Abstract WP382: Primary Stroke Centers - What Should We Measure?

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Background and Issues: Primary stroke centers are struggling to find their voice in the spectrum of stroke care. It is not feasible for all of us grow into Comprehensive Stroke Centers or even offer endovascular intervention. Victims of our own success, 7 of the 8 stroke Core Measures are discontinued by CMS. Meanwhile we must find other measures to continue to improve the effectiveness of stroke care and our value to our local population, EMS providers, internal stakeholders and the Joint Commission.Purpose: The purpose of this project at our 433-bed community hospital was to shift the focus from micro-management of outdated metrics to a macro-view of our program and demonstrate an effective method for internal evaluation.Methods: We followed the CDC guidelines for public health program evaluation. We reviewed the evidence for all aspects of our program, and developed a program logic model (Figure 1) and theory-based evaluation questions. We used a mixed-methods approach to analyze data for each question. We engaged our leaders in focus groups to review the findings.Results: Table 1 shows examples of our findings. Eleven program leaders, including the hospital medical director, the ED medical director, and nursing directors, identified four priorities: expanding our community outreach, improving ED stroke processes, increasing the use of stroke order sets, and improving post-discharge follow-up recommendations.Conclusions: Structured program evaluation is a means for primary stroke centers to continue to improve outcomes for stroke patients and justify their valuable role in the continuum of stroke care.

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