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Frequently Asked Questions
What is a System of Care?
“An effective system of care includes specialized, independently verified, state designated treatment centers that support an integrated approach to increasing public awareness of initial symptom recognition, reduce the impact of trauma, stroke and STEMI occurrence through evidence based standard treatment regimens and ongoing quality improvement.”1
Is it mandatory for all hospitals in Michigan to participate in the Systems of Care initiative?
No, the Systems of Care initiative for stroke and STEMI (ST-elevation myocardial infarction) is voluntary and all-inclusive regardless of hospital size or geographical location just as the trauma system is.
Facilities should consider and plan to participate in the system at a level that meets their current resources.
What are some of the benefits of an integrated System of Care?
A regional system of care for time-sensitive emergencies ensures an organized, coordinated effort within a geographic area to deliver a comprehensive range of patient care integrated within the local medical and public health systems.
These systems of care incorporate a variety of disparate healthcare components into a formal structure that is established, supported, and supervised within statute, administrative rules, and policy.
A systems approach can have a positive impact on patient outcomes. Research demonstrated that a standardized approach to systems of care has led to a 15 % relative reduction in 30-day in-hospital mortality in acute stroke.2
Patients who received care at a Level I or II trauma facility had a 25 % reduction in mortality.3
“The value of a time-sensitive emergency system of care is derived from the coordinated transition between each phase of an incident including prevention measures, education, early symptom recognition, early access to EMS, standardized pre-hospital response and transport, care in a designated hospital and rehabilitation to achieve improved patient outcomes.”1
How long have experts across the country been discussing and writing about Systems of Care for stroke and STEMI?
The recognition that time is muscle (STEMI), and brain tissue (stroke) has been acknowledged by experts in the field for more than 18 years. In 2005, the American Stroke Association published recommendations for the establishment of stroke systems of care (link). Additionally, the American Heart Association recommended the establishment of a STEMI System of Care since 2006. Many states
across the country have made efforts to formalize a systems approach to these time sensitive emergencies in regulation. Trauma has had a systems approach to traumatic injuries beginning in 1966 with the advent of the formation of the EMS system followed in 1976 with the publication of the guidelines/criteria for trauma facilities.
How long has the State of Michigan been pursuing a Systems of Care for Time Sensitive Emergencies initiative?
This current initiative continues and builds upon discussions that began when the Michigan Department of Community Health (now MDHHS) convened a group of stroke and cardiovascular stakeholders in 2011 to consider an integrated systems approach to the time sensitive emergencies of trauma, stroke, and STEMI.
What is the goal of the Systems of Care initiative?
The goal of the Michigan Systems of Care initiative is to incorporate and integrate the time-dependent emergencies of stroke and STEMI into the existing operationalized regional trauma system in Michigan.
Do other states have a System of Care?
Many states, cities, and regions throughout the United States and around the world are developing multi-tiered systems of care for patients suffering from time-sensitive emergencies such as trauma, stroke, and ST elevation myocardial infarction (STEMI) events. https://www.cdc.gov/dhdsp/pubs/docs/Pre-Hospital_Post-Hospital_Stroke_PEAR-508.pdf
When is the systems of care initiative expected to roll out?
The process of the implementation for systems of care is ongoing. It takes time and planning to ensure that all the components are ready to be operationalized in a systematic, organized way. While there has been significant progress, there are still steps that must be completed to move forward. In 2022, in a collaborative effort from partners across the state, administrative rules for both service lines (stroke and STEMI) were completed and a Request for Rule making submitted. Review, approval, and adoption of administrative rules is overseen by the Michigan Office of Administrative Hearings and Rules (MOAHR), a bureau under Licensing and Regulatory Affairs (LARA). It includes revisions for formatting and style requirements, submission of a regulatory impact statement, public comment, and a report from the Joint Commission for Administrative Rules (JCAR). That process can take up to 18 months. In the meantime, planning and preparation continues. As more information becomes available, updates will be provided here.
Will there be opportunities for stakeholder participation in the future?
Yes. As staging work is being planned that moves the system to launch when the rules are adopted, there will be a need for ad hoc work groups and committees to provide input. The Division of EMS and Systems of Care SOC Section is currently working to compile a database of those (physicians, program managers/coordinators, data managers, to name a few) working in stroke/STEMI or both programs. This will assist when reaching out to stakeholders when necessary. If interested in participating, please reach out to Katelyn Schaible, Department Manager, Stroke and STEMI SOC SchaibleK2@michigan.gov.
Alternately, if you are contacted and no longer working with these programs we would appreciate if you let us know.
What are the regions for the Stroke and STEMI Systems of Care?
Michigan Systems of Care integrate the time-sensitive emergencies of stroke and STEMI into the existing regional trauma system. The rule language describes a system that when operationalized fully would expand the Regional Trauma Network into a Regional System of Care Network, with three branches: trauma, stroke, and STEMI.
What level of stroke designation can my facility apply for?
Michigan stroke care facilities that have obtained certification by a nationally recognized (by CMS) professional review organization and have met state requirements will apply to the state to be designated at that certified level. The four levels are Comprehensive Stroke Center (Level I), Thrombectomy-Capable Stroke Center (Level II), Primary Stroke Center (Level III), and Acute Stroke Ready (Level IV).
For more information regarding certifying bodies and the levels of care, follow the links provided below.
The Joint Commission (Advanced Stroke) Stroke Certification | The Joint Commission
Level I- Comprehensive Stroke Center
Level II- Thrombectomy-Capable Stroke Center
Level III- Primary Stroke Center
Level IV- Acute Stroke Ready Hospital
DNE-GL (Det Norske Veritas) DNV Healthcare | Customer Portal | DNV Healthcare | Customer Portal (dnvhealthcareportal.com)
Comprehensive Stroke Center Certification (CSCC)
Primary Stroke Center Certification Pluss (PSCC+)
Primary Stroke Center Certification (PSCC)
Acute Stroke Ready Certification (ASRC)
Accreditation Commission for Health Care (formally HFAP) ACHC (hfap.org)
Comprehensive Stroke Center
Thrombectomy Ready Stroke Center
Primary Stroke Center
Stroke Ready Center
What level of STEMI designation can my facility apply for?
Michigan STEMI care facilities that have obtained accreditation by a nationally recognized professional review organization and have met state requirements will apply to the state to be designated at that accredited level.
For more information regarding accrediting bodies and the levels of care, follow the links provided below.
The Joint Commission (Advanced Cardiac) Cardiac Certification | The Joint Commission
Comprehensive Cardiac Center
Comprehensive Heart Attack Center
Primary Heart Attack Center
Acute Heart Attack Ready Center
American College of Cardiology (ACC) Chest Pain Center Accreditation
Chest Pain Center Certification
Chest Pain Center with Primary PCI
Chest Pain Center
Primary PCI and Resuscitation
What is the difference between Verification and Designation?
Verification is a process whereby a nationally recognized organization reviews and ascertains that a facility has met the required resources and met published standards. The verification is usually conferred for a set amount of time.
Designation can only be conferred by a state entity. A designation by the Michigan Department of Health and Human Services (MDHHS) is conferred when a facility is recognized as having specific resources and met published standards as verified by a nationally recognized review organization.
Will there be a data registry the Stroke and STEMI Systems of Care?
Data is an important component of systems of care. It allows participants to understand how the system is functioning and ensures that patients receive the highest quality of care throughout the continuum.1 Integration of Stroke and STEMI systems of care into the existing Trauma system will include a statewide registry to collect data in order evaluate system performance and support regional performance improvement and patient care/outcomes. Discussion is ongoing. More information will be available as planning and implementation moves forward.
Where can I find more resources about Systems of Care?
Michigan Trauma System- MDHHS - Michigan Statewide Trauma System
Michigan Systems of Care- MDHHS - Michigan Systems of Care Stroke and STEMI
Systems of Care White paper- A Statewide System (michigan.gov)
American Heart Association-Systems of Care for STEMI: AHA Policy Statement - American College of Cardiology (acc.org)
American Heart Association-Recommendations for the Establishment of Stroke Systems of Care: A 2019 Update | Stroke (ahajournals.org)
STEMI Certification/Accreditation Links:
American College of Cardiology (ACC) links: Chest Pain Center- Chest Pain Center Accreditation
Stroke Certification Links:
The Joint Commission (TJC)- Stroke Certification | The Joint Commission
Accreditation Commission for Health Care (ACHC/HFAP)- Stroke Certification – ACHC (hfap.org)
Det Norske Veritas (DNV)- https://www.dnvglhealthcare.com/hospitals?search_type=and&q=&c=&c=19221&c=&c=19190&prSub mit=Search
Who do I contact for more information?
Katelyn Schaible – Department Manager, Stroke and STEMI Systems of Care SchaibleK2@michigan.gov
Aaron Brown-Systems of Care Coordinator BrownA68@michigan.gov
Jennifer Monaghan -Stroke and STEMI Designation Coordinator MonaghanJ@michigan.gov
Eileen Worden-State Systems of Care Manager WordenE@michigan.gov
- 1 Michigan Department of Health and Human Services, A Statewide System of Care for Time Sensitive Emergencies The integration of Stroke and STEMI Care into the Regional Trauma System, 2020
- 2 Ganesh A, Lindsay P, Fang J, Kapral MK, Cote R, Joiner I, Hakim AM, Hill MD. Integrated systems of stroke care and reduction in 30-day mortality: a retrospective analysis. Neurology. 2016; 86:898–904. doi: 10.1212/WNL.0000000000002443CrossrefMedlineGoogle Scholar
- 3 MacKenzie EJ, Rivara FP, Jurkovich GJ, et al. A national evaluation of the effect of trauma-center care on mortality. N Engl J Med 2006; 354:366-378.