California's stroke registry: A model of successful partnerships

Background: To improve health outcomes and reduce costs related to acute stroke, a leading cause of death and disability, systemic changes in health care are being promoted, including strategies that support the development of Stroke Systems of Care. These strategies include pre-hospital assessment and preferential transport of eligible patients; criteria for the designation of receiving hospitals; and the appropriate use of electronic data systems to monitor quality measures.

Methods: California is developing an electronic data system for the secure collection and exchange of acute stroke pre-hospital and hospital data. This web-based repository of acute stroke data (the California Stroke Registry [CSR]) is designed to promote quality improvement for stroke care. In working to achieve this goal, a highly collaborative partnership has emerged in California.

Results: In partnership with the American Heart Association / American Stroke Association (AHA/ASA) and Local Emergency Medical Services Agencies (LEMSAs), the California Department of Public Health (CDPH) has built the infrastructure needed to support the secure exchange of health information between point-of-care providers and public health. In Phase I, California hospitals currently using AHA/ASA's Get With The Guidelines-Stroke were invited to join the CSR. In Phase II, additional hospitals were recruited based on location, population served, and clinical capacity. This process was facilitated through the development of an integrated platform for standardizing and storing acute stroke data, generated from hospitals using other various data collection tools. In Phase III, a partnership with selected LEMSAs enabled the linking of pre-hospital and hospital data, thereby minimizing reporting demands on hospitals and providing LEMSAs with the critical information needed to evaluate their Systems of Care. To streamline data submission, data sharing, and report generation, a secure, web-based portal for use by CSR hospitals, the LEMSAs, and CDPH has now been constructed. This data platform will enable the exchange of key clinical information and will provide an opportunity for hospitals to meet a "Meaningful Use" core objective for electronic health records.

Discussion: Systems of Care for stroke depend on strong partnerships and the exchange of health information to improve the quality and efficiency of health care. CDPH, AHA/ASA, and LEMSAs have developed a system that will support data collection, facilitate timely submission of hospital data to meet reporting requirements, reduce disparities in treatment, and, ultimately, improve health outcomes.