Implementing M:L in South Dakota Darrin Smith, Senior Director of Advocacy and State Health Alliances

What is Mission: Lifeline? Mission: Lifeline is the American Heart Association's national initiative to advance the systems of care for patients with ST-segment elevation myocardial infarction (STEMI). The overarching goal of the initiative is to reduce mortality and morbidity for STEMI patients and to improve their overall quality of care.

The Need 1.4 million people will suffer a heart attack1.4 million people will suffer a heart attack Approximately 400,000 of those will experience STEMIApproximately 400,000 of those will experience STEMI 30% of STEMI patients do not receive any form of treatment to restore blood flow, whether through clot-busting drugs or percutaneous coronary intervention (PCI), the latter being the preferred therapy which uses mechanical means such as stents, balloon angioplasty or surgery.30% of STEMI patients do not receive any form of treatment to restore blood flow, whether through clot-busting drugs or percutaneous coronary intervention (PCI), the latter being the preferred therapy which uses mechanical means such as stents, balloon angioplasty or surgery. Time is muscle. The outcome of STEMI events depends greatly on the care patients receive and the timeframe in which they receive it. Through Mission: Lifeline, the American Heart Association wants to ensure that healthcare systems are able to deliver prompt and appropriate care to STEMI patients during the critical "golden hour" following their heart attack.

The Need, cont… According to the Centers for Disease Control, South Dakota is in the Class 5 category for STEMI death rates, making it one of the states with the highest STEMI death rates in the nation. To make timely and appropriate care for STEMI patients the standard across this country, Mission: Lifeline has identified a number of complex challenges that must be overcome: Public/Patient EducationPublic/Patient Education Enhancing Emergency Medical ServicesEnhancing Emergency Medical Services Enhancing Hospital ServicesEnhancing Hospital Services Quality Data TrackingQuality Data Tracking ProtocolsProtocols

The Goal To meet the overarching goal, Mission: Lifeline will bring together the necessary partnerships between: Patients and care giversPatients and care givers EMSEMS Physicians, nurses and other providersPhysicians, nurses and other providers PCI-Referring hospitals (Non-PCI capable)PCI-Referring hospitals (Non-PCI capable) PCI-Receiving hospitals (PCI capable)PCI-Receiving hospitals (PCI capable) Department of HealthDepartment of Health Office of EMSOffice of EMS Office of Rural HealthOffice of Rural Health Quality Improvement OrganizationsQuality Improvement Organizations State and local policymakersState and local policymakers Third-party payersThird-party payers Health SystemsHealth Systems

South Dakota Today Hospital/EMS MapHospital/EMS Map M:L Hospital Survey resultsM:L Hospital Survey results ML EMS Survey results (next slide)ML EMS Survey results (next slide)

SD M:L EMS Survey ALS complete = 8 (6%)ALS complete = 8 (6%) ALS complete w/o transmsn = 19 (14.3%)ALS complete w/o transmsn = 19 (14.3%) ALS not complete = 22 (16.5%)ALS not complete = 22 (16.5%) BLS w/12-Lead = 3 (2.3%)BLS w/12-Lead = 3 (2.3%) BLS w/o 12-Lead = 81 (60.9%)BLS w/o 12-Lead = 81 (60.9%)

SD M:L Project $9M+ three year project funded by an $8.4M grant from the Helmsley Charitable Trust$9M+ three year project funded by an $8.4M grant from the Helmsley Charitable Trust This is the 2 nd largest grant the American Heart Association has ever received on any level – national, regional, or localThis is the 2 nd largest grant the American Heart Association has ever received on any level – national, regional, or local This project will impact literally every licensed ambulance service and licensed hospital in the state of South DakotaThis project will impact literally every licensed ambulance service and licensed hospital in the state of South Dakota

SD M:L Project, cont….. This will revolutionize heart attack patient care in SD – we currently have one of the highest 10 STEMI death rates according to the CDCThis will revolutionize heart attack patient care in SD – we currently have one of the highest 10 STEMI death rates according to the CDC This project is designed to produce a “model system” that can then be implemented across the Midwest and nation, making SD a leader in heart attack systems of careThis project is designed to produce a “model system” that can then be implemented across the Midwest and nation, making SD a leader in heart attack systems of care

What it means to SD? Successful implementation of Mission: Lifeline will mean that South Dakota will have: One of the most advanced, if not the most advanced, coordinated heart attack systems of care in the United StatesOne of the most advanced, if not the most advanced, coordinated heart attack systems of care in the United States The highest percentage of ambulance services in the nation equipped with 12-lead ECGsThe highest percentage of ambulance services in the nation equipped with 12-lead ECGs The highest percentage of 12-lead ECG-trained emergency medical technicians in the nationThe highest percentage of 12-lead ECG-trained emergency medical technicians in the nation The highest percentage of ambulance services transmitting 12- lead ECG results in the nationThe highest percentage of ambulance services transmitting 12- lead ECG results in the nation

What it means to SD, cont…. The highest percentage of hospitals with 12-lead ECG- receiving station software in the nationThe highest percentage of hospitals with 12-lead ECG- receiving station software in the nation The highest percentage of hospitals in the nation utilizing the ACTION Registry-Get WithThe Guidelines (GWTG) data collection toolThe highest percentage of hospitals in the nation utilizing the ACTION Registry-Get WithThe Guidelines (GWTG) data collection tool One of the states with the highest percentage of hospitals in the nation with written STEMI patient treatment and transport protocols.One of the states with the highest percentage of hospitals in the nation with written STEMI patient treatment and transport protocols.

Implementation Strategies Aggressive public education and awareness campaigns will be executed to raise awareness and knowledge levels with respect to signs and symptoms of heart attack and the need to activate the system immediatelyAggressive public education and awareness campaigns will be executed to raise awareness and knowledge levels with respect to signs and symptoms of heart attack and the need to activate the system immediately Aggressive medical provider education and awareness efforts will be executed to recruit medical professionals as partners in educating their patients about heart attack warning signs and symptoms, and the need to call immediatelyAggressive medical provider education and awareness efforts will be executed to recruit medical professionals as partners in educating their patients about heart attack warning signs and symptoms, and the need to call immediately Assistance to every ambulance service in South Dakota in acquiring the most up-to-date 12-lead ECG equipmentAssistance to every ambulance service in South Dakota in acquiring the most up-to-date 12-lead ECG equipment Implementation of a robust, comprehensive 12-lead ECG training program and ensuring that every ambulance service in South Dakota has access to quality 12-lead ECG training;Implementation of a robust, comprehensive 12-lead ECG training program and ensuring that every ambulance service in South Dakota has access to quality 12-lead ECG training;

Implementation Strategies…. Assurance that 12-lead ECGs in South Dakota ambulance services are transmitting results to medical facilities that are equipped to receive those transmissionsAssurance that 12-lead ECGs in South Dakota ambulance services are transmitting results to medical facilities that are equipped to receive those transmissions Through work with our stakeholders, assurance that emergency department staff in every South Dakota hospital are trained to properly administer fibrinolytic therapyThrough work with our stakeholders, assurance that emergency department staff in every South Dakota hospital are trained to properly administer fibrinolytic therapy

Implementation Strategies…. Assurance that appropriate protocols are in place for EMS and hospital personnel to provide for the most appropriate care for each STEMI patientAssurance that appropriate protocols are in place for EMS and hospital personnel to provide for the most appropriate care for each STEMI patient Establishment of the first of its kind “real time” evaluation tool with the American Heart Association/American College of Cardiology jointly developed quality improvement program, Action Registry-Get With The Guidelines, which will track patient data and information throughout the entire continuum of STEMI system care and allow us to evaluate and monitor on a regular basis the improvements being made and the need for improvement in other areas of each systemEstablishment of the first of its kind “real time” evaluation tool with the American Heart Association/American College of Cardiology jointly developed quality improvement program, Action Registry-Get With The Guidelines, which will track patient data and information throughout the entire continuum of STEMI system care and allow us to evaluate and monitor on a regular basis the improvements being made and the need for improvement in other areas of each system

Project Budget Highlights EMS: $4MEMS: $4M –$3.5M for 12-Leads –$225K for transmission –$300K for training & materials

Project Budget Highlights…. Hospitals: $3MHospitals: $3M –$775K for 12-Lead receiving station software –$2M for ACTION Registry GWTG –$75K for Lytics Training

Project Budget Highlights…. Other highlights:Other highlights: –Full Time SD M:L Director –Annual Conferences in SF & RC –Public/Provider Education –Evaluation –Positioning SD as a leader

Miscellaneous Register your systemRegister your system linesdwww.americanheart.org/missionlife linesdwww.americanheart.org/missionlife linesdwww.americanheart.org/missionlife linesd

LUNCH

The Plan & The Budget $9M+ over 3 years$9M+ over 3 years

“Human Resources” ML DirectorML Director Travel BudgetTravel Budget Lobbyist/Regulatory ConsultantLobbyist/Regulatory Consultant

EMS 12-Lead ECG’s12-Lead ECG’s 12-Lead Modem’s12-Lead Modem’s 12-Lead subscription12-Lead subscription 12-Lead Transmission12-Lead Transmission Hands On TrainingHands On Training Training MaterialsTraining Materials

12-Lead ECG’s Lead ECG’s placed Lead ECG’s placed All 127 licensed ground servicesAll 127 licensed ground services % % 46 75% (16 services)46 75% (16 services) Grant-like application processGrant-like application process

12-Lead ECG’s Modems placed in all 12-Lead’s (where applicable)Modems placed in all 12-Lead’s (where applicable) 3 year subscription provided (when necessary)3 year subscription provided (when necessary)

12-Lead ECG’s All units will transmitAll units will transmit Transmission data plan providedTransmission data plan provided

EMS Training & Materials Hands on TrainingHands on Training Learn: Rapid STEMI ID online toolLearn: Rapid STEMI ID online tool STEMI Provider ManualSTEMI Provider Manual Every SD Ambulance ServiceEvery SD Ambulance Service Every EMTEvery EMT

Hospitals 12-Lead ECG Receiving capability12-Lead ECG Receiving capability Action Registry – Get with the Guidelines (ARG)Action Registry – Get with the Guidelines (ARG) Fibrinolytic Therapy TrainingFibrinolytic Therapy Training

12-Lead Receiving Capability 50 Hospitals50 Hospitals Receiving capabilities/formatsReceiving capabilities/formats

ACTION – Registry GWTG Data Collection Tool developed by AHA/ACCData Collection Tool developed by AHA/ACC Focused on entire continuum of careFocused on entire continuum of care QI Staff & WebinarsQI Staff & Webinars 50 Hospitals – 3 Funding Tiers50 Hospitals – 3 Funding Tiers

ACTION – Registry GWTG PCI Receiving Centers:PCI Receiving Centers: –Year 1: 6 receiving centers, 90% of $75,000 FTE –Year 2: 6 receiving centers, 70% of $75,000 FTE, 1 new center at 90% of $75,000 FTE –Year 3: 6 receiving centers at 50% of $75,000, 1 center at 70%, 2 new centers at 90% of $75,000 FTE

ACTION – Registry GWTG Referring FTE Reimbursement TIER 1:Referring FTE Reimbursement TIER 1: –Year 1: 5 largest PCI-referring facilities - 70% of $50,000 FTE –Year 2: 4 PCI-referring facilities - 50% of $50,000 FTE –Year 3: 2 PCI-referring facilities - 30% of $50,000 FTE

ACTION – Registry GWTG Referring FTE Reimbursement TIER 2:Referring FTE Reimbursement TIER 2: Remaining PCI-referring facilities – to be divided accordingly, total FTE reimbursement incentive of $195,000Remaining PCI-referring facilities – to be divided accordingly, total FTE reimbursement incentive of $195,000

Fibrinolytic Therapy Training 50 Hospitals50 Hospitals $75K budgeted over 3 years$75K budgeted over 3 years Hands-On or Online/CD based?Hands-On or Online/CD based?

Public Awareness/Education $85K annually for 3 years$85K annually for 3 years Campaign TBDCampaign TBD

Evaluation Public Awareness – Years 1 & 3Public Awareness – Years 1 & 3 Project Evaluation – 1 manuscript in Year 1; 2 manuscripts in Years 2 & 3Project Evaluation – 1 manuscript in Year 1; 2 manuscripts in Years 2 & 3

M:L Model Sharing Sharing the SD system model: 4 Trips in Year 24 Trips in Year 2 8 Trips in Year 38 Trips in Year 3

QUESTIONS???

Annual Conferences 2 Annually2 Annually 1 East River – Sioux Falls1 East River – Sioux Falls 1 West River – Rapid City1 West River – Rapid City

Annual Conferences 150 Attendees East River150 Attendees East River 100 Attendees West River100 Attendees West River 1 Paid Speaker per event1 Paid Speaker per event

Annual Conferences Similar Topics/SchedulesSimilar Topics/Schedules Dates (November 3 rd or 4 th )Dates (November 3 rd or 4 th ) Format/Topics???Format/Topics???

Policy Issues EMS ProtocolsEMS Protocols Hospital DesignationHospital Designation

Other Items/Open Discussion

Next Task Force Meeting

ADJOURN!!!