The Minnesota Stroke Registry to the Minnesota Stroke System: From Data Collection to Practice Implementation *

BACKGROUND: Stroke is the fifth-leading cause of death in Minnesota, and a leading cause of disability in adults.  While stroke incidence and mortality have declined over the past several decades, much attention remains on reducing risk and improving care.  Since 2007, the Minnesota Department of Health (MDH) has been funded by CDC to implement stroke quality improvement activities, including the Minnesota Stroke Registry (MSR) program, which has grown from 13 to 55 participating hospitals at the end of 2014.  In that time, the state of Minnesota has enacted both mandatory reporting of quality measures for stroke (2011) and legislation to designate stroke ready hospitals (2013).  This abstract describes overall improvements in emergency care for stroke patients in Minnesota, and the first quantitative evaluation of the stroke-capable hospital designation process.

METHODS: Minnesota’s stroke quality measures – Door-to-Imaging  within 25 minutes (DTI-25) and Door-to-Needle (tPA) within 60 minutes (DTN-60) – for all reporting hospitals are compared from inception until 2014.  Patterns of change over time are compared by hospital characteristics, including urban/rural location, geographic region, facility size, MSR program participation, and acute stroke designation status.  Additional information on hospital infrastructure is collected from hospitals applying for Acute Stroke Ready hospital designation during 2014.

RESULTS: Since inception, the percentage of stroke patients meeting the 25 minute door-to-imaging target has increased from 46% (2012) to 58% (2014).  In the first year of data collection for door-to-needle time, hospitals were meeting the 60 minute goal 69% of the time.  Hospitals designated Acute Stroke Ready in 2014 performed significantly better than non-designated hospitals on both performance measures in 2014 (60% vs. 45% for DTI-25 and 67% vs. 53% for DTN-60).  Hospitals participating in quality improvement registries and those designated Primary or Comprehensive Stroke Centers, or seeking Minnesota Acute Stroke Ready hospital designation, also perform significantly better on both the DTI-25 and DTN-60 quality measures.  Within Acute Stroke Ready-designated hospitals, those which had laboratory and CT technicians in house at all hours demonstrated significantly better performance on DTN-60, but not DTI-25.

CONCLUSIONS: This work demonstrates the value of state-coordinated efforts to improve the quality of acute care for stroke patients.  Hospital quality measures enable quantitative assessments of the benefits of stroke quality improvement programs and the value of state stroke care designations, both for hospitals and the state health agency.  This project is the first step in a longer-term evaluation of the impact of stroke programs at MDH.