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Transforming Stroke Care: MetaStar's Impact in Wisconsin

May 29, 2024

May is the American Stroke Association’s (ASA) American Stroke Month. Often unrecognized and untreated, strokes can have devastating consequences:

  • Each year, nearly 800,000 stroke patients join the 9.4 million adults (20 years old or older) in the United States who have had a stroke and are living with its effects. Of those 800,000 patients, over 160,000 will die.
  • One American has a stroke every 40 seconds, and one American dies of a stroke every 3.25 minutes.
  • 40% of strokes in the United States occur in males, and 60% occur in females.
  • The risk of having a first stroke is nearly twice as high for non-Hispanic Black adults as for White adults. Non-Hispanic Black adults and Pacific Islander adults have the highest rates of death due to stroke.
  • Strokes rank fifth among all causes of death in the United States.
  • In 2020 (the latest year for which data is available), 2,091 people in Wisconsin died of strokes.
    • Strokes are the leading cause of disability in Wisconsin.
    • About 25% of people who recover from their first stroke will have another one within five years.
    • Up to 80% of strokes are preventable.
(Sources: Wisconsin Environment Public Health Tracking Program, The Centers for Disease Control and Prevention, Wisconsin Department of Health Services Coverdell Program, Stroke Awareness Foundation)

The cost of strokes in human lives and resources continues to grow each year. There’s no better way to mark this important awareness month than to discover the ways the Wisconsin Department of Health Services (WI DHS) and MetaStar are enhancing the continuum of care for stroke patients across the state.

The Quest for Better Stroke Care

Paul Coverdell was a Georgia Senator who died from an intracerebral hemorrhage in July 2000 while serving in Congress. He served the people of Georgia for nearly 17 years before his death at age 61.

This tragedy led to the creation of a new stroke care program. In 2004, the Centers for Disease Control and Prevention (CDC) established the Paul Coverdell National Acute Stroke Program in response to Senator Coverdell’s death and a three-year study on stroke care in the United States. The program provides funding to state health departments that are committed to improving stroke care.

Wisconsin’s community-based organizations, emergency medical services (EMS), hospitals, professional organizations (like the ASA and the American Heart Association [AHA]), academic institutions, public health, and industry partners work together to “ensure that all patients in Wisconsin receive timely, high-quality acute stroke care” (WI DHS).

MetaStar Meets Coverdell

Dot Bluma, BSN, RN, CPHQ, is MetaStar’s stroke project specialist. She provides invaluable support to the program. Bluma currently works with hospitals to analyze data, finding areas where more focus or education is needed. “I’m our data geek on this program,” she said with a laugh. “I’m a nurse, but I’ve become a data nerd.” She has three colleagues on the Coverdell team, one who works with EMS, and two others who work with community partners, all with the same goal of improving stroke care in Wisconsin.

Wisconsin Coverdell in Action

Though the broad focus of a Coverdell program is decided by the CDC, the awardee states can choose to work on specific areas anywhere along the stroke-care continuum that fit within the broader focus. Wisconsin has chosen several areas to focus on for the current program’s focus on disparities.

Dot Bluma with Coverdell banner featuring Risk Factor Rick“We always start with educating the community,” said Bluma. “How can we prevent a stroke from happening?” Educational materials created by the Coverdell team addressed that question. “Risk Factor Rick,” created in 2023, explains stroke risks and how to combat them. “BE FAST Bella,” created in 2017, educates about the signs of a stroke, using an acronym adapted from the ASA’s FAST acronym. With the most recent Coverdell program, the materials were translated into Spanish, Hmong, Somali, and Russian, which, along with English, are the languages most frequently spoken by stroke patients in Wisconsin. “We want to meet people where they are and be cognizant of everybody’s diversity,” Bluma said.

Equally important is ensuring that when the patient goes home, their individual needs are met. In addition to medication, regular blood tests, and follow-up appointments, the Coverdell program provided the opportunity to begin including community resources in stroke recovery. Bluma described an integrated health program between the Milwaukee Fire Department (MFD) and Froedtert Hospital that refers certain high-risk stroke patients to the MFD Mobile Integrated Health Program (MIH). MFD performs home visits, assesses and addresses safety concerns, provides education, and more. MIH then sends a report back to Froedtert who enters the information into the database so outcomes can be studied. “It’s been a phenomenal connection,” Bluma said. ” Clients say it’s been worth its weight in gold.”

Decoding Coverdell Data

With so many areas that could be the focus of this much-needed program, how does Coverdell identify which areas should and could be targeted for improvement? They use data from the AHA’s Get With The Guidelines®-Stroke database. According to the registry, over 9.5 million patient records from over 3,400 hospitals have been entered. The database provides a rich data set for analyzing stroke care at the hospital, Wisconsin, and national levels. Factors like bed size, hospital certification, sex, and more can be analyzed and interpreted to improve the quality of stroke care. Bluma spends part of her time working in the database and helping hospitals with their data. EMS data can also be integrated into the Get With The Guidelines®-Stroke database to provide a fuller picture of patient care and transitions.

Additionally, Coverdell creates hospital report cards based on the Get With The Guidelines®-Stroke database. Hospitals can now easily compare their data and benchmarks with all Coverdell hospitals in Wisconsin and hospitals nationally. Similar report cards have been created for EMS as well.

The Future of Stroke Care

Bluma isn’t one to rest on her laurels. She continues to sift through data to identify ways to improve stroke care in Wisconsin. “Addressing disparities in stroke care is an area we need to have a bigger focus on,” explained Bluma. Through continued work by implementing evidence-based stroke care education and protocols to reduce geographic, racial, and ethnic disparities, MetaStar aims to pave the way for targeted approaches that address individual patient needs. Continuing to leverage the relationships between community-based organizations, emergency medical services, hospitals, and patients and families are crucial in successful pre and post stroke care. The ongoing approach is to continue to build on prior work, provide equitable and inclusive care to diverse communities, and leverage data and technology, to ensure the future of stroke care will be more equitable and effective.

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