR,AL,OK,SC,NC,MS,LA,GA,MO,KY,TX) All 12 JC Primary Stroke Centers in state of OR reside in metropolitan areas More than 1 in 4 Oregonians live >60 min from a stroke center < 10 stroke neurologists in entire state of OR 10 stroke neurologists in entire state of OR Providence Health Systems cares for ~18% of stroke victims in Oregon with 2 Comprehensive Stroke Centers in Portland, OR and 6 smaller hospitals throughout state
5 Telestroke: Bridging the Rural-Urban Gap in OR Spoke/Partner (Patient) Hub (Stroke Neurologist) Broadband Internet
6 Sustainability of Telestroke Focus has been on financial factors Equally important to include - Improved access to care - Improved quality of care and outcomes
7 Lower cost by reducing expensive transfers Telestroke and the Institute for Healthcare Improvement Triple Aim Improved outcomes by increasing tpa treatment rates Improved access to stroke specialists
8 Providence Telestroke Network
9 Providence Telestroke Network 16 Partner sites: 7 Providence and 9 non- Providence hospitals First hospital went live April 2010 Hospital Size (range): 65% CAH (15 to 176 beds) All facilities receive comprehensive provider and nursing education, standardized ischemic stroke protocols, data abstraction tools and training Quality improvement reporting and feedback on quarterly basis
10 Providence Telestroke Network 2 Comprehensive Stroke Centers (Hubs) w/ 4 Stroke Neurologists All calls routed through h Transfer Center Provide full consult including: - dictated note in the partner s medical record - tpa dosing, administration assistance and consent - assist with transfer and admission - follow-up calls and automatic 24 hr consults for tpa treated and stay Centralized data and quality metrics staff (Hubs & Partners)
11 Lower cost by reducing expensive transfers Providence Telestroke Network and the IHI Triple Aim Improved outcomes by increasing tpa treatment rates Improved access to stroke specialists
12 Telestroke Activity Across the Network April 2010 April 2012 Number
13 Lower cost by reducing expensive transfers Telestroke and the IHI Triple Aim Improved outcomes by increasing tpa treatment rates Improved access to stroke specialists
14 Percent Transfer Rate of Ischemic Strokes Among Consults for Network
15 Providence Telestroke Network <75 mi. 7 Sites >75mi 9 Sites Transfer Rate Among g Consults 15
16 Providence Telestroke Network 38 % 27 % 6 Months After Telestroke Engagement Transfer Rate Among g Consults
17 Providence Telestroke Network 42% 17% 12 Months After Telestroke Engagement Transfer Rate Among g Consults
18 Providence Telestroke Network 28.6% 11.4% 18 Months After Telestroke Transfer Rate Among g Consults
19 Providence Telestroke Network 25% Reduction in Transfer Rate 50% Reduction in Transfer Rate 18 Months After Telestroke Transfer Rate Among g Consults
20 Lower cost by reducing expensive transfers Telestroke and the IHI Triple Aim Improved outcomes by increasing tpa treatment rates Improved access to stroke specialists
21 Percent Treated with IV-tPA Among Ischemic Strokes 13 Fold Increase U.S. average 2.4%
22 Providence Telestroke Network Meets the IHI Triple Aim Improved outcomes: 13 Fold increase in tpa Treatment 46% reduction in NIHSS Improved access to stroke specialists: > 700 Stroke Neurology Consults from Partners Lower cost, improved efficiency: 37% Reduction in Transfers
23 Acknowledgements PTN Hub Team: Nicholas Okon, DO Ted Lowenkopf, MD Lisa Yanase, MD John Zurasky, MD Alex Lasko Elizabeth Baraban, PhD Nancy Rynex Tamela Stuchiner Mike Schmitt Susie Fisher, RN Valerie Mays, y, RN Bonnie Smith Partner Sites:
24 Methods: Data Sources/Outcomes Data Sources Pre-Engagement/Go-Live Data: Historicals provided by hospital, publicly available compensation data, Get With the Guidelines (GWTG ) Online Tool, Providence transfer center information Post-Engagement/Go-Live Data: Providence transfer center information, GWTG tool, publicly available compensation data Outcomes Consults (phone or beam-in) Beam-ins Only Patients transferred out of partner hospitals Patients treated with IV-tPA (clot-busting drug for acute strokes) Cost of transfer
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