Implementing the Kentucky Stroke Improvement Cooperative (KSIC) to Advance Stroke Care Across the Care Continuum in Kentucky

Abstract Stroke was the fifth highest cause of death in Kentucky and in the United States in 2018. Overall, Kentuckians have high rates of stroke and heart disease as well as high blood pressure and high cholesterol, which increase the risk of both conditions. Over 2,200 Kentuckians died from stroke or stroke related complications in 2018. 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. In particular, the Appalachian region of Kentucky has disproportionately more health-challenges than the rest of the state including higher levels of poverty, unemployment, and health disparities. Of major concern is that in Appalachian Kentucky, the stroke mortality rate is 14% higher than the national average and 8% higher than the rest of the state. Although several programs have been established in Kentucky to reduce the burden of stroke in the state by optimizing the quality and organization of stroke – care, additional gains can be achieved with a more integrated and comprehensive approach. The goal of this grant will be to expand upon the existing efforts to create a more extensive and coordinated approach to reduce the impact of stroke in populations at the greatest risk due to health disparities such as low income, limited access to care and low health literacy. The proposed project is designed to achieve the following outcomes: • Increase access and participation in the statewide Stroke Encounter Quality Improvement Project (SEQIP) from the current 38 hospitals to help close the gap in stroke care for high burden populations and optimize stroke care across the continuum. In addition to hospitals, expand participation to encompass the community, primary care clinics, EMS, rehabilitation centers and long-term care facilities. • Expand coordination between SEQIP programs, the 33 hospitals in the statewide Norton Healthcare-UK Stroke Care Network (SCN) and the 36 Certified Stroke Centers in Kentucky. • Increase access and utilization of Get with the Guidelines-Stroke (GWTG-S) across Kentucky. • Increase understanding and compliance with evidence-based performance measures in GWTG-S metrics. • Expand existing stroke systems of care to coordinate across the care continuum to extend access to rural and underserved populations, including leveraging existing federal and state resources to coordinate transitions of care for high-risk patient populations. • Increase the dissemination of evidence-based guidelines for improvement of hypertension, obesity, and diabetes control, identified as being among 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. Several strategies will be used to achieve these outcomes, including leveraging existing stroke prevention and care infrastructure to develop a more coordinated approach to standardized messaging and training. Building from SEQIP utilization, SCN activities, and maximizing the use of GWTG-S will foster data-driven improvement across the stroke care continuum in Kentucky.