As part of a major effort to improve stroke care throughout Florida, stroke experts with the University of Miami Health System and the Miller School of Medicine continue to engage stroke center physicians and health providers, researchers, and policymakers throughout the state.
The Florida Stroke Registry, a statewide initiative led by stroke neurologists and researchers at the Miller School’s Department of Neurology, pools data from hospitals participating in the American Heart Association’s “Get With The Guidelines – Stroke” quality improvement program. By tracking, measuring, and benchmarking Florida hospitals’ performance and outcome metrics, the registry has had a direct impact on the quality of care and reduction in disparities at participating hospitals.
“The goal is to raise the bar in stroke care throughout the state by identifying gaps and instituting effective systems of care,” said renowned UM stroke neurologist Ralph L. Sacco, M.D., M.S., director of the Florida Stroke Registry, professor and Olemberg Chair of Neurology. “Stroke care has greatly improved over the past several years, and it’s important that all stroke care systems have the latest knowledge and resources to better serve stroke patients.”
To engage stroke centers throughout the state, the Miller School, a national leader in stroke care and research, recently hosted the 7th Annual Florida Stroke Registry Meeting in Tampa. Each year the meeting is held at a different location in the state. This year’s meeting was at the University of South Florida’s Center for Advanced Medical Learning and Simulation and attracted more than 100 stakeholders, including physicians, nurses, emergency medical service providers, hospital administrators, policymakers, and stroke survivors and their caregivers. About 50-60 stroke centers throughout the state were represented.
The meeting featured a keynote address by the Florida Department of Health, UM team presentations on the registry’s annual accomplishments, and three interactive panel discussions on the registry’s findings, initiatives, stroke/EMS policy, and other discussions related to three phases in stroke care: pre-hospital, acute stroke in-hospital, and post-hospital.
“The gathering of stroke center representatives from across the state shows the commitment to saving lives and improving the quality of life for stroke survivors,” said Jose G. Romano, M.D., chief of the Miller School’s Stroke Division, professor of neurology, and director of the UM/Jackson Memorial Hospital Comprehensive Stroke Center. “Having a robust database and being able to analyze datasets from hospitals and EMS systems has given our work across the state a major boost.”
State Funding and Legislation
The meeting came on the heels of UM’s Department of Neurology receiving $750,000 in state funds to support the registry -- an increase from the $500,000 state award in 2018. The appropriation was sponsored by Sen. Lauren Book (D-Plantation) and Rep. Ana Maria Rodriguez (R-Doral), who have been avid supporters of improving stroke care.
“I think it’s important because we see so many Floridians who have been struggling either themselves or people that they know, with a stroke,” said Rodriguez, “Anything we can do to help alleviate or minimalize the long-term effects of stroke incidences is something that we’d want to support.”
Dr. Sacco thanked legislators for their support, saying that the appropriations and legislation help the initiative expand and reach its goals.
“To run the team, to crank the data, to get all of the hospitals on board, to have our annual meeting, it’s really influenced the quality of care and we need fiscal support,” said Dr. Sacco, who also serves as executive director of the Evelyn F. McKnight Brain Institute, senior associate dean for clinical and translational science, and director of UM’s Clinical and Translational Science Institute.
Currently more than 110 Florida stroke centers participate in the registry. By 2020, the team’s goal is to have participation from all 161 stroke centers listed with the Florida Agency for Health Care Administration, the state agency responsible for the administration of licensure and regulation of Florida’s health facilities.
Data from participating Florida Stroke Registry hospitals currently includes more than 290,000 Florida stroke cases, allowing experts to look at trends in stroke care over time.
Unique among others, the Florida Stroke Registry was designed to provide data-driven perspectives on racial, ethnic, sex and geographic stroke disparities. The latest 16 analyses between 2010-2018 show continued improvements among all races and ethnic groups for overall stroke care in Florida hospitals. Unfortunately, trends indicate continued disparities and gaps in care among black Florida residents, who are less likely to receive the clot-dissolving drug tPA (tissue plasminogen activator).
The registry was established in 2012 under a five-year cooperative grant from the National Institutes of Health and Stroke Prevention Intervention Research Program. The registry’s online portal contains educational tools, related research publications, and hospital-specific annual reports, which enable hospitals to track and measure their stroke quality of care through various performance metrics.
With state funding, UM has been able to develop additional self-monitoring tools for hospitals, such as the regional dashboards. These reports feature metrics on critical lifesaving practices, such as thrombolytic and endovascular treatment times, and allow hospitals to track and measure their performance within their county or region. The information improves communication between stroke centers and EMS providers and informs transportation policy to better equip and mobilize paramedics to identify strokes in the field and transport patients to the appropriate stroke center.
The UHealth stroke team eventually wants to incorporate community outreach into the registry to better educate Florida residents on stroke risk factors, symptoms, and use of 911 services.
"Our Florida Stroke Registry has been an amazing collaboration between Florida hospitals that have raised the bar for quality of hospital care for patients with stroke,” said Tatjana Rundek, M.D., Ph.D., who co-directs the registry and is professor of neurology and public health sciences, executive vice chair for research and faculty affairs in the Department of Neurology, scientific director of the Evelyn F. McKnight Brain Institute, and Evelyn F. McKnight Chair for Learning and Memory in Aging at the Miller School.
“The hospitals participating in the registry are excited to see how their stroke quality care parameters are improving every year and benefit their patients. This makes our collaboration for improved stroke care unique in the nation."