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NEXT-LEVEL STROKE CARE ing a stroke disparities training program, disparities dashboards and a door-to-nee- dle (DTN) interactive module. The train- ing program informs a broad spectrum of stakeholders in the strategies needed to decrease stroke disparities in underserved groups. The hospital disparities dashboards allow sites to benchmark their adher- ence to stroke metrics by race-ethnicity and sex and compare their performance to other hospitals in the region and state. Furthermore, regional stroke care advo- cacy groups have expressed interest in the development of regional dashboards to share best practices, improve regional stroke-care delivery and strengthen part- nerships within existing stroke systems. Finally, the DTN module, an interactive, web-based tool designed for EMS, stroke and ED teams, emphasizes evidence- based best practices to effectively shorten DTN times. The future of stroke registries includes ef for ts to improve patient transitions of care and data collection after acute stroke hospitalization, primarily targeting disparities in short- and long-term stroke outcomes (mortality, disability and read- mission). In Florida, movement toward a statewide stroke registry standardizing data collection has also commenced. Findings from the FL-PR CReSD and other described registries highlight the need for continued investments in state- and nationwide QI programs targeting areas where stroke performance is sub- optimal and disparities exist. Collaborative partnerships promoting the sharing of data and best practices will support and strengthen comprehen- sive stroke systems across the care con- tinuum, translating into lives saved and a substantial impact made on the burden of stroke. REFERENCES 1. Kochanek KD, Murphy SL, Xu J, Arias E. Mor talit y in the United States, 2013. 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Kleindor fer D, de los Rios L a Rosa F, Khatri P, et al. Temporal trends in acute s troke management. Stroke, 2013 Jun; 44 (6 Suppl 1): S129–31. 16. Xian Y, Holloway RG, Chan PS, et al. A ssociation bet ween s troke center hospitalization for acute ischemic s troke and mor talit y. JAMA, 2011 Jan 26; 305(4): 373– 80. 17. Schwamm LH, Reeves MJ, Pan W, et al. Race/ethnicit y, qualit y of care, and outcomes in ischemic s troke. Circulation, 2010 Apr 6; 121(13): 1,492–501. 18. Reeves MJ, Fonarow GC, Zhao X, et al. Qualit y of care in women with ischemic s troke in the GW TG program. Stroke, 2009 Apr; 40 (4): 1,127–33. 19. Schwamm LH, Fonarow GC, Reeves MJ, et al. Get With the Guidelines–Stroke is associated with sus tained improvement in care for patient s hospitalized with acute s troke or transient ischemic at tack. Circulation, 2009 Jan 6; 119(1): 107–15. 20. Centers for Disease Control and Prevention (CDC). Use of a regis tr y to improve acute s troke care —seven s tates, 2005 –2009. MMWR Morb Mor tal Wkly Rep, 2011 Feb 25; 60 (7): 206 –10. 21. Sacco RL, Gardener H, Wang K, et al. Racial-ethnic disparities in acute s troke care in the Florida-Puer to Rico Collaboration to Reduce Stroke Disparities Study. J Am Hear t Assoc, 2017 Feb 14; 6(2). 22. A sdaghi N, Romano JG, Wang K, et al. Sex disparities in ischemic s troke care: FL-PR CReSD Study (Florida-Puer to Rico Collaboration to Reduce Stroke Disparities). Stroke, 2016 Oc t; 47(10): 2,618 –26. ABOUT THE AUTHORS Maria A. Ciliber ti-Vargas, MPH, is projec t manager of the FL-PR CReSD study and a first-year student in the primar y care physician assistant program at the Universit y of Southern California's Keck School of Medicine. Reach her at Ciliber t@usc.edu. Ralph L. Sacco, MD, MS, FAHA, FA AN, is principal investigator of the FL-PR CReSD study, a professor and chair of neurology and the Olemberg Family Chair of Neurological Disorders at the Universit y of Miami's Miller School of Medicine. He is current president of the American Academy of Neurology. Reach him at Rsacco@med.miami.edu. Figure 2: IV tPA administration (arrive by 3.5 hours, treat by 4.5 hours) by race-ethnicity, 2010–2016 Off hours: Mon.–Fri., 6 p.m.–7 a.m., Saturdays, Sundays and government holidays Figure legend: Blue—Florida/white; orange—Florida/black; gray—Florida/Hispanic 30 NOVEMBER 2017 | EMSWORLD.com