Abstract TP313: A Metro Chicago Learning Collaborative Model to Improve Smoking Cessation Rates in Stroke Patients

Background: While learning collaborative models have been shown to aid implementation of published national guidelines, less is known about their role in informing health care providers about emerging topics not yet written into guidelines. National guidelines state that stroke patients who have a history of smoking should receive smoking cessation intervention prior to hospital discharge. However, guidelines do not include recommendations related to e-cigarette use. Launched July 2018, the Metro Chicago Smoking Cessation Initiative was a one-year pilot aimed at improving understanding of smoking cessation interventions provided at discharge, smoking behavior post-discharge, and best practices for reducing smoking rates at 20 Chicago area hospitals. While hospital practices and patient behavior around e-cigarettes was not an aim, the learning collaborative model enabled hospital participants to report their experiences and enact practice changes related to e-cigarettes. Methods: The pilot used a Learning Collaborative model that included a quality improvement leader, health behavior content experts, reporting of experiences and data, and sharing of best practices. Pilot participating hospitals were required to attend quarterly online learning sessions and use Get With The Guidelines® Stroke for data entry. Hospitals documented smoking cessation intervention provided at time of discharge and contacted patients via phone at 30 days post-discharge to gather data on current smoking use, quit attempts, and therapies used. Hospitals completed a baseline questionnaire reporting current smoking cessation practices and a mid-point questionnaire reporting changes to practice and experiences as a pilot participant. Responses were reviewed for themes related to e-cigarettes. Results: See Table 1 Conclusions: A Learning Collaborative Model may be a method for identifying strategies for practice changes prior to guideline recommendations.

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Abstract 218: Expanding a Learning Collaborative Model in Chicago to Improve Door to Needle for Stroke Thrombolysis: Raising the Bar

Circulation Cardiovascular Quality and Outcomes ◽

10.1161/circoutcomes.10.suppl_3.218 ◽

2017 ◽

Vol 10 (suppl_3) ◽

Author(s):

Shyam Prabhakaran ◽

Renee M Sednew ◽

Kathleen O’Neill

Keyword(s):

Best Practices ◽

Performance Improvement ◽

Best Practice ◽

Learning Collaborative ◽

Collaborative Model ◽

Stroke Registry ◽

Chicago Area ◽

Regional Collaboration ◽

Content Expert ◽

And Performance

Background: There remains significant opportunities to reduce door-to-needle (DTN) times for stroke despite regional and national efforts. In Chicago, Quality Enhancement for the Speedy Thrombolysis for Stroke (QUESTS) was a one year learning collaborative (LC) which aimed to reduce DTN times at 15 Chicago Primary Stroke Centers. Identification of barriers and sharing of best practices resulted in achieving DTN < 60 minutes within the first quarter of the 2013 initiative and has sustained progress to date. Aligned with Target: Stroke goals, QUESTS 2.0, funded for the 2016 calendar year, invited 9 additional metropolitan Chicago area hospitals to collaborate and further reduce DTN times to a goal < 45 minutes in 50% of eligible patients. Methods: All 24 hospitals participate in the Get With The Guidelines (GWTG) Stroke registry and benchmark group to track DTN performance improvement in 2016. Hospitals implement American Heart Association’s Target Stroke program and share best practices uniquely implemented at sites to reduce DTN times. The LC included a quality and performance improvement leader, a stroke content expert, site visits and quarterly meetings and learning sessions, and reporting of experiences and data. Results: In 2015, the year prior to QUESTS 2.0, the proportion of patients treated with tPA within 45 minutes of hospital arrival increased from 21.6% in Q1 to 31.4% in Q2. During the 2016 funded year, this proportion changed from 31.6% in Q1 to 48.3% in Q2. Conclusions: Using a learning collaborative model to implement strategies to reduce DTN times among 24 Chicago area hospitals continues to impact times. Regional collaboration, data sharing, and best practice sharing should be a model for rapid and sustainable system-wide quality improvement.

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Abstract 101: A Learning Collaborative Model to Improve Door to Needle Time for Stroke Thrombolysis in Chicago

Circulation Cardiovascular Quality and Outcomes ◽

10.1161/circoutcomes.9.suppl_2.101 ◽

2016 ◽

Vol 9 (suppl_2) ◽

Author(s):

Shyam Prabhakaran ◽

Kathleen O’Neill ◽

Keyword(s):

Best Practices ◽

Ct Scanner ◽

Learning Collaborative ◽

Collaborative Model ◽

Team Members ◽

Stroke Registry ◽

Face To Face ◽

Regional Collaboration ◽

Stroke Team ◽

Get With The Guidelines

Background: Door-to-needle (DTN) times have remained suboptimal despite overall increases in tissue plasminogen activator use (tPA) for stroke in Chicago. The American Heart Association’s (AHA) Quality Enhancement for Speedy Thrombolysis in Stroke (QUESTS) initiative aimed to identify barriers to reduce DTN times at Chicago’s 15 primary stroke centers (PSCs) and increase the proportion of patients treated with tPA within 60 minutes of hospital arrival. Methods: Starting in January 2013, we used face-to-face and on-site meetings with each PSC’s stroke team members to share AHA Target Stroke best practices and strategies to reduce DTN time. A survey of current practice was completed at each site to determine opportunities for improvement and repeated at 1 year to assess implementation of new strategies. We used the Get With The Guidelines (GWTG) Stroke registry to aggregate baseline data DTN times and track performance in each quarter of 2013. Results: At baseline, 5 strategies were notably under-utilized at Chicago’s 15 PSCs: 1) Direct to CT scanner (baseline: 0 sites; 1 year: 5 sites); 2) pre-mixing tPA (baseline: 1 site; 1 year: 14 sites); 3) tPA prior to laboratory results (baseline: 3 sites; 1 year: 7 sites); 4) stroke code activation at triage (baseline: 4 sites; 1 year: 13 sites); and 5) streamlined consent process (baseline: 0 sites; 1 year: 12 sites. The proportion of patients treated within 60 minutes increased in each quarter of 2013 from 25% in quarter 1 to 60% in quarter 4 (p<0.01). The median DTN time decreased from 89.5 minutes in quarter 1 to 55 minutes in quarter 4 (p<0.01). Conclusions: Using a learning collaborative model to implement strategies to reduce DTN times among 15 PSCs in Chicago, we observed major improvements within a few months. Regional collaboration and best practices sharing should be a model for rapid and sustainable system-wide quality improvement.

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Abstract 18789: A Learning Collaborative Model to Improve Door to Needle Time for Stroke Thrombolysis in Chicago

Circulation ◽

10.1161/circ.130.suppl_2.18789 ◽

2014 ◽

Vol 130 (suppl_2) ◽

Author(s):

Shyam Prabhakaran ◽

Kathleen O’Neill ◽

Keyword(s):

Best Practices ◽

Ct Scanner ◽

Learning Collaborative ◽

Collaborative Model ◽

Team Members ◽

Stroke Registry ◽

Face To Face ◽

Regional Collaboration ◽

Stroke Team ◽

Get With The Guidelines

Background: Door-to-needle (DTN) times have remained suboptimal despite overall increases in tissue plasminogen activator use (tPA) for stroke in Chicago. The American Heart Association’s (AHA) Quality Enhancement for Speedy Thrombolysis in Stroke (QUESTS) initiative aimed to identify barriers to reduce DTN times at Chicago’s 15 primary stroke centers (PSCs) and increase the proportion of patients treated with tPA within 60 minutes of hospital arrival. Methods: Starting in January 2013, we used face-to-face and on-site meetings with each PSC’s stroke team members to share AHA Target Stroke best practices and strategies to reduce DTN time. A survey of current practice was completed at each site to determine opportunities for improvement and repeated at 1 year to assess implementation of new strategies. We used the Get With The Guidelines (GWTG) Stroke registry to aggregate baseline data DTN times and track performance in each quarter of 2013. Results: At baseline, 5 strategies were notably under-utilized at Chicago’s 15 PSCs: 1) Direct to CT scanner (baseline: 0 sites; 1 year: 5 sites); 2) pre-mixing tPA (baseline: 1 site; 1 year: 14 sites); 3) tPA prior to laboratory results (baseline: 3 sites; 1 year: 7 sites); 4) stroke code activation at triage (baseline: 4 sites; 1 year: 13 sites); and 5) streamlined consent process (baseline: 0 sites; 1 year: 12 sites. The proportion of patients treated within 60 minutes increased in each quarter of 2013 from 25% in quarter 1 to 60% in quarter 4 (p<0.01). The median DTN time decreased from 89.5 minutes in quarter 1 to 55 minutes in quarter 4 (p<0.01). Conclusions: Using a learning collaborative model to implement strategies to reduce DTN times among 15 PSCs in Chicago, we observed major improvements within a few months. Regional collaboration and best practices sharing should be a model for rapid and sustainable system-wide quality improvement.

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Abstract TMP68: Expanding a Learning Collaborative Model in Chicago to Improve Door to Needle for Stroke Thrombolysis: Raising the Bar

Stroke ◽

10.1161/str.48.suppl_1.tmp68 ◽

2017 ◽

Vol 48 (suppl_1) ◽

Author(s):

Shyam Prabhakaran ◽

Renee M Sednew ◽

Kathleen O’Neill

Keyword(s):

Best Practices ◽

Performance Improvement ◽

Best Practice ◽

Learning Collaborative ◽

Collaborative Model ◽

Stroke Registry ◽

Chicago Area ◽

Regional Collaboration ◽

Content Expert ◽

And Performance

Background: There remains significant opportunities to reduce door-to-needle (DTN) times for stroke despite regional and national efforts. In Chicago, Quality Enhancement for the Speedy Thrombolysis for Stroke (QUESTS) was a one year learning collaborative (LC) which aimed to reduce DTN times at 15 Chicago Primary Stroke Centers. Identification of barriers and sharing of best practices resulted in achieving DTN < 60 minutes within the first quarter of the 2013 initiative and has sustained progress to date. Aligned with Target: Stroke goals, QUESTS 2.0, funded for the 2016 calendar year, invited 9 additional metropolitan Chicago area hospitals to collaborate and further reduce DTN times to a goal < 45 minutes in 50% of eligible patients. Methods: All 24 hospitals participate in the Get With The Guidelines (GWTG) Stroke registry and benchmark group to track DTN performance improvement in 2016. Hospitals implement American Heart Association’s Target Stroke program and share best practices uniquely implemented at sites to reduce DTN times. The LC included a quality and performance improvement leader, a stroke content expert, site visits and quarterly meetings and learning sessions, and reporting of experiences and data. Results: In 2015, the year prior to QUESTS 2.0, the proportion of patients treated with tPA within 45 minutes of hospital arrival increased from 21.6% in Q1 to 31.4% in Q2. During the 2016 funded year, this proportion changed from 31.6% in Q1 to 48.3% in Q2. Conclusions: Using a learning collaborative model to implement strategies to reduce DTN times among 24 Chicago area hospitals continues to impact times. Regional collaboration, data sharing, and best practice sharing should be a model for rapid and sustainable system-wide quality improvement.

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Abstract W MP99: Race/Ethnic and Sex Differences in EMS Transport among Hospitalized U.S. Stroke Patients: Analysis of the National Get With The Guidelines-Stroke Registry

Stroke ◽

10.1161/str.46.suppl_1.wmp99 ◽

2015 ◽

Vol 46 (suppl_1) ◽

Author(s):

Heidi Mochari-Greenberger ◽

Ying Xian ◽

Anne S Hellkamp ◽

Phillip J Schulte ◽

Deepak L Bhatt ◽

...

Keyword(s):

Ethnic Group ◽

Insurance Coverage ◽

Health Insurance Coverage ◽

National Sample ◽

Stroke Patients ◽

Hispanic Males ◽

Stroke Registry ◽

Black Females ◽

History Of ◽

Get With The Guidelines

Background: Calling 911 is the recommended first step when stroke symptoms occur. Differences in activation of emergency medical services (EMS) may contribute to race/ethnic and sex disparities in stroke outcomes. The purpose of this study was to determine whether EMS utilization varies among a contemporary, diverse national sample of hospitalized acute stroke patients. Methods: We analyzed data from 398,798 stroke patients admitted to 1,613 Get With The Guidelines-Stroke participating hospitals from 10/1/11-3/31/14. Multivariable logistic regression was utilized to evaluate the associations between race/ethnic group and sex, with EMS use, adjusting for potential confounders. Results: Patients were 50.4% female, 69% white, 19% black, 8% Hispanic, 3% Asian, 1% other; 85.9% ischemic stroke. Overall 58.6% of stroke patients were transported to the hospital by EMS. EMS utilization differed by sex and race/ethnic group (interaction p<0.001). White females were most likely to use EMS (62.0%) and Hispanic males were least likely to (52.2%). Age, health insurance coverage, and history of prior stroke or TIA varied significantly among race/ethnic groups (p<0.0001). After adjustment for both patient and hospital characteristics, Hispanic and Asian men and women were less likely than their white counterparts to utilize EMS; black females were less likely than white females to utilize EMS (Table). Conclusion: EMS use was low overall and differential by race/ethnicity and sex. These contemporary data support a need for targeted initiatives to increase EMS transport among U.S. stroke patients.

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Abstract TP373: Developing a Pre-Arrival Report Card

Stroke ◽

10.1161/str.51.suppl_1.tp373 ◽

2020 ◽

Vol 51 (Suppl_1) ◽

Author(s):

Dot Bluma ◽

Bethany Girtler ◽

Jessica Link ◽

Megan Elderbrook

Keyword(s):

Performance Improvement ◽

Stroke Care ◽

Report Card ◽

Transitions Of Care ◽

Report Cards ◽

Learning Collaborative ◽

Stroke Patients ◽

Aggregated Data ◽

Data Points ◽

Get With The Guidelines

Background and Purpose: Hospitals’ communication with EMS on pre-arrival evidence based measures is essential in ensuring the best care for stroke patients in their community. To assist in assessing EMS pre-hospital care, the Wisconsin Coverdell Stroke Program (Coverdell) developed a quarterly report card for each of our participating hospitals. Coverdell’s 66 participating hospitals represent 78% of annual stroke admissions to Wisconsin hospitals. Coverdell utilizes the data entered into Get With The Guidelines® (GWTGs) - Special Initiatives tab. The data in the report card can be used to identify gaps in quality stroke care, followed by identifying performance improvement opportunities which can be initiated to address these gaps in care. Methods: Coverdell hospitals participate in the quarterly Coverdell Learning Collaborative (CLC) where they review several aggregated data points. CLC recognized a report card would provide an opportunity for participating hospitals to discuss the pre-arrival quality measures with their EMS providers and assist in developing a trusting relationship. To develop the report card, Coverdell’s Epidemiologist and Stroke Project Specialist analyzed the data measures from the GWTGs- Special Initiatives tab. We determined the need to provide benchmark groups for comparison, and to have established goals for each measure to assist in motivating and gauging progress of quality improvement initiatives. Findings: Coverdell released the pilot quarterly report card in Q3 2018. We then met with Stroke Coordinators whose hospitals were entering into the GWTGs Special Initiatives tab to discuss the goals, measures, and the need for modifications. The Q4 2018 report card incorporated the identified edits. Conclusion: Providing quarterly report cards with EMS pre-arrival measures will assist hospitals and their EMS providers in jointly identifying, planning, and implementing performance improvement initiatives in efforts to ensure seamless transitions of care for stroke patients in their community.

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Abstract 21: Patient and Hospital Characteristics Associated with Assessment for Rehabilitation During Hospitalization for Acute Ischemic Stroke

Stroke ◽

10.1161/str.43.suppl_1.a21 ◽

2012 ◽

Vol 43 (suppl_1) ◽

Author(s):

Janet Prvu Bettger ◽

Lisa Kaltenbach ◽

Mathew Reeves ◽

Eric E Smith ◽

Gregg C Fonarow ◽

...

Keyword(s):

Ischemic Stroke ◽

Stroke Unit ◽

Multivariable Analysis ◽

Care Facility ◽

Healthcare Facility ◽

Stroke Patients ◽

Chi Square ◽

Rehabilitation Care ◽

History Of ◽

Get With The Guidelines

Introduction: Delays in post-stroke rehabilitation can negatively affect functional recovery and health-care costs. While clinical guidelines recommend that all stroke patients receive a standardized assessment during the acute hospitalization, the degree and determinants of acute assessment for rehabilitation (AAR) following ischemic stroke are unknown. Methods: We analyzed data from 1540 Get With The Guidelines-Stroke hospitals from 01/08/2008 to 03/31/2011. Patients who died in hospital, left AMA, or were transferred in from or out to another acute hospital were excluded. Univariate (chi-square or Wilcoxon as appropriate) and multivariable logistic regression analyses with GEE were used to identify factors independently associated with an AAR while accounting for within hospital clustering. Results: Among 616,982 ischemic stroke patients, 89.5% had an AAR documented. Those without AAR were more likely white, older, female, unable to ambulate prior to admission, from a chronic care facility, have Medicare health insurance and comorbid conditions. Also without an AAR were those with moderate-severe stroke (NIHSS≥6), unable to ambulate on day 2, and were not cared for in a stroke unit. Nine percent of patients discharged home without services were not assessed for rehabilitation. In multivariable analysis, many factors were independently associated with receiving an AAR; however, patients with the greatest odds (OR>1.2) were of Black race, without a history of carotid stenosis, ambulating independently prior to admission, had stroke symptoms outside of a healthcare facility, were treated at a Northeast hospital, in a stroke unit, had complications from thrombolytic therapy, and were ambulating on hospital day 2 ( Table ). Conclusion: Although 90% of ischemic stroke patients received an AAR, the results suggest important subpopulations were overlooked. Quality improvement efforts are needed to ensure that all stroke patients are assessed and referred for the appropriate level of rehabilitation care for their needs. Further research of the unexplained variation in AAR is warranted.

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Use of A Learning Collaborative to Implement Integrated Smoking Cessation Care for Veterans with PTSD

PsycEXTRA Dataset ◽

10.1037/e533652013-230 ◽

2012 ◽

Author(s):

Lori Ebert ◽

Kim Hamlett-Berry ◽

Miles McFall ◽

Andrew Saxon ◽

Carol Malte ◽

...

Keyword(s):

Smoking Cessation ◽

Learning Collaborative

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Trying to Professionalize Expert Knowledge (Part I): The Short Life of the Municipal Administration Service, 1926-1933

Public Voices ◽

10.22140/pv.525 ◽

2017 ◽

Vol 15 (1) ◽

pp. 9 ◽

Cited By ~ 1

Author(s):

Mordecai Lee

Keyword(s):

Best Practices ◽

Public Administration ◽

Expert Knowledge ◽

Building Blocks ◽

Early History ◽

Short Life ◽

Organizational History ◽

Municipal Administration ◽

History Of ◽

Wide Dissemination

One of the building blocks of the professionalization of American public administration was the recognition of the need for expert knowledge and the wide dissemination of that information to practitioners. Municipal civil servants could adopt and adapt these best practices in their localities. Such was the purpose of the Municipal Administration Service (1926-1933), initially founded by the National Municipal League and funded by the Rockefeller philanthropies. This article is an organizational history of the Service. It presents the life cycle of the agency, including its operations, funding, problems, and the behind-the-scenes public administration politics which led to its demise. In all, the Municipal Administration Service captures the early history of American public administration, its attempt to demonstrate that it was a full-fledged profession with recognized experts and managerial advice that ultimately proved unable to perpetuate itself.

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