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EMSWORLD.com | NOVEMBER 2017 29 For More Information Circle 22 on Reader Service Card Paul Coverdell National Acute Stroke Registry. The GWTG-S program improves quality for in-hospital acute stroke care through the implementation of evidence-based guidelines. GWTG-S is the largest stroke registry and QI program for hospitalized stroke patients and since its inception in 2003, approximately 1,650 participating hospitals have entered millions of patient records. Data from this large QI registry have provided critical insight into race- ethnic and sex disparities in acute stroke care, showing lower quality of in-hospital care for blacks and women. 17,18 Similarly the Coverdell program, estab- lished in 2001, was designed as a surveil- lance system to monitor, promote and improve the quality of stroke care in hos- pitals nationwide. Currently nine state health departments (California, Georgia, Massachusetts, Michigan, Minnesota, New York, Ohio, Washington and Wisconsin) are supported through the Coverdell program, partnering with hundreds of hospitals, EMS agencies and community service provid- ers to develop high-quality stroke systems of care to improve care and reduce dis- parities in underserved populations. From 2005–2015, more than 620,000 patients benefited from hospital participation in this program. The FL-PR CReSD Study Participation in stroke registries has been associated with increased adherence to stroke performance measures, leading to marked improvements in the delivery of care. 19,20 A few states have organized acute stroke registries focused on overall care monitoring and improvement, but no program has targeted race-ethnic dispari- ties as a primary focus. Awareness of disparities is a neces- sary first step toward changing behavior and creating interventions to effectively address them. While Florida is not cur- rently a Coverdell-funded state, under the guidance of the University of Miami Miller School of Medicine, with the participation of the AHA, the University of Puerto Rico and Hospital HIMA (a Puerto Rican hospi- tal consortium), the Florida-Puerto Rico Collaboration to Reduce Stroke Disparities (FL-PR CReSD) study was established in 2013 and funded by the National Institute of Neurological Disorders and Stroke. The FL-PR CReSD is a multicenter ini- tiative designed to address disparities in stroke care through the creation of a vol- untary stroke registry with data from par- ticipating GWTG-S hospitals throughout Florida and Puerto Rico. The Florida Puerto Rico Stroke Registry aims to evaluate race- ethnic, sex and geographic disparities in acute stroke care, investigate the frequen- cy of disparities in short- and longer-term outcomes, and develop and disseminate culturally tailored QI programs to address identified disparities. The FL-PR CReSD conceptual frame- work (Figure 1) graphically describes its cyclic impact on stroke care QI. Data integrated from prehospital (Florida's EMSTARS database), in-hospital (GWTG- S) and post-hospital (CMS database) set- tings are analyzed to track quality of care and identify disparities. Culturally tailored QI interventions based on recognized dis- parities may effect changes within levels of the stroke-care continuum (individual, healthcare system, community, policy makers) that interact and form multilevel determinants of health. Resulting changes in stroke care and outcomes are reflect- ed in the data provided to the registry, at which point the cycle begins again. As of June 2017, the Florida Puerto Rico Stroke Registry consisted of 91 hospitals (76 in Florida, 15 in Puerto Rico) and over 150,000 stroke cases. Registry data has shown that stroke-care performance has improved over time for all race-ethnic groups with a similar trend also seen by sex. 21,22 In Florida, overall stroke care as measured by defect-free care (compliance with all eligible GWTG-S performance metrics) was comparable across race- ethnic groups and sex, though disparities in IV tPA administration were observed. While the percentage of patients receiv- ing IV tPA by 4.5 hours when arriving to the hospital by 3.5 hours rose over time regardless of race-ethnicity, African-Amer- icans in Florida were less likely to receive tPA in this later time window regardless of arrival during "on" or "off" hours com- pared to whites (Figure 2). No differences were observed for Hispanics. Addition- ally, despite increases in the annual rate of thrombolysis with no significant differ- ences between sexes, women were less likely to receive IV tPA overall. Although EMS use is independently associated with more rapid stroke evaluation and treat- ment, we found that fewer than half of all patients arrived by EMS regardless of race-ethnicity and sex. Future analyses will focus on regional and prehospital dispari- ties in Florida. Addressing Disparities To address identified disparities, the FL-PR CReSD has developed and disseminated various stakeholder interventions, includ- FROM COMPRESSION BANDAGES TO CHEST DRESSINGS AND CONVENIENCE KITS, H&H; HAS THE FIRST-RESPONDER PRODUCTS YOU NEED. H&H; Medical Corporation 1-800-328-5708 www.gohandh.com The H * VENT Vented Chest Seal features a unique hex-channel venting system to help prevent occlusion from bodily fluids when used on an open chest injury. With the unique hex-channel venting system, it provides multiple vent openings in the event that one or more channels become occluded. PACKAGE SIZE: 4.5″ × 7.25″ × 0.25″ WEIGHT: 1.3 OZ. 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