Abstract W P222: Multidisciplinary Public-Private Collaboration Improve Rural Stroke Care

Abstract

Background: North Dakota has substantially rural demographics with unique logistics, challenges, and other socio-economic complexities affecting timely intervention in stroke patients. The North Dakota Stroke System of Care (NDSSoC) Taskforce was legislatively created in 2009 and implemented, with authority to recommend system changes for state health officer implementation. The NDSSoC Task Force is composed of 11 appointed multidisciplinary members collaborating to provide recommendations in the development of a Stroke System of Care in North Dakota. Hypothesis: Implementation of the NDSSoC will result in improved timely interventions and increased quality of care. Methods: Quality of care was measured based on data input into the State Stroke Registry (SSR). The SSR utilizes the American Heart Association’s Get with the Guidelines®-Stroke (GWTG-S), an in hospital quality improvement program. The 2010 and 2013 data was compared. Results: The percent of acute ischemic stroke patients who arrived at the hospital within 2 hours of time last known well and for whom IV t-PA was initiated within 3 hours increased from 30.9% in 2010 to 80.9% in 2013. Cases receiving a brain CT scan within 25 minutes of arrival to the hospital increased from 16% of patients in 2010 to 25% in 2013. The structure has led to tertiary and state resource investment to support NDSSoC strategies, with a state annual investment of funding equivalent to 59 cents per capita and a state funded FTE coordinator. Conclusions: A collaborative statewide effort led by a multidisciplinary team can improve timely intervention and quality of care in stroke. The statewide task force with implementation authority can be successfully applied to areas with a rural demographic.