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Frequently Asked Questions

  • For more than 25 years heart disease, stroke, and unintentional injury have been the top five leading causes of death in the state.1  As stated in the Whitepaper A Statewide System of Care for Time Sensitive Emergencies The Integration of Stroke and STEMI Care into the Regional Trauma System “Stroke, STEMI and trauma patients require timely EMS triage, informed diagnosis, and definitive treatment by a multidisciplinary team of healthcare providers, supported by appropriate resources, in order to reduce the risk of death or serious disability.”1 The paper also notes that “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

    Experts in the field have long recognized that a systems approach can have a positive impact on patient outcomes. For instance, research demonstrated that standardized approach to systems of care has led to a 15% relative reduction in 30-day in-hospital mortality in acute stroke.Patients who receive care at a Level I or Level II trauma facility (verified resources to care for seriously injured) had a 25% reduction in mortality.3

    Michigan is developing a regional system of care for time-sensitive emergencies which includes stroke, ST-elevation myocardial infarction (STEMI), and traumatic injuries. This establishes an organized, coordinated effort within a geographic area to deliver a comprehensive range of patient care integrated into the existing trauma system.  These systems of care will capitalize on the experience and gains made by developing the trauma system, enhance efficiencies and further collaboration with a variety of disparate healthcare components into a formal structure that is established, supported, and supervised within statute, administrative rules, and policy.

     

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    Administrative Rules outline how systems are operationalized. The Rules for stroke and STEMI systems were drafted with the understanding that stroke and STEMI would be integrated into the existing trauma system. While stroke and STEMI have some language specific to their service lines both were intentionally written to mirror concepts like trauma (data collection, accreditation/certification, organizational structure, and advisory committees). Stakeholders, partners, and advisory bodies advise on policies, procedures, and inform timeline development.

    Systems require time, thoughtful input from stakeholders and a formal plan that builds on initial steps to implement the system effectively. The trauma system took almost twelve years to be fully operational. It’s not expected to take as long to operationalize stroke and STEMI as the trauma system has already put the necessary processes, policies, procedures, and organizational structures in place.

    Stroke Administrative Rules
    STEMI Administrative Rules

     

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    The following is not listed in order of priority, but a general outline of the steps needed to operationalize the system. Of note, some steps require inputs not necessarily in the full control of the Section i.e., when a registry vendor contract will be finalized.

    • The department is drafting a timeline of when the system components should be developed and/or in place.
      • The Request for Proposal project that will identify a vendor/software that will collect data for stroke and STEMI is ongoing. Finalizing this will assist in developing more formal timelines. 
    • A facility survey/assessment related to readiness/needs for system participation in development to establish baseline and priority needs.
      • The assessment was developed and disseminated to stakeholders in the first quarter of 2024 and has provided insights about where programs are as well as created a more complete contact list.
      • The survey is still open for responses. Systems of Care Assessment Survey
      • Updated program contact information should be sent to Katelyn Schaible at schaiblek2@michigan.gov
    • Timeline and procedure for convening required advisory bodies is under consideration.
      • The Administrative Rules outline the role of advisory bodies for systems of care at both the regional and state level. The Statewide Stroke Advisory Subcommittee and the Statewide STEMI Advisory Subcommittee will act as the departments subject matter experts for the clinical and operational components of stroke and STEMI care.
      • The application process for participation on the Stroke and STEMI advisory bodies will open on May 6th and will close on August 30th at 5:00 pm.  A formal letter and link to the application will be sent out via email and posted on the SOC website.
    • Communication tools and updates are being planned.
      • A one-page description of System of Care in Michigan designed to inform program administrators is planned for distribution in early 2024. This draft is currently in development. 
    • Office Hours.
      • The section is developing a schedule for Office Hours held by the section and covering topics related to program development and system building. The first session will be held on Thursday June 27th from 1-2 pm. You can join the meeting by clicking this link. We will provide a brief presentation about advisory bodies and answer any questions you may have during this session.

     

    • Attend SOC Office Hours to learn more about the progress in system development. See the schedule for updated programming. 
    • Contact List: Please make sure the Division of EMS and Systems of Care SOC Section has current information that includes: physicians, specialists, program managers/coordinators, data managers etc. who are working in stroke/STEMI or both. This will assist when reaching out to stakeholders when necessary. Reach out to Katelyn Schaible, Department Manager, Stroke and STEMI SOC SchaibleK2@michigan.gov to confirm your contact information is on file.
    • Survey: Complete the survey/assessment mentioned in next steps when it is received. Systems of Care Assessment Survey
    • Check in at the SOC website Frequently Asked Questions Section to get updates on the discussion and implementation plan https://www.michigan.gov/mdhhs/doing-business/trauma/stroke-stemi
    • Please note there is no required work, meeting or activity that needs to take place immediately. The Department is planning a variety of communication modalities to ensure that all our partners and stakeholders are up to date on the implementation plans.
  • Katelyn Schaible – Departmental Manager, Stroke and STEMI Systems of Care
    SchaibleK2@michigan.gov
    (517) 282-2172

    Eileen Worden-Systems of Care Section Manager (Trauma, Stroke, and STEMI)
    WordenE@michigan.gov
    (517) 643-2296 
  • No, the Systems of Care initiative for stroke and STEMI, like the trauma system, is voluntary and all-inclusive regardless of hospital size or geographical location. Facilities should consider and plan to participate in the system at a level that meets their current resources. Of course, all systems are most effective if a majority of stakeholders participate. 

  • Yes, 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.

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  • Verification is a process whereby a nationally recognized organization reviews and ascertains that a facility has met the required resources and published standards. The verification is usually conferred for a set amount of time. Stroke and STEMI use different names to describe a similar process where a nationally recognized professional organization accredits a facility as having met a certain level of standards and are considered certified or accredited.

    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 by a nationally recognized review organization and are therefore verified/accredited/certified. They must also meet specifically defined Michigan criteria (not yet finalized) related to regional performance improvement, regional risk reduction activities, and data collection, then they are designated by the state. The designation process for stroke and STEMI requires several key elements including developing policy and procedure as well as data collection (registry). It is not expected that the designation process will be drafted, pilot tested, and formalized until later in the development phase.
  • Michigan stroke care facilities that have obtained certification by a nationally recognized professional review organization (CMS) and have met state requirements (these details here have not been finalized) 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
  • Michigan STEMI care facilities that have obtained accreditation by a nationally recognized professional certifying and accrediting organization and have met state requirements (these details have not been finalized) will apply to the state to be designated at that accredited level. The processes, forms, policies, and procedures for STEMI certification/accreditation will not be finalized until later in the development plan and is registry dependent. The advisory bodies will advise and assist in outlining this process more completely.

    Please note the following Administrative Rule language. The terms used are specific and slightly different from the Rule language in the Stroke rules, (equivalent) to department approved nationally recognized professional certifying and accrediting organizations that have equivalent certification standards to the organizations noted below and will be presented to the STEMI advisory subcommittee for consideration:

    A STEMI receiving center shall provide evidence of current certification or accreditation by a department-approved nationally recognized professional certifying and accrediting organization that the healthcare facility has the resources required to be certified as meeting all the criteria for a certified STEMI receiving center equivalent to a TJC-AHA comprehensive STEMI center or TJC-AHA primary heart attack center or an ACC chest pain center with PCI or a Corazon PCI/Catheterization program, or subsequent equivalent certification or accreditation as approved by the department with the advice of the STEMI advisory subcommittee.


    A STEMI referral facility shall provide evidence of current certification or accreditation by a department-approved nationally recognized professional certifying and accrediting organization that the healthcare facility has the resources required to be certified as meeting all the criteria for a certified STEMI referral facility equivalent to a TJC-AHA acute heart attack ready center or an ACC non-PCI chest pain center or a Corazon chest pain center or subsequent equivalent certification or accreditation as approved by the department with the advice of the STEMI advisory subcommittee.
     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

    Corazon Cardiovascular Program Accreditation

    Chest Pain Center
    Cath/PCI

  • Yes, as noted in the document, 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 The goal is to have an integrated data collection system that allows for seamless integration. More information will be available as planning and implementation moves forward.
  • Michigan Trauma System - MDHHS - Michigan Statewide Trauma System
    Michigan Systems of Care - MDHHS - Michigan Systems of Care Stroke and STEMI
    Systems of Care Recommendations - SYSTEMS OF CARE FOR TIME SENSITIVE EMERGENCIES (michigan.gov)
    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

    American Heart Association/TJC: Heart Attack Center (AHA/TJC) - Heart Attack Center Certifications | American Heart Association

    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) - DNV Healthcare

     

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.

 

Trauma Frequently Asked Questions