IMPROVE Stroke Care- Developing and Optimizing Regional Systems of Stroke Care

Study Overview
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Brief Summary
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The purpose of this program is to develop a regional integrated stroke system that identifies, classifies, and treats patients with acute ischemic stroke more rapidly and effectively with reperfusion therapy.

Detailed Description
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The design is based upon the implementation of best practice, that is, based on a comprehensive review of AHA guidelines regarding treatment of acute stroke, ICH (intracranial hemorrhage) and SAH(sub arachnoid hemorrhage). In the second phase, the project will be doing national and international surveys of best practices among comprehensive stroke centers and then combine evidence based guidelines and recommendation as well as expert consensus and guidelines when high level evidence is not available from the published literature. The aim to improve public stroke awareness, stroke symptom recognition within the time benefit window for treatment and calling 9-1-1, EMS transportation, and the proportion and speed of reperfusion therapy (fibrinolytic and in appropriate patients- endovascular treatment) in eligible patients. These improvements in acute stroke care delivery are expected to result in lower mortality, fewer recurrent strokes, and improved long term functional outcomes that we will measure.

Official Title
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IMPlementation of Best PRactices fOr Acute Stroke Care - Developing and Optimizing Regional Systems of Stroke Care

Conditions
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Acute Stroke, Intracranial Hemorrhages, Subarachnoid Hemorrhage

Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Adult patients > 18 years of age who undergo the local acute code stroke process Exclusion Criteria: In house patients with stroke are not included in this data set.

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Spoke Hospital<br>Patients that undergo the Code Stroke process at Spoke Hospitals | |
| Hub Hospital<br>Patients that undergo the Code Stroke process at Hub Hospitals | |
| Transfer<br>Patients that undergo the Code Stroke process at a Spoke Hospital and transfer to the Hub Hospital | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in Time from door to drug as measured by medical record | The time frame starting from the earliest time that the patient is documented as arriving to the hospital to the beginning time of the administration of the drug (TPA) | From baseline (Q1, 2017), to Quarter 4 (2020) | 
| Change in Time from Door to Tici 2c/3 flow measured by medical record | The time frame starting from the earliest time that the patient is documented as arriving to the hospital to the beginning time of Tici 2c/c flow noted in the vessel | From baseline (Q1, 2017), to Quarter 4 (2020) | 
| Change in Time from Door to Administration of Reversal Agent as measured by medical record | The time frame starting from the earliest time that the patient is documented as arriving to the hospital to the beginning time of the administration of the drug (reversal agent) | From baseline (Q1, 2017), to Quarter 4 (2020) | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in Number of Deaths from Stroke as measure by medical record | Count of number of deaths from stroke | From baseline (Q1, 2017) to Quarter 4 (2020) | 
| Change in Functional Long Term Outcomes as measured by Modified Rankin Scale | Modified Ranking Scale ranges from 0-6, 0 No symptoms at all No significant disability despite symptoms; able to carry out all usual duties and activities Slight disability; unable to carry out all previous activities, but able to look after own affairs without assistance Moderate disability; requiring some help, but able to walk without assistance Moderately severe disability; unable to walk without assistance and unable to attend to own bodily needs without assistance Severe disability; bedridden, incontinent and requiring constant nursing care and attention Dead | From baseline , 3 months |