Abstract TP285: Levers for Facilitating the Establishment of Stroke Systems of Care

Introduction: During 2012-2015 the Centers for Disease Control and Prevention’s (CDC) Paul Coverdell National Acute Stroke Program (PCNASP) funded 11 state health departments to improve quality of stroke care by developing systems of care that span the continuum of pre-hospital, hospital, and post-hospital care. Hypothesis: We assessed the hypothesis that state- and health system-level factors facilitate establishing stroke systems of care. Methods: We conducted 72 semi-structured telephone interviews with stakeholders of the 11 PCNASP grantees, such as program and quality improvement (QI) personnel, and emergency medical services (EMS) and hospital staff. Using grounded theory (Glaser and Strauss), we developed and applied a coding scheme to interview transcripts to identify emerging themes related to factors affecting establishing stroke systems of care. Results: Findings indicate that state- and health system-level characteristics affect experiences establishing stroke systems of care. State-level characteristics include demographics and geography, incidence of stroke, existence of legislation, and leadership. Large states, low population density, and low incidence of stroke posed a challenge to establishing systems of care. The existence of state stroke care hospital designation and the centralization of authority to establish and implement statewide standard of care and destination protocols played a key role in incentivizing participation in QI efforts across the continuum of care. Infrastructure, capacity, and relationships at the health system-level were associated with establishing systems of care. Respondents shared examples of barriers, such as the high number of volunteer versus paid EMS providers, the feasibility and resources to convene EMS and hospital staff for trainings and building support; facilitators included the existence of well-established, collaborative relationships between EMS, hospitals, and rehabilitation agencies. Conclusion: Contextual factors unique to each state affected the achievement that PCNASP grantees experienced in establishing systems of care. Individualizing implementation given contextual factors may facilitate success of stroke systems of care throughout the nation.