Michigan Stroke Program — Partnerships & Collaborations

Beth Anderson, MPH
Chronic Disease Epidemiology Section Manager
e-mail: andersonb@michigan.gov
Anderson provides oversight for data management projects and supervises the program coordinator and registry manager, the stroke data analyst, the EMS stroke quality improvement coordinator, and the stroke informatics epidemiologist. She has more than a decade of experience in public health, including asthma, cardiovascular health, oral health, cancer genomics, and diabetes. In her position as manager of the Chronic Disease Epidemiology Section (CDES) in the MDHHS Lifecourse Epidemiology and Genomics Division (LEGD), she oversees epidemiologic work in chronic disease and genomics epidemiology.

Krystal Quartermus, MS, RD
Co-Principal Investigator
Cardiovascular Health, Nutrition and Physical Activity Section Manager
e-mail: quartermusk@michigan.gov
Quartermus oversees the quality improvement (QI) component of the cooperative agreement and ensures that QI-related grant objectives are met. She is the manager of the Cardiovascular Health, Nutrition and Physical Activity Section in the MDHHS Division of Chronic Disease and Injury Control (DCDIC). She currently is the principal investigator (PI) on multiple CDC grants, including the 1815¹ and 1817² cooperative agreements.

Adrienne Nickles, MPH
Co-Principal Investigator
Program Coordinator & Registry Manager
e-mail: nicklesa@michigan.gov
Nickles is the program coordinator and registry manager for MiSP, and is responsible for surveillance and epidemiologic activities. These include: ongoing and enhanced surveillance reporting; data submissions to the Centers for Disease Control and Prevention (CDC); continuing enrollment of hospitals and management of the hospital data collection system; ensuring the quality of data collected; expanding on the use of Medicaid/Medicare claims to understand transitions of care; planning and providing staff support for the MiSP Steering Committee; and analyzing the stroke systems of care-related data and communication of findings. In addition, she also works on the development of the integrated stroke EHR data system, MiStroke. Nickles is a member of the Michigan EMS Data Advisory Board and provides staff support to the MiSP registry consultant and the EMS clinical consultant. She has a master's degree in epidemiology and has served as the epidemiologist for MiSP since 2012.

Justin Allen, BA, EMT-P
Emergency Medical Services (EMS) QI Coordinator
e-mail: allenj29@michigan.gov
As EMS QI coordinator and program evaluator, Allen collaborates with medical control authorities (MCAs), EMS agencies, and hospitals to develop prehospital reports and identify areas for quality improvement. He also works closely with the MDHHS Division of EMS and Trauma on initiatives to improve the quality of stroke care.

Olivia Barth, MPH
Chronic Disease Informatics Epidemiologist
e-mail: bartho@michigan.gov
Barth coordinates the Chronic Disease Registry Leveraging Electronic Health Record Data, or Chronicle. Chronicle is a real-time statewide disease surveillance system designed to capture electronic health record (EHR) data and explore stroke events and hypertension burden throughout Michigan.

Ghada Ibrahim, MS
Stroke Data Analyst
e-mail: ibrahimg@michigan.gov
As the data analyst and program evaluator, Ibrahim assists the program coordinator and registry manager with routine surveillance and linkage activities in support of MiSP activities, including: ongoing and enhanced surveillance reporting; routine management of the hospital data collection system; assisting in ensuring the quality of data collected; implementing developed EMS-related data algorithms and reporting; running regular reports for participating hospitals; conducting the annual hospital inventory survey; and providing document management for data use agreements and IRB protocols.

Naomi J. Ishioka, RN MSN NHDP-BC CEN
Nurse Consultant MDHHS for Stroke and STEMI Care
e-mail: ishiokaN@michigan.gov
As the nurse consultant, Ishioka provides statewide leadership, expert consultation and technical assistance in the area of clinical systems and quality improvement in stroke care for a state level program as well as to community-based agencies and other groups across the state.
 

¹ CDC Program 1815: Improving the Health of Americans Through Prevention and Management of Diabetes, Heart Disease, and Stroke

² CDC Program 1817: Innovative State and Local Public Health Strategies to Prevent and Manage Diabetes, Heart Disease, and Stroke
 

Stacie Demel, DO, PhD (MiSP Clinical Consultant)
Stroke Program Physician Advisor
Sparrow Hospital

Mathew Reeves, BVSc, PhD (MiSP Registry Consultant)
Professor of Epidemiology and Biostatistics
Michigan State University Department of Epidemiology and Biostatistics

Adam Oostema, MD, FACEP (MiSP EMS Clinical Consultant)
Assistant Professor
Michigan State University College of Human Medicine
Department of Emergency Medicine

Rebecca Banat, MSN/ED, BSN, RN, ONC, CNRN
Genesys Regional Medical Center

Todd Chassee, MD
Medical Director
Kent County EMS

Cynthia Green-Edwards
Director
MDHHS Office of Medicaid Health Information Technology

Chris Lewandowski, MD
Henry Ford Hospital

Kevin Putman, MSA, EMT-P, I/C
Michigan EMS Data Manager
MDHHS/Western Michigan University Medical School

MDHHS Heart Disease and Stroke Prevention Unit (HDSP): HDSP and MiSP work together to promote stroke and hypertension awareness, stroke risk factor management, identify areas with disparities in risk factor burden, and align strategies with 1815 and 1817 funded activities. Together, they are working to develop an integrated EHR-based stroke and hypertension data collection system that will be integrated into CHRONICLE, the MDHHS chronic disease EHR database, to better align program activities and leverage resources. During monthly meetings, strategies are developed to identify opportunities to reduce disparities in risk factors and expand the integrated data systems.

Michigan WISEWOMAN Program: The WISEWOMAN (Well-Integrated Screening and Evaluation for WOMen Across the Nation) program serves low-income, uninsured, and underinsured women ages 40 to 64 years with heart disease and stroke risk factor screenings and services that promote healthy behaviors to reduce the risk for heart disease and stroke.

MDHHS Million Hearts: Million Hearts® 2022 is a national initiative to prevent 1 million heart attacks and strokes within 5 years. It focuses on implementing a small set of evidence-based priorities and targets that can improve cardiovascular health for all.

CDC Paul Coverdell National Acute Stroke Registry (PCNASR): MiSP collaborates with CDC PCNASR on all aspects of program maintenance and expansion, including: utilizing technical assistance on the development and necessary data elements and metrics measured in the integrated data system; sharing of lessons learned; evaluation development; and workgroup participation. MiSP shares data from the integrated data system and provides reports, including evaluation reports, to CDC.

Michigan Stroke Systems of Care Expert Writing Group (MSSOC): MiSP will support MSSOC by providing data and quality improvement expertise and will advocate for stroke policies through the implementation of rules and legislation for stroke systems of care. MiSP will support data collection needs established by the SSOC Expert Writing Group Data Committee through the use and expansion of the MiStroke Registry. MISP incorporate feedback received from MSSOC to ensure optimal statewide reporting, including updating data elements and EMS and hospital metrics as needed.

MDHHS Office of Equity and Minority Health (OEMH): OEMH will serve on the MiSP Steering Committee and work with MiSP to identify opportunities to provide education to partners related to implicit bias and to implement activities related to decreasing disparities in risk, care, and outcomes in areas that experience a high burden of stroke, as well as in the Medicaid population.

American Heart Association (AHA): MiSP will build on the long-established partnership with AHA to improve Get-With-The-Guidelines-Stroke (GWTG-S) data quality, care performance, and program reach. MiSP will meet with AHA bi-weekly during the entirety of the grant. AHA has agreed to assist MiSP in triaging clinical questions from our EMS and hospital partners to AHA content area experts. AHA will continue to provide updates and guidance to MISP concerning national and statewide stroke initiatives, will act as the program's GWTG-S liaison, and will serve on the MiSP Steering Committee.

MDHHS EMS Section: MiSP will meet regularly with EMS Section staff to review stroke data and identify opportunities to improve stroke care. Staff from the MDHHS EMS Section will provide feedback regarding EMS quality of care initiatives, as well as access to MiEMSIS data. They also will continue to serve as a conduit to partnership expansion to EMS regions in Michigan identified in the MiSP recruitment plan. MiSP will continue to identify data quality issues and report them to MDHHS EMS. It also will provide updates concerning the MiStroke system and promote the expansion of the MiStroke system to STEMI, Trauma, and other relevant systems of care.

MDHHS Trauma Section: The Trauma Section will continue to share knowledge gained from developing a coordinated trauma system to apply to the expansion of MiSP and SSOC legislation.

Michigan Health and Hospital Association (MHA): MHA will share evidence-based best practices for stroke treatment with members and will advocate for SSOC legislation.

MiSP Hospitals: Hospitals will provide data, share best practices with participating hospitals and EMS, work to improve quality of care based upon data reports and guidance, participate in MiSP evaluation activities, and attend trainings concerning data abstraction, clinical best practices, stroke prevention, stroke risk management, and disparities in stroke risk, incidence, care, and outcomes.

Greater Lansing Stroke Collaborative (GLSC): MiSP will continue to support GLSC to enhance collaboration between tri-county area hospitals and EMS agencies. GLSC aims to improve transition of care, patient outcomes, and information sharing between pre-hospital & hospital settings. MiSP will leverage lessons learned from this partnership and promote them in newly formed stroke coalitions in communities that experience disparities in stroke risk factors, incidence, care, and outcomes.

Michigan Medical Control Authorities (MCAs): MCAs will provide guidance and expertise in addressing gaps and barriers to shared information between hospitals and EMS and in understanding of quality and representativeness of data from MiEMSIS. They will serve as liaisons to EMS agencies in their jurisdictions to implement care and data quality improvement activities promoted by MiSP.

Michigan Medical Services Administration (MSA): MSA will provide guidance on accessing Medicaid data and linking it to MiStroke. This work will identify opportunities in the Medicaid population to reduce stroke risk and readmissions after a stroke. Through MiStroke, we plan to track readmissions in Medicaid and leverage health information exchange (HIE) to further develop the integrated stroke data system.

MDHHS Community Integrated Paramedicine (CIP) Program: CIP will work together with MiSP to create opportunities to educate community paramedics about stroke risk factors, disparities, and signs and symptoms. CIP will provide educational opportunities to EMS and hospital partners about the value of community paramedics, their scope of practice, and how they can be integrated into the system of stroke care. MiSP will work with CIP to identify opportunities to integrate the CIP data collection system with MiStroke.

Michigan Association of Ambulance Services (MAAS): MiSP will collaborate with MAAS to create and disseminate stroke education and training for EMS providers throughout the state. MAAS will also assist in the recruitment of EMS partners and be a strong advocate for MiSP at the state level.

Michigan Community Health Worker Alliance (MiCHWA): MiCHWA will work with MiSP to create opportunities to educate community health workers about stroke risk factors, disparities, and signs and symptoms. MiCHWA will provide educational opportunities to EMS and hospital partners about the value of community paramedics, their scope of practice, and how they can be integrated into the system of stroke care. MiSP will identify opportunities to provide stroke data to community health workers.

Michigan Center for Rural Health (MCRH): MCRH will assist in recruiting hospitals in rural locations. MiSP will work with MCRH to identify opportunities to improve services among the rural population that could reduce stroke risk and incidence.

MDHHS Aging and Adult Services Agency: MiSP will work with the Aging and Adult Services Agency to link community resources and address disparities among those in the aging population who are at the highest risk for stroke and poor health outcomes.

MDHHS Compliance Office and the Policy and Planning Administration: In coordination with the MDHHS Compliance Office and the MDHHS Policy and Planning Administration, MiSP will work to align its health information technology (HIT) activities with the department's greater data strategy and other EHR data projects being conducted throughout the state. With the assistance of the MDHHS Compliance Office, MiSP also will explore the establishment of data linkages between MiStroke and the MDHHS Medicaid Warehouse and statewide master person index.

• Online directory of hospitals and health care systems that partner with MiSP
   
• Map of hospitals and health care systems that partner with MiSP, by county and region
    
• Explanations of the different types of stroke centers
   

What benefits do hospitals and health care systems that join MiSP receive?

• MiSP provides individual hospital calls, as well as offers to provide onsite visits, assistance with data interpretation, and/or support creating customized data reports and presentation of results.
   
• MiSP sponsors interactive monthly conference calls that present valuable topics and discussions that can impact best practice/challenges/successes. MiSP evaluates ongoing participant feedback from those calls and modifies future calls in response to that feedback.
            
• MiSP offers participating hospitals and health care systems assistance in using the registry website and preparing MiSP reports.

 

• The primary goal of the MiSP program is to improve the quality of care and outcomes for patients hospitalized with stroke and TIA in Michigan. MiSP provides support to participating hospitals to continue to monitor and improve the delivery of high-quality care for acute stroke patients. To do that, the program runs personalized quarterly, bi-annual, and annual performance reports that measure each participating hospital's compliance with consensus performance measures, relative to all participating hospitals. These reports include:
• Annual Benchmark Report: allows hospital to see its performance compared to other hospitals partnering with MiSP.
• Annual Hospital Data Scorecard: It summarizes the quarterly and annual compliance with the achievement, quality, target stroke, reporting, defect-free, and CSC&TSC performance measures highlighting those with the greatest opportunity for improvement.
• Quarterly Comprehensive Stroke Centers (CSC) and Thrombectomy Stroke Centers (TSC) Performance Measures Report: it displays the performance of the CSC measures CSTK-1-CSTK-12 at all MiSP CSC/TSC participating hospitals.
• Quarterly Performance Measures Report: it displays compliance with the achievement, quality, target stroke, and defect free performance measures for all participating hospitals (CSC, PSC, and TSC).
• Bi-Annual Michigan Stroke Program Hypertension Data Report: it displays the overall number and percent of stroke patients who arrived at all MiSP participating hospitals with a history of hypertension, with a history of hypertension who arrived at the hospital on an antihypertensive medication, and with a history of hypertension who were prescribed an antihypertensive treatment at discharge. The data are also shown by patient demographics, stroke type, payment source, and discharge disposition. The report provides the fallout cases as well for further investigation.
• Re-abstraction Data Quality Report: Ensuring the quality of the stroke registry’s data is essential to its credibility and value. The MiSP program monitors data reliability twice a year through re-abstraction of patient records entered by participating hospitals. An excel report is provided as well detailing the site’s mismatches.
• MiSP conducts an annual inventory survey to help program staff and participants better understand issues associated with acute stroke care. The responses to that survey are used to identify what type of quality improvement (QI) interventions work in what settings, where gaps exist, and how to better help hospitals with fewer resources.

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If your hospital or health care system would like to become a partner with MiSP, please contact nicklesa@michigan.gov.
 

• Online directory of Emergency Medical Service (EMS) agencies that partner with MiSP
   
• List of Medical Control Authorities (MCAs) that currently partner with the MiSP (includes participating EMS agencies within each MCA)
   

What benefits do EMS agencies and MCAs that join MiSP receive?

• MiSP is working to assess and reduce barriers to communication among emergency medical services (EMS) agencies and their receiving hospitals. Members of the MiSP team collect feedback from agencies and use it to determine ways they can assist EMS agencies, MCAs and hospitals in working together to improve patient hand-offs and the transfer of crucial outcome information.
   
• Quality prehospital stroke care is proven to be vital in improving patient outcomes and reducing stroke morbidity and mortality. Participating MCAs and EMS agencies receive assistance with quality improvement activities through workshops, meetings, and teleconferences along with other tools including:

• EMS annual survey: it intends for all EMS providers and all responses remain anonymous and confidential. The feedback is used by the Michigan Stroke Program to identify gaps and strengths in stroke quality of care practices and help determine future activities and interventions.

• Quarterly EMS Agency Stroke Performance Scorecard: it serves as a tool for EMS agencies and Medical Control Authorities to monitor, evaluate and improve stroke care within their jurisdictions and identify quality improvement opportunities.

• Quarterly Medical Control Authority Performance Measure Benchmark Report: It allows MCA to see its performance compared to other MCAs partnering with MiSP.

• MiSP has linked data from the Michigan EMS Information System (MI-EMSIS) database to the state stroke registry data file and used the combined data to produce quarterly EMS Linkage Reports. The purpose of the reports is to provide feedback to an MCA, benchmarked against statewide data and all participating MCAs and the hospitals they service in order to support the monitoring, evaluation, and improvement of care for stroke patients from time of EMS activation to in-hospital hand-off and treatment. 

 
If your MCA or EMS agency would like to partner with MiSP, please contact both nicklesa@michigan.gov and allenj29@michigan.gov.