CDC grant aims to improve care and outcomes for stroke patients throughout Kentucky

UK HealthCare, UofL Health, the Kentucky Department for Public Health's Heart Disease and Stroke Prevention Program (KHDSP), and other state partners have been awarded the prestigious Paul Coverdell National Acute Stroke Program Grant by the Centers for Disease Control and Prevention.

This $1.8 million grant aims to optimize both stroke prevention among those at high risk as well as improve the care and outcomes for stroke patients throughout Kentucky.

The grant will be spread out over three years and will allow the coordination and expansion of existing efforts to improve stroke-related health outcomes. Kentucky health care systems and community providers will work together to implement comprehensive stroke systems for those at high risk for stroke and those who have had a stroke.

This award could not come at a better time, because Kentucky has among the highest rates of stroke-related deaths in the country."

Dr. Larry B. Goldstein, Chairman, Department of Neurology, University of Kentucky

Goldstein is also the co-director of the Kentucky Neuroscience Institute.

"Over 2,000 Kentuckians die from stroke or stroke-related complications each year. Health behaviors and conditions that contribute to stroke are present at high rates in Kentucky with contributions from smoking, obesity, diabetes, hypertension, excessive alcohol use, and physical inactivity. Although there are several existing stroke programs in Kentucky, we are excited that this project will coordinate and expand upon these efforts to improve stroke outcomes for Kentuckians."

Goldstein, who is also the principal investigator for the grant project, says the Coverdell award will also allow them to specifically target areas of the Commonwealth that are disproportionately affected by stroke, such as the Appalachian counties. The mortality rate due to stroke in that region is 14% higher than the national average and 8% higher than the rest of the state.

KHDSP and the Stroke Encounter Quality Improvement Project (SEQIP) have made significant strides over the last 10 years improving stroke systems of care in the Commonwealth and growing access to stroke care by increasing the number of certified stroke centers in the state, increasing delivery of acute stroke treatments that can reverse or minimize stroke deficits, and sharing best practices to help facilitate care delivery during hospitalization and after discharge.

In a similar fashion, the UK/Norton Healthcare Stroke Care Network (SCN) works with area hospitals to provide clinical guidance and oversight to providers with the goal of ensuring stroke patients receive the right treatment at the right time.

This grant will coordinate and expand these existing efforts in Kentucky to improve stroke-related health outcomes by working with Kentucky health care systems and community providers to implement comprehensive stroke systems for those at high risk for stroke and those who have had a stroke.

"This award validates the voluntary efforts of stroke center personnel, EMS representatives, community partners, KHDSP staff and colleagues in public health, as well as all other stakeholders who have worked tirelessly, across geopolitical boundaries, in a collaborative effort since SEQIP's inception in 2009 to advance stroke systems of care in our state," said Kari Moore, chair of SEQIP and project co-investigator. "We are excited to continue to build upon these efforts supported by the Coverdell award."

"The Paul Coverdell National Acute Stroke Program will allow expansion of our statewide efforts to serve rural and underserved citizens of the Commonwealth, to reduce disparities, and monitor our progress," said Dr. Kerri S. Remmel, chair of the University of Louisville Department of Neurology and co-chair of the KHDSP Task Force.

"The program will facilitate continuous quality improvement in the full continuum of care from the moment a patient has a stroke through their emergency services, hospitalization, and rehabilitation to their outpatient preventive care. We are extremely enthusiastic about collaborating with our partners in the Coverdell Program to improve stroke systems of care in Kentucky."

As part of the Coverdell initiative, the Kentucky Stroke Improvement Cooperative (KSIC) will be created to provide leadership for improving the quality of stroke care in the Commonwealth. Building from the KHDSP Task Force and SEQIP, the UK and UofL Stroke Programs, and the SCN, this group will lead the collaborative effort to transform Kentucky's stroke care and outcomes by improving health approaches and practices.

This will be accomplished by utilizing collaborative workgroups to turn knowledge into behavior change and to increase the use of evidence-based guidelines for health systems change. KSIC will accomplish its purpose by:

• Increasing public awareness of stroke and related issues in the community.
• Identifying and eliminating disparities that affect the health outcomes of Kentuckians.
• Providing education about stroke and its management.
• Serving as a link between the community and stroke care and supportive resources.
• Utilizing data to prioritize coalition goals and activities.
• Increasing diversity of its members.

The KSIC will be a catalyst for enhancing activities of other organizations promoting the health and well-being of all Kentuckians at risk, having and living with the effects of stroke.

"There has been a lot of great work across the Commonwealth to improve the care of stroke patients," said Brent McKune, managing director of the UK HealthCare Kentucky Regional Extension Center and project co-investigator. "The Coverdell funding gives us the opportunity to provide a coordinated effort to provide support and improve processes to ensure a high quality of care."

Since its inception in 2005, the Coverdell Program has funded programs to ensure that all Americans receive the highest quality stroke care, a leading cause of death and long-term disability, by supporting coordinated stroke systems of care.

Joining nine other states currently funded by the Paul Coverdell National Acute Stroke Program, Kentucky's program will:

• Increase access and participation in the statewide Kentucky Heart Disease and Stroke Prevention Task Force from the current 38 hospitals to help close the gap in stroke care for high-burden populations. In addition to focusing on hospitals, the project will expand participation to encompass the community, primary care clinics, EMS, rehabilitation centers and long-term care facilities.
• Expand coordination between existing programs including the Kentucky Stroke Encounter Quality Improvement Project, the statewide UK/Norton Healthcare Stroke Care Network, and the 36 certified Stroke Centers in Kentucky.
• Increase access, understanding, utilization and compliance with evidence-based performance measures of the American Heart Association's Get With the Guidelines Stroke Program.
• Expand existing systems of care to coordinate and extend access to rural and underserved populations.
• Increase the dissemination of evidence-based guidelines for improvement of hypertension, obesity and diabetes control, which are the leading risk factors for stroke disproportionately affecting high-burden populations.
• Reduce stroke disparities and deaths over the long term and improve outcomes throughout Kentucky with a focus on Appalachia and underserved communities at highest risk.

"We look forward to this exciting work and hope to lead the way in improving stroke-related care for the people of the Commonwealth of Kentucky," Goldstein said.