Accelerating Treatments for Better Acute Ischemic Stroke Outcomes A CMS Special Innovation Project

Transcription

1 Accelerating Treatments for Better Acute Ischemic Stroke Outcomes A CMS Special Innovation Project Mary Fermazin, MD, MPA Chief Medical Officer Vice President, Health Policy and Quality Measurement Health Services Advisory Group (HSAG) November 14, 2016 *EXPRESS=Expediting the Process of Evaluating and Stopping Stroke

2 Objectives Describe the background and origin of the Centers for Medicare & Medicaid Services (CMS) Special Innovation Project. Share the aims and scope of the stroke project. Discuss strategies for spread. 2

3 CMS Quality Strategy: Concurrently Pursue Three Aims Better Care Improve overall quality by making healthcare more patient-centered, reliable, accessible, and safe. Healthier People Smarter Spending Improve population health by supporting proven interventions to address behavioral, social, and environmental determinants of health, in addition to delivering higher-quality care. Reduce the cost of quality healthcare for individuals, families, employers, and government. 3 Source: The Centers for Medicare & Medicaid Services

4 Background CMS Special Innovation Projects A rigorous investigation on the effectiveness of QI interventions that if implemented at scale would greatly improve healthcare quality. Interventions that have existing moderate level of evidence regarding their effectiveness, but have little or no evidence in larger population or settings. Interventions that streamline patient flow resulting in efficiencies, improved satisfaction, decreased mortality, better, healthier people and smarter spending. 4 *IV tpa=intravenous tissue plasminogen activator

5 Stanford Clinical Excellence Center s Stroke Care Bundle 1. Engaging patients and caregivers as partners to attain early recognition of stroke symptoms 2. Optimizing pre-hospital stroke management and communication 3. Implementing efficient hospital pathways to appropriate and timely treatments 5

6 Project Partners Stanford Clinical Excellence Center KPNC California Stroke Registry/California Coverdell Program Contra Costa County Emergency Medical Services (EMS) Agency American Heart Association/American Stroke Association (AHA/ASA) Right Care Initiative 6

7 Project Aims Improve door to needle time and increase the percentage of acute ischemic stroke patients who benefit from early thrombolysis or endovascular treatment. $ Reduce Reduce disability and mortality from acute ischemic stroke. healthcare costs associated with stroke. 7

8 Project Tasks Project participants will work on applying Lean methodology to processes that promote: Rapid identification of stroke cases, including early recognition of stroke symptoms by patients and caregivers Rapid delivery of IV tpa Rapid selection of patients with large vessel occlusion and rapid transfer for endovascular treatment Data sharing and quarterly feedback report 8

9 Strategies for Spread Promote peer to peer learning and rapid cycle innovation through the hospital and EMS collaborative. Develop toolkit that contains resources for pre-hospital and in-hospital interventions. Share project results (lessons learned and best practices) through the Right Care Initiative-University of Best Practices. 9

10 Project Structure Steering Committee Pre-Hospital In-Hospital Community Engagement Workgroup Hospital/EMS Workgroup Hospital Stroke Improvement Workgroup 10

11 Community Engagement 11

12 Act FAST 12

13 Thank you! Mary Fermazin, MD, MPA Chief Medical Officer HSAG

14 CMS Disclaimer This material was prepared by Health Services Advisory Group, the Medicare Quality Improvement Organization for California, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The contents presented do not necessarily reflect CMS policy. Publication No. CA-11SOW-S.STK