1. The Future of Stroke in Your State: Kansas Janice Sandt MS,BSN,RN,CCM FINANCIAL DISCLOSURES: None UNLABELED/UNAPPROVED USES DISCLOSURE: None

2. The Future of Stroke in Your State: Kansas Review regional, statewide initiatives

4. Stroke Death Rate per 100,000, 35+,All Race, All Gender, 2008-2010 Centers for Disease Control and Prevention http://nccd.cdc.gov

5. Kansas: Stroke Death Rate per 100,000 2008-2010 Centers for Disease Control and Prevention http://nccd.cdc.gov

6. Kansas: Ischemic Stroke Death Rate per 100,000 2008-2010 Centers for Disease Control and Prevention http://nccd.cdc.gov

7. Kansas: Hemorrhagic Stroke Death Rate per 100,000 2008-2010 Centers for Disease Control and Prevention http://nccd.cdc.gov

8. Kansas: Stroke Hospitalization Rate per 1,000 Medicare Beneficiaries 2008-2010 Centers for Disease Control and Prevention http://nccd.cdc.gov

9. Confusion / Trouble Speaking91.3% Sudden Numbness / Weakness 95.3% Sudden Trouble Seeing 76.4% Sudden Chest Pain / Discomfort 46.2% (incorrect answer) Trouble walking, dizziness, loss of balance 90.2% Severe headache with no known cause 63.4% Only 22.8% got all questions correct and identified 911 as the correct first response. 9

10. Survey Results (60% of hospita reporting) Survey results (60% of 129 hospitals reporting): 43.3% of hospitals stated they were not equipped / staffed to care for stroke 45.5% of hospitals stated they were interested in participating in telestroke. 70% of hospitals do not have an ER Physician available 24 x 7 79.5% of hospitals do not have a stroke team 41.0% do not have pre-written stroke orders 68.5% do not have stroke pathways for stroke patients that are admitted. 17.5% do not have pharmacological thrombolysis available 25% do not have a set protocol for the use of tPA. 67.6% are interested in support for Community Stroke Awareness 10

11. 11 2012 Task Force Goals Include the following: Air ambulance, fixed wing and ambulance locations Neuro-interventional Centers Primary Stroke Centers Emergent Stroke Ready Hospitals Hospitals NOT Stroke Ready Give all hospitals the opportunity to participate and self-identify. Support local EMS as they pursue policies / protocols that meet the needs of the regional stroke system of care. Work in concert with the State Board of EMS Identify possible gaps in service and solutions for overcoming. Work with local hospitals to implement a state- wide, stroke signs and symptom campaign with an emphasis on: Recognizing Symptoms and Calling 911 immediately The local stroke system of care Partners providing advanced care. STROKE CAPABILITY MAPTRANSPORT / TREATMENT GUIDELINESSTROKE SIGNS AND SYMPTOMS

12. 64 hospitals (50% of Kansas Hospitals) are participating in KISS in one of 4 categories: Emergent Stroke Ready (52), Primary Stroke Center (9), 24/7 Neuro-Interventional Center/Primary Stroke Center (2) Advanced Comprehensive Stroke Center (1)

14. Lessons Learned LESSONS LEARNED: Most small hospitals want to provide the very best stroke care. The need for stroke focused clinical education is especially important for ESRH’s. This education is best offered regionally or electronically. The Stroke Champion also wears many other “hats”. Most common barrier to implementation is Door to CT interpretation within 45 minutes CT tech call protocol is too long requiring revision ( one hour too long!) Contracted provider unable to meet obligation for read time Changed providers for radiology support The most important educational message for EMS to support the ESRH is that Onset of Symptom is not the same as Last Known Well (Normal). Physicians who are hesitant to treat can be swayed through physician to physician communication. (Don’t be afraid to address the conflict directly.)

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17. The Future of Stroke in Your State: Kansas The Kansas Heart & Stroke Collaborative A care delivery and payment model to improve rural Kansans’ heart health and heart attack and stroke outcomes to reduce total cost of care for that population. Residents of rural Northwest Kansas counties at risk of or have suffered heart attack or stroke Approximately 13,000 Medicare/Medicaid beneficiaries

18. Kansas Heart and Stroke Collaborative Participants

19. Anticipated Outcomes Reduce total cost of care for target population by $13.8 million (1.9 percent savings) Reduce deaths from heart disease and stroke by 20 percent

20. Kansas Heart and Stroke Collaborative Year 1 Target population: acute care admissions with discharge diagnosis of heart attack and stroke. Estimated number of patients: 630 Interventions STEMI protocols depending on geographical location PCI within 90 minutes Thrombolytic treatment Acute ischemic stroke protocols IV tPA for eligible patients Transitional care management (TCM) for secondary prevention: call in 2 days, face to face in 2-4 weeks PCP, health coach, patient engagement

21. The Future of Stroke in Your State: Kansas Where you live should not determine whether you live!