Michigan and MOSAIC Data Review...Michigan and MOSAIC Data Review 2017 ANNUAL WORKSHOP 4/26/2017....

35
Michigan and MOSAIC Data Review 2017 ANNUAL WORKSHOP 4/26/2017 Adrienne Nickles, MPH Michigan’s Ongoing Stroke Registry to Accelerate the Improvement of Care

Transcript of Michigan and MOSAIC Data Review...Michigan and MOSAIC Data Review 2017 ANNUAL WORKSHOP 4/26/2017....

Page 1: Michigan and MOSAIC Data Review...Michigan and MOSAIC Data Review 2017 ANNUAL WORKSHOP 4/26/2017. Adrienne Nickles, MPH. Michigan’s Ongoing Stroke Registry to Accelerate the Improvement

Michigan and MOSAIC Data Review

2 0 1 7 A N N U A L W O R K S H O P

4262017Adrienne Nickles MPH

Michiganrsquos Ongoing Stroke Registry to Accelerate the Improvement of Care

Overview

Stroke in Michigan trends in hospitalization mortality and risk factors

Data Use How are participating hospitals using their data

Hospital Arrival Mode and Door-to-needle time measurements (DIT ITN DTN)

Future Directions of Post-hospital Follow-up Project

Age-adjusted Stroke Hospitalization Rates Michigan 2000-2015

303 299 294284

273 267 267 262 255 251237 235 227 227 224 233

0

5

10

15

20

25

30

35

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

Rat

e pe

r 10

000

Year

ICD-10

Denominator used from 2000-20014 ICD-9ICD-10 used to calculate hospitalization rates starting in 2015

Overall_Rates

Stroke
Year
Rate per 10000
303
299
294
284
273
267
267
262
255
251
237
235
227
227
224
233

total

Sheet3

Age-adjusted Stroke Mortality Rates Michigan 2000-2014

606584 583

539519

488

44943 423

396 394 387372 363

377

609584 572

546512

48448 435

421396 391 379 369 369 365

0

10

20

30

40

50

60

70

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014

Rat

e pe

r 100

000

Year

MI US

Overall_Rates

MI
US
Year
Rate per 100000
606
609
584
584
583
572
539
546
519
512
488
48
449
448
43
435
423
421
396
396
394
391
387
379
372
369
363
369
377
365

CVD_Age

0-34
35-64
65-84
85+
Year
Age-Adjusted Rate per 100000
43
140
16141
86689
508
1348
15291
82889
45
1338
14891
79536
54
1324
14033
75185
41
1242
13209
69088
48
1283
1291
66011
48
1207
12246
6786
5
1206
1182
66153
43
1175
11619
66406

HD_Age

0-34
35-64
65-84
85+
Year
Age-Adjusted Rate per 100000
345
1158
1247
64879
416
112
11794
61938
35
1103
11529
58746
45
110
10827
56172
313
1048
10086
51609
38
1078
9937
49828
384
1019
9413
51918
42
1008
9174
50961
36
982
904
51209

CHD_Age

0-34
35-64
65-84
85+
Year
Age-Adjusted Rate per 100000
0613
874
7701
4670
0898
818
9012
44369
0889
799
8759
41061
0793
785
8018
38358
0865
757
7421
34644
097
773
7245
32617
088
727
6856
33503
117
709
6585
32727
102
657
6403
32504

Stroke_Age

0-34
35-64
65-84
85+
Year
Age-Adjusted Rate per 100000
068
174
2589
15841
0638
157
2522
1504
072
169
2397
1528
0737
157
2249
13741
0652
138
220
12629
0553
145
2063
11398
0734
127
196
11256
064
1368
1832
10718
047
134
1804
10646

HF_Age

35-64
65-84
85+
Year
Age-Adjusted Rate per 100000
3047
936
8287
2596
88
8285
2648
878
8057
3176
902
7722
2709
863
7586
2955
878
7388
2979
884
8354
274
828
7483
333
85
8102

total

CVD_RG

White Male
Black Male
White Female
Black Female
Year
Age-Adjusted Rate per 100000
4276
5424
3033
4161
4066
5524
2813
4091
3928
5468
2767
4114
3734
518
2638
3887
3448
5079
2432
3643
3366
4983
2375
3545
3276
4994
2313
3477
3236
4845
2223
327
3158
4694
2238
3327

Stroke_RG

White Male
Black Male
White Female
Black Female
Year
Age-Adjusted Rate per 100000
61
768
561
703
575
752
539
681
573
806
528
66
516
662
498
629
463
743
476
562
449
663
429
585
434
63
411
556
415
631
392
494
402
606
392
509

HD_RG

White Male
Black Male
White Female
Black Female
Year
Age-Adjusted Rate per 100000
3393
4298
227
3206
3232
4445
2124
3166
3118
4317
2197
3157
2986
4184
1957
3001
2777
3983
1783
2838
2704
4009
1776
2679
2644
3981
1739
2642
2619
3972
1679
2532
2566
3819
1687
2606

CHD_RG

White Male
Black Male
White Female
Black Female
Year
Age-Adjusted Rate per 100000
2625
329
1608
243
2478
3356
1508
2314
2404
3154
1419
2313
2221
3093
1328
209
2067
2956
119
1983
1989
2885
117
1853
1922
2903
1139
1825
1921
2771
1074
1645
1824
2592
1071
1722

HF_RG

White Male
Black Male
White Female
Black Female
Year
Age-Adjusted Rate per 100000
255
206
245
17
267
225
225
167
242
238
227
203
256
217
222
189
243
167
214
206
24
218
217
172
255
246
229
202
23
225
208
196
25
216
226
185

race_gender

Sheet3

Age-adjusted stroke mortality rates by race and gender Michigan 2000 to 2014

0

10

20

30

40

50

60

70

80

90

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014

Age

-Adj

uste

d R

ate

per 1

000

00

Year

White Male

Black Male

White Female

Black Female

Overall_Rates

CVD
CHD
HD
HF
Stroke
Year
Rate per 10000
3694
2118
2851
245
603
3524
2006
2719
237
577
3421
192
2631
233
571
3258
179
2517
233
527
3034
1656
2337
224
496
2972
1611
2308
224
464
2898
1564
226
24
444
2825
1516
2216
219
425
2791
1472
2192
233
419

CVD_Age

0-34
35-64
65-84
85+
Year
Age-Adjusted Rate per 100000
43
140
16141
86689
508
1348
15291
82889
45
1338
14891
79536
54
1324
14033
75185
41
1242
13209
69088
48
1283
1291
66011
48
1207
12246
6786
5
1206
1182
66153
43
1175
11619
66406

HD_Age

0-34
35-64
65-84
85+
Year
Age-Adjusted Rate per 100000
345
1158
1247
64879
416
112
11794
61938
35
1103
11529
58746
45
110
10827
56172
313
1048
10086
51609
38
1078
9937
49828
384
1019
9413
51918
42
1008
9174
50961
36
982
904
51209

CHD_Age

0-34
35-64
65-84
85+
Year
Age-Adjusted Rate per 100000
0613
874
7701
4670
0898
818
9012
44369
0889
799
8759
41061
0793
785
8018
38358
0865
757
7421
34644
097
773
7245
32617
088
727
6856
33503
117
709
6585
32727
102
657
6403
32504

Stroke_Age

0-34
35-64
65-84
85+
Year
Age-Adjusted Rate per 100000
068
174
2589
15841
0638
157
2522
1504
072
169
2397
1528
0737
157
2249
13741
0652
138
220
12629
0553
145
2063
11398
0734
127
196
11256
064
1368
1832
10718
047
134
1804
10646

HF_Age

35-64
65-84
85+
Year
Age-Adjusted Rate per 100000
3047
936
8287
2596
88
8285
2648
878
8057
3176
902
7722
2709
863
7586
2955
878
7388
2979
884
8354
274
828
7483
333
85
8102

total

CVD_RG

White Male
Black Male
White Female
Black Female
Year
Age-Adjusted Rate per 100000
4276
5424
3033
4161
4066
5524
2813
4091
3928
5468
2767
4114
3734
518
2638
3887
3448
5079
2432
3643
3366
4983
2375
3545
3276
4994
2313
3477
3236
4845
2223
327
3158
4694
2238
3327

Stroke_RG

White Male
Black Male
White Female
Black Female
Year
Age-Adjusted Rate per 100000
61
768
561
703
575
752
539
681
573
806
528
66
516
662
498
629
463
743
476
562
449
663
429
585
434
63
411
556
415
631
392
494
402
606
392
509
375
616
372
464
372
565
366
513
373
548
366
44
348
587
349
477
347
506
34
462
369
506
352
482

HD_RG

White Male
Black Male
White Female
Black Female
Year
Age-Adjusted Rate per 100000
3393
4298
227
3206
3232
4445
2124
3166
3118
4317
2197
3157
2986
4184
1957
3001
2777
3983
1783
2838
2704
4009
1776
2679
2644
3981
1739
2642
2619
3972
1679
2532
2566
3819
1687
2606

CHD_RG

White Male
Black Male
White Female
Black Female
Year
Age-Adjusted Rate per 100000
2625
329
1608
243
2478
3356
1508
2314
2404
3154
1419
2313
2221
3093
1328
209
2067
2956
119
1983
1989
2885
117
1853
1922
2903
1139
1825
1921
2771
1074
1645
1824
2592
1071
1722

HF_RG

White Male
Black Male
White Female
Black Female
Year
Age-Adjusted Rate per 100000
255
206
245
17
267
225
225
167
242
238
227
203
256
217
222
189
243
167
214
206
24
218
217
172
255
246
229
202
23
225
208
196
25
216
226
185

race_gender

Sheet3

Local Health Department data can be found at wwwmichigangovbrfsSource CDC BRFSS

RISK FACTORMI

2011

MI

2013

MI

2014

MI

2015US 2015

2015 NATIONAL RANKING

Current Smoking 233 214 212 207 175 11

Blood Pressure Ever Told High 342 346 NA 331 309 18

Cholesterol Ever Told High 418 406 NA 382 364 12

Overweight (BMIgt25) 342 347 349 351 355 32tied

Obese (BMIgt30) 313 315 307 312 298 16

No Leisure Time Physical Activity 236 244 255 255 262 27

Diabetes 100 104 104 107 100 18tied

Prevalence of CVD Risk Factors Michigan Adults 1990-2015Compared to 2015 National Prevalence

233214 212 207

175

10

15

20

25

30

MI 2011 MI 2013 MI 2014 MI 2015 US 2015

Current Smoking

342 346331

309

20

25

30

35

40

MI 2011 MI 2013 MI 2014 MI 2015 US 2015

Blood Pressure Ever told high

342 347 349 351 355

20

25

30

35

40

MI 2011 MI 2013 MI 2014 MI 2015 US 2015

Overweight (BMIgt25)

313 315 307 312298

20

25

30

35

40

MI 2011 MI 2013 MI 2014 MI 2015 US 2015

Obese (BMIgt30)

418406

382364

30

35

40

45

50

MI 2011 MI 2013 MI 2014 MI 2015 US 2015

Cholesterol Ever told high

10 104 104 10710

0

3

6

9

12

15

MI 2011 MI 2013 MI 2014 MI 2015 US 2015

Diabetes

236 244255 255 262

10

15

20

25

30

MI 2011 MI 2013 MI 2014 MI 2015 US 2015

No Leisure Time Physical Activity

11 1216 18

2732tied

05

101520253035404550

CurrentSmoking

CholesterolEver told high

Obese(BMIgt30)

BloodPressure Ever

told high

Diabetes No LeisureTime Physical

Activity

Overweight(BMIgt25)

2015 NATIONAL RANKING(1st is worst)

18tied

MOSAIC 2015-2020 Focus of Grant Developing Stroke Systems of

Care Community Awareness EMS In-hospital QI Transition of Care Post-Discharge

12

Pre-hospital Care

A V A I L A B L E D A T A

13

EMSMOSAIC Data Linkage

-The MOSAIC Team continues to link data from the Michigan EMS Information System (MiEMSIS) to MOSAIC Data- Reports have been created for and reviewed by the

Tri-County Area MCA and Detroit East MCA- This work will expand to other MCA regions that

serve hospitals participating in MOSAIC

GWTG Special Initiatives Tab

-A free tab that can be enabled in GWTG-The purpose of the tab is to collect data concerning patient hand-off from EMS

MOSAIC Participating Hospitals

Aspirus Keweenaw Hospital (Laurium)

Aspirus Grand View HospitalAspirus Iron River HospitalAspirus Ontonagon HospitalBixby Medical CenterBronson Methodist HospitalCovenant Health CareDetroit Receiving HospitalGenesys Regional Medical CenterHenry Ford Hospital Herrick Medical CenterHuron Valley-Sinai HospitalLakeland Regional Medical Center McLaren Bay Regional Medical CenterMcLaren Greater Medical Center

McLaren Macomb HospitalMcLaren Northern MI HospitalMcLaren Oakland Medical CenterMcLaren Port Huron HospitalMcLaren Regional Medical CenterMercy Health Saint Maryrsquos HospitalMetro Health HospitalMunson Medical Center

ProMedica Monroe Regional HospitalSparrow HospitalSt Joseph Mercy - Ann ArborSt Joseph Mercy ChelseaSt Joseph Mercy Livingston HospitalSt Mary MercySt Mary of Michigan HospitalU of M Hospital

Hospital Infrastructure19

Among all participating hospitals the average number of

Licensed beds was 374 (range 25 to 1059 beds)

Inpatient discharges was 17076 (range 1064 to 48916 patients)

Acute stroke discharges (primary diagnosis only) was 417 (range 34 to 982 patients)

Case Demographics MOSAIC Registry

VariablesN() or statistics(Total N=68906)

Age at admission (years)Median 710Range 180 - 1060Mean (SE) 697(01)

GenderMale 32886 (477)Female 36015 (523)

RaceAfrican American 9900 (197)AIAN 132 (03)Asian 320 (06)More than one race 44 (01)Unknown 3679 (73)White 36190 (720)Missing 70

EthnicityHispanic or Latino 804 (16)Others 49531 (984)

VariablesN() or statistics(Total N=68906)

Health insuranceMedicaid 2284 (45)MedicaidPrivate 211 (04)Medicare 16863 (336)Medicare Medicaid 2313 (46)

MedicareMedicaidPrivate125 (02)

MedicarePrivate 13640 (272)ND 268(05)No insurance 2123 (42)Private 12356 (246)

Arrival modeEMS 21052 (429)Private

transportationother19313 (393)

Transfer from another hospital

7733(157)

ND or unknown 1021 (21)Missing 1216

Who receives data reports on your stroke quality of care

21

7055

70

10085

65

40

Hos

pita

lC

EO

up

per

man

agem

ent

Hos

pita

lB

oard

Chi

efN

ursi

ngO

ffice

r(C

NO

)

Str

oke

Tea

m

Phy

sici

anS

trok

eC

ham

pion

Chi

ef o

fM

edic

ine

Oth

er

Data Use

1) In the most recent calendar year have you run additional analyses (beyond what was required for reporting) on your hospitalrsquos own stroke data

2)How frequently have you run and used the analyses generated

22

Yes (N=16) 80

No (N=4) 20Weekly (N=2) 125

Monthly (N=8) 500

Less than monthly but more

than 1-2 times(N=6) 375

Data Use

What is the main reason you do not run your own additional analyses (Select one best answer)

23

Not sure how to run analyses

25

Not sure what analyses are needed would be helpful 25

Other 50

Data Use

In the most recent calendar year what reports did you run

24

813 688

Pre-programmedautomated reports in thedata collection tool (eg GWTG)

Additional reports beyond pre-programmed reports from the tool

Data Use

How do you use these analyses reports

25

813 688375

Inform quality improvement (QI) efforts andor plan

ldquoaction itemsrdquo

Report to management administration on our

progress

Other

Data Use

If you run additional analysis what action items QI efforts did you plan as a result of these reports

26

o Discharge education intensive statin use

o Door to tPA time and dysphagia

o Review data between spoke amp hub hospitals regarding transfers IV-tPA administration Mechanical thrombectomy and SAH

o QI efforts were addressed in the department involving calling Stroke Alert on call for cases with FAST symptoms

o ED Medical Director works with team to fix fallouts and problematic areas We have seen improvement

o Process changes (ie fallout emails to RN manager) physician querieso Increased documentation of NIHSS ownership from individual units regarding stroke quality

improvement goalso Daily dysphagia screening determination of whowhat team responsible for documenting initial NIHSS

looking at patients beyond 2h LKW arrival

Hospital Arrival Mode Door-to Needle and Pre-Notification

Reports 2016

Percent of Cases Who Arrived via EMSMOSAIC 2009-2016

Table 1 Arrival Mode among Stroke Cases by Demographics MOSAIC 2016

Demographics N=3496 550 N=2938 450Stroke Type Ischemic 2558 542 2164 458 Hemorrhagic 560 728 209 272 TIA 378 478 413 522Age Group lt 50 Years 233 433 305 567 50-79 Years 1982 497 2008 503 ge 80 Years 1379 688 625 312Sex Female 1933 576 1422 424 Male 1661 523 1516 477Race Black 659 530 584 470 White 2824 557 2248 443 Other Missing 111 512 106 488

MOSAIC AggregateArrival Mode

EMS Private Mode

Table 2 Door-to-Needle Times by Arrival Mode among Stroke Cases MOSAIC 2016

Time Elements (in Minutes)Number of

Patients Mean (Minutes) Median

(Minutes)Range

(Minutes)Door-to-Image 4901 575 400 00-2700 Arrived via EMS 2767 463 270 00-2700 Arrived via Private Transportation 2134 720 570 00-2620

Door-to-Image (among t-PA treated) 492 155 130 00-970 Arrived via EMS 370 125 110 00-840 Arrived via Private Transportation 122 243 215 20-970Image-to Needle 492 500 450 70-2090 Arrived via EMS 370 503 460 70-2090 Arrived via Private Transportation 122 483 420 90-1770Door-to Needle 492 655 570 200-2180 Arrived via EMS 370 629 560 200-2180 Arrived via Private Transportation 122 726 650 290-2060Included ischemic or hemorrhagic cases with times that were less or equal to 270 minutes (45 hours)Transferred cases were excluded

MOSAIC Aggregate

Table 3 Pre-Notification among Stroke Cases Who Arrived Via EMS by Demographics MOSAIC 2016

Demographics N=2015 584 N=1437 416Stroke Type Ischemic 1523 622 924 378 Hemorrhagic 306 566 235 434 TIA 142 381 231 619Age Group lt 50 Years 133 607 86 393 50-79 Years 1105 585 784 415 ge 80 Years 777 578 567 422Sex Female 1075 578 786 422 Male 940 591 651 409Race Black 307 517 287 483 White 1657 602 1097 398 Other 51 490 53 510

All HospitalsPre-Notification

Yes No

MOSAIC Transitions of Care Project

Post-discharge data collection tool is being implemented into Outcome Science as a tab

Post-Discharge amp Transition of Care

Reporting on changes within 30 days of discharge from hospital via follow-up callschart review Interval events Physician follow-up visits Lifestyle changes Lab assessments Medication managementadherence Rehab amp Functional outcomes Falls

MOSAIC Website

wwwMichigangovstroke

Adrienne Nickles MPHnicklesamichigangov

Thank You

  • Michigan and MOSAIC Data Review
  • Overview
  • Age-adjusted Stroke Hospitalization Rates Michigan 2000-2015
  • Slide Number 4
  • Age-adjusted Stroke Mortality Rates Michigan 2000-2014
  • Slide Number 6
  • Slide Number 7
  • Slide Number 8
  • Slide Number 9
  • Slide Number 10
  • Slide Number 11
  • MOSAIC 2015-2020
  • Pre-hospital Care
  • EMSMOSAIC Data Linkage
  • Slide Number 15
  • GWTG Special Initiatives Tab
  • Slide Number 17
  • MOSAIC Participating Hospitals
  • Hospital Infrastructure
  • Case Demographics MOSAIC Registry
  • Who receives data reports on your stroke quality of care
  • 1) In the most recent calendar year have you run additional analyses (beyond what was required for reporting) on your hospitalrsquos own stroke data 2)How frequently have you run and used the analyses generated
  • What is the main reason you do not run your own additional analyses (Select one best answer)
  • In the most recent calendar year what reports did you run
  • How do you use these analyses reports
  • If you run additional analysis what action items QI efforts did you plan as a result of these reports
  • Hospital Arrival Mode Door-to Needle and Pre-Notification Reports 2016
  • Percent of Cases Who Arrived via EMSMOSAIC 2009-2016
  • Table 1 Arrival Mode among Stroke Cases by Demographics MOSAIC 2016
  • Table 2 Door-to-Needle Times by Arrival Mode among Stroke Cases MOSAIC 2016
  • Table 3 Pre-Notification among Stroke Cases Who Arrived Via EMS by Demographics MOSAIC 2016
  • MOSAIC Transitions of Care Project
  • Slide Number 33
  • MOSAIC Website
  • Adrienne Nickles MPHnicklesamichigangov
CVD
Year White Male Black Male White Female Black Female
2000 4276 5424 3033 4161
2001 4066 5524 2813 4091
2002 3928 5468 2767 4114
2003 3734 518 2638 3887
2004 3448 5079 2432 3643
2005 3366 4983 2375 3545
2006 3276 4994 2313 3477
2007 3236 4845 2223 327
2008 3158 4694 2238 3327
change 234 79 237 164
Heart Disease
Year White Male Black Male White Female Black Female
2000 3393 4298 227 3206
2001 3232 4445 2124 3166
2002 3118 4317 2197 3157
2003 2986 4184 1957 3001
2004 2777 3983 1783 2838
2005 2704 4009 1776 2679
2006 2644 3981 1739 2642
2007 2619 3972 1679 2532
2008 2566 3819 1687 2606
Stroke
Year White Male Black Male White Female Black Female
2000 61 768 561 703 176
2001 575 752 539 681 138
2002 573 806 528 66 15
2003 516 662 498 629 147
2004 463 743 476 562
2005 449 663 429 585
2006 434 63 411 556
2007 415 631 392 494
2008 402 606 392 509
2009 375 616 372 464
2010 372 565 366 513
2011 373 548 366 44
2012 348 587 349 477
2013 347 506 34 462
2014 369 506 352 482
Coronary Heart Disease
Year White Male Black Male White Female Black Female
2000 2625 329 1608 243
2001 2478 3356 1508 2314
2002 2404 3154 1419 2313
2003 2221 3093 1328 209
2004 2067 2956 119 1983
2005 1989 2885 117 1853
2006 1922 2903 1139 1825
2007 1921 2771 1074 1645
2008 1824 2592 1071 1722
Heart Failure
Year White Male Black Male White Female Black Female
2000 255 206 245 17
2001 267 225 225 167
2002 242 238 227 203
2003 256 217 222 189
2004 243 167 214 206
2005 24 218 217 172
2006 255 246 229 202
2007 23 225 208 196
2008 25 216 226 185
Not sure what this data is from previously HD Stroke
Year White Female Black Female White Female Black Female
2000 227 3206 561 703
2001 2124 3166 539 681
2002 2197 3157 528 66
2003 1957 3001 498 629
2004 1783 2838 476 562
2005 1776 2679 429 585
2006 1739 2642 411 556
2007
2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2009 2009 2009 2009
2010 2010 2010 2010
2011 2011 2011 2011
2012 2012 2012 2012
2013 2013 2013 2013
2014 2014 2014 2014
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
CVD
Year US Michigan 0-34 35-64 65-84 85+
2000 3397 3694 43 140 16141 86689
2001 3265 3524 508 1348 15291 82889
2002 3174 3421 45 1338 14891 79536
2003 3061 3258 54 1324 14033 75185
2004 2885 3034 41 1242 13209 69088
2005 2773 2972 48 1283 1291 66011
2006 2898 48 1207 12246 6786
2007 2825 5 1206 1182 66153
2008 2791 43 1175 11619 66406
Heart Disease
Year US Michigan 0-34 35-64 65-84 85+
2000 2576 2851 345 1158 1247 64879
2001 2478 2719 416 112 11794 61938
2002 2408 2631 35 1103 11529 58746
2003 2323 2517 45 110 10827 56172
2004 217 2337 313 1048 10086 51609
2005 2111 2308 38 1078 9937 49828
2006 226 384 1019 9413 51918
2007 2216 42 1008 9174 50961
2008 2192 36 982 904 51209
Stroke
Year US Michigan HP 2010 0-34 35-64 65-84 85+
2000 609 603 50 068 174 2589 15841
2001 579 577 50 0638 157 2522 1504
2002 562 571 50 072 169 2397 1528
2003 535 527 50 0737 157 2249 13741
2004 50 496 50 0652 138 220 12629
2005 466 464 50 0553 145 2063 11398
2006 444 50 0734 127 196 11256
2007 425 064 1368 1832 10718
2008 419 047 134 1804 10646
79 27 243 289
Coronary Heart Disease
Year US Michigan HP 2010 0-34 35-64 65-84 85+
2000 1868 2118 162 0613 874 7701 4670
2001 1778 2006 162 0898 818 9012 44369
2002 1709 192 162 0889 799 8759 41061
2003 1628 179 162 0793 785 8018 38358
2004 1502 1656 162 0865 757 7421 34644
2005 1444 1611 162 097 773 7245 32617
2006 1564 162 088 727 6856 33503
2007 1516 117 709 6585 32727
2008 1472 102 657 6403 32504
168 11 283
Heart Failure
Year US Michigan 35-64 65-84 85+
2000 203 245 3047 936 8287
2001 202 237 2596 88 8285
2002 194 233 2648 878 8057
2003 194 233 3176 902 7722
2004 189 224 2709 863 7586
2005 189 224 2955 878 7388
2006 24 2979 884 8354
2007 219 274 828 7483
2008 233 013 333 85 8102
Heart Disease Stroke
Michigan White Michigan Black US White US Black Michigan White Michigan Black US White US Black
1990 334 4315 317 3915 1990 638 733 629 917
1991 3289 4108 3088 3865 1991 626 781 607 894
1992 3126 3987 3011 3777 1992 609 694 598 86
1993 3234 429 3046 3843 1993 614 77 609 866
1994 3134 4156 295 3661 1994 634 875 609 869
1995 3048 4131 2912 3672 1995 638 925 615 879
1996 2997 380 2842 354 1996 617 804 61 852
1997 2851 3683 2764 345 1997 604 77 598 816
1998 2884 3586 2681 3406 1998 598 729 576 803
1999 2781 3692 2634 3367 1999 609 812 598 824
2000 2757 3663 2536 3265 2000 586 737 587 824
2001 261 3695 2435 3169 2001 56 718 558 788
2002 2522 3659 2367 3084 2002 553 729 542 763
2003 2409 350 2282 3002 2003 511 655 514 743
2004 222 3311 2133 2806 2004 477 633 48 699
2005 219 3227 2005 442 616
2006 2144 320 2006 426 589
2007 2007
2008 2008
CVD CHD HD HF Stroke
2000 3694 2118 2851 245 603
2001 3524 2006 2719 237 577
2002 3421 192 2631 233 571
2003 3258 179 2517 233 527
2004 3034 1656 2337 224 496
2005 2972 1611 2308 224 464
2006 2898 1564 226 24 444
2007 2825 1516 2216 219 425
2008 2791 1472 2192 233 419
2000 2000 2000
2001 2001 2001
2002 2002 2002
2003 2003 2003
2004 2004 2004
2005 2005 2005
2006 2006 2006
2007 2007 2007
2008 2008 2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2000 2000 2000 2000 2000
2001 2001 2001 2001 2001
2002 2002 2002 2002 2002
2003 2003 2003 2003 2003
2004 2004 2004 2004 2004
2005 2005 2005 2005 2005
2006 2006 2006 2006 2006
2007 2007 2007 2007 2007
2008 2008 2008 2008 2008
CVD
Year White Male Black Male White Female Black Female
2000 4276 5424 3033 4161
2001 4066 5524 2813 4091
2002 3928 5468 2767 4114
2003 3734 518 2638 3887
2004 3448 5079 2432 3643
2005 3366 4983 2375 3545
2006 3276 4994 2313 3477
2007 3236 4845 2223 327
2008 3158 4694 2238 3327
change 234 79 237 164
Heart Disease
Year White Male Black Male White Female Black Female
2000 3393 4298 227 3206
2001 3232 4445 2124 3166
2002 3118 4317 2197 3157
2003 2986 4184 1957 3001
2004 2777 3983 1783 2838
2005 2704 4009 1776 2679
2006 2644 3981 1739 2642
2007 2619 3972 1679 2532
2008 2566 3819 1687 2606
Stroke
Year White Male Black Male White Female Black Female
2000 61 768 561 703 176
2001 575 752 539 681 138
2002 573 806 528 66 15
2003 516 662 498 629 147
2004 463 743 476 562
2005 449 663 429 585
2006 434 63 411 556
2007 415 631 392 494
2008 402 606 392 509
Coronary Heart Disease
Year White Male Black Male White Female Black Female
2000 2625 329 1608 243
2001 2478 3356 1508 2314
2002 2404 3154 1419 2313
2003 2221 3093 1328 209
2004 2067 2956 119 1983
2005 1989 2885 117 1853
2006 1922 2903 1139 1825
2007 1921 2771 1074 1645
2008 1824 2592 1071 1722
Heart Failure
Year White Male Black Male White Female Black Female
2000 255 206 245 17
2001 267 225 225 167
2002 242 238 227 203
2003 256 217 222 189
2004 243 167 214 206
2005 24 218 217 172
2006 255 246 229 202
2007 23 225 208 196
2008 25 216 226 185
Not sure what this data is from previously HD Stroke
Year White Female Black Female White Female Black Female
2000 227 3206 561 703
2001 2124 3166 539 681
2002 2197 3157 528 66
2003 1957 3001 498 629
2004 1783 2838 476 562
2005 1776 2679 429 585
2006 1739 2642 411 556
2007
2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
CVD
Year US Michigan 0-34 35-64 65-84 85+
2000 3397 3694 43 140 16141 86689
2001 3265 3524 508 1348 15291 82889
2002 3174 3421 45 1338 14891 79536
2003 3061 3258 54 1324 14033 75185
2004 2885 3034 41 1242 13209 69088
2005 2773 2972 48 1283 1291 66011
2006 2898 48 1207 12246 6786
2007 2825 5 1206 1182 66153
2008 2791 43 1175 11619 66406
Heart Disease
Year US Michigan 0-34 35-64 65-84 85+
2000 2576 2851 345 1158 1247 64879
2001 2478 2719 416 112 11794 61938
2002 2408 2631 35 1103 11529 58746
2003 2323 2517 45 110 10827 56172
2004 217 2337 313 1048 10086 51609
2005 2111 2308 38 1078 9937 49828
2006 226 384 1019 9413 51918
2007 2216 42 1008 9174 50961
2008 2192 36 982 904 51209
Stroke
Year US Michigan HP 2010 0-34 35-64 65-84 85+
2000 609 603 50 068 174 2589 15841
2001 579 577 50 0638 157 2522 1504
2002 562 571 50 072 169 2397 1528
2003 535 527 50 0737 157 2249 13741
2004 50 496 50 0652 138 220 12629
2005 466 464 50 0553 145 2063 11398
2006 444 50 0734 127 196 11256
2007 425 064 1368 1832 10718
2008 419 047 134 1804 10646
79 27 243 289
Coronary Heart Disease
Year US Michigan HP 2010 0-34 35-64 65-84 85+
2000 1868 2118 162 0613 874 7701 4670
2001 1778 2006 162 0898 818 9012 44369
2002 1709 192 162 0889 799 8759 41061
2003 1628 179 162 0793 785 8018 38358
2004 1502 1656 162 0865 757 7421 34644
2005 1444 1611 162 097 773 7245 32617
2006 1564 162 088 727 6856 33503
2007 1516 117 709 6585 32727
2008 1472 102 657 6403 32504
168 11 283
Heart Failure
Year US Michigan 35-64 65-84 85+
2000 203 245 3047 936 8287
2001 202 237 2596 88 8285
2002 194 233 2648 878 8057
2003 194 233 3176 902 7722
2004 189 224 2709 863 7586
2005 189 224 2955 878 7388
2006 24 2979 884 8354
2007 219 274 828 7483
2008 233 013 333 85 8102
Heart Disease Stroke
Michigan White Michigan Black US White US Black Michigan White Michigan Black US White US Black
1990 334 4315 317 3915 1990 638 733 629 917
1991 3289 4108 3088 3865 1991 626 781 607 894
1992 3126 3987 3011 3777 1992 609 694 598 86
1993 3234 429 3046 3843 1993 614 77 609 866
1994 3134 4156 295 3661 1994 634 875 609 869
1995 3048 4131 2912 3672 1995 638 925 615 879
1996 2997 380 2842 354 1996 617 804 61 852
1997 2851 3683 2764 345 1997 604 77 598 816
1998 2884 3586 2681 3406 1998 598 729 576 803
1999 2781 3692 2634 3367 1999 609 812 598 824
2000 2757 3663 2536 3265 2000 586 737 587 824
2001 261 3695 2435 3169 2001 56 718 558 788
2002 2522 3659 2367 3084 2002 553 729 542 763
2003 2409 350 2282 3002 2003 511 655 514 743
2004 222 3311 2133 2806 2004 477 633 48 699
2005 219 3227 2005 442 616
2006 2144 320 2006 426 589
2007 2007
2008 2008
Stroke
CVD MI US
2000 3694 606 609
2001 3524 584 584
2002 3421 583 572
2003 3258 539 546
2004 3034 519 512
2005 2972 488 48
2006 2898 449 448
2007 2825 43 435
2008 2791 423 421
2009 262 396 396
2010 394 391
2011 387 379
2012 372 369
2013 363 369
2014 377 365
2000 2000 2000
2001 2001 2001
2002 2002 2002
2003 2003 2003
2004 2004 2004
2005 2005 2005
2006 2006 2006
2007 2007 2007
2008 2008 2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2000 2000
2001 2001
2002 2002
2003 2003
2004 2004
2005 2005
2006 2006
2007 2007
2008 2008
2009 2009
2010 2010
2011 2011
2012 2012
2013 2013
2014 2014
CVD Stroke
2000 2175 303
2001 2178 299
2002 2142 294
2003 2103 284
2004 2061 273
2005 2013 267
2006 2025 267
2007 1904 262
2008 1802 255
2009 1746 251
2010 1665 237
2011 235
2012 227
2013 227
2014 224
2015 233
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
Page 2: Michigan and MOSAIC Data Review...Michigan and MOSAIC Data Review 2017 ANNUAL WORKSHOP 4/26/2017. Adrienne Nickles, MPH. Michigan’s Ongoing Stroke Registry to Accelerate the Improvement

Overview

Stroke in Michigan trends in hospitalization mortality and risk factors

Data Use How are participating hospitals using their data

Hospital Arrival Mode and Door-to-needle time measurements (DIT ITN DTN)

Future Directions of Post-hospital Follow-up Project

Age-adjusted Stroke Hospitalization Rates Michigan 2000-2015

303 299 294284

273 267 267 262 255 251237 235 227 227 224 233

0

5

10

15

20

25

30

35

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

Rat

e pe

r 10

000

Year

ICD-10

Denominator used from 2000-20014 ICD-9ICD-10 used to calculate hospitalization rates starting in 2015

Overall_Rates

Stroke
Year
Rate per 10000
303
299
294
284
273
267
267
262
255
251
237
235
227
227
224
233

total

Sheet3

Age-adjusted Stroke Mortality Rates Michigan 2000-2014

606584 583

539519

488

44943 423

396 394 387372 363

377

609584 572

546512

48448 435

421396 391 379 369 369 365

0

10

20

30

40

50

60

70

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014

Rat

e pe

r 100

000

Year

MI US

Overall_Rates

MI
US
Year
Rate per 100000
606
609
584
584
583
572
539
546
519
512
488
48
449
448
43
435
423
421
396
396
394
391
387
379
372
369
363
369
377
365

CVD_Age

0-34
35-64
65-84
85+
Year
Age-Adjusted Rate per 100000
43
140
16141
86689
508
1348
15291
82889
45
1338
14891
79536
54
1324
14033
75185
41
1242
13209
69088
48
1283
1291
66011
48
1207
12246
6786
5
1206
1182
66153
43
1175
11619
66406

HD_Age

0-34
35-64
65-84
85+
Year
Age-Adjusted Rate per 100000
345
1158
1247
64879
416
112
11794
61938
35
1103
11529
58746
45
110
10827
56172
313
1048
10086
51609
38
1078
9937
49828
384
1019
9413
51918
42
1008
9174
50961
36
982
904
51209

CHD_Age

0-34
35-64
65-84
85+
Year
Age-Adjusted Rate per 100000
0613
874
7701
4670
0898
818
9012
44369
0889
799
8759
41061
0793
785
8018
38358
0865
757
7421
34644
097
773
7245
32617
088
727
6856
33503
117
709
6585
32727
102
657
6403
32504

Stroke_Age

0-34
35-64
65-84
85+
Year
Age-Adjusted Rate per 100000
068
174
2589
15841
0638
157
2522
1504
072
169
2397
1528
0737
157
2249
13741
0652
138
220
12629
0553
145
2063
11398
0734
127
196
11256
064
1368
1832
10718
047
134
1804
10646

HF_Age

35-64
65-84
85+
Year
Age-Adjusted Rate per 100000
3047
936
8287
2596
88
8285
2648
878
8057
3176
902
7722
2709
863
7586
2955
878
7388
2979
884
8354
274
828
7483
333
85
8102

total

CVD_RG

White Male
Black Male
White Female
Black Female
Year
Age-Adjusted Rate per 100000
4276
5424
3033
4161
4066
5524
2813
4091
3928
5468
2767
4114
3734
518
2638
3887
3448
5079
2432
3643
3366
4983
2375
3545
3276
4994
2313
3477
3236
4845
2223
327
3158
4694
2238
3327

Stroke_RG

White Male
Black Male
White Female
Black Female
Year
Age-Adjusted Rate per 100000
61
768
561
703
575
752
539
681
573
806
528
66
516
662
498
629
463
743
476
562
449
663
429
585
434
63
411
556
415
631
392
494
402
606
392
509

HD_RG

White Male
Black Male
White Female
Black Female
Year
Age-Adjusted Rate per 100000
3393
4298
227
3206
3232
4445
2124
3166
3118
4317
2197
3157
2986
4184
1957
3001
2777
3983
1783
2838
2704
4009
1776
2679
2644
3981
1739
2642
2619
3972
1679
2532
2566
3819
1687
2606

CHD_RG

White Male
Black Male
White Female
Black Female
Year
Age-Adjusted Rate per 100000
2625
329
1608
243
2478
3356
1508
2314
2404
3154
1419
2313
2221
3093
1328
209
2067
2956
119
1983
1989
2885
117
1853
1922
2903
1139
1825
1921
2771
1074
1645
1824
2592
1071
1722

HF_RG

White Male
Black Male
White Female
Black Female
Year
Age-Adjusted Rate per 100000
255
206
245
17
267
225
225
167
242
238
227
203
256
217
222
189
243
167
214
206
24
218
217
172
255
246
229
202
23
225
208
196
25
216
226
185

race_gender

Sheet3

Age-adjusted stroke mortality rates by race and gender Michigan 2000 to 2014

0

10

20

30

40

50

60

70

80

90

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014

Age

-Adj

uste

d R

ate

per 1

000

00

Year

White Male

Black Male

White Female

Black Female

Overall_Rates

CVD
CHD
HD
HF
Stroke
Year
Rate per 10000
3694
2118
2851
245
603
3524
2006
2719
237
577
3421
192
2631
233
571
3258
179
2517
233
527
3034
1656
2337
224
496
2972
1611
2308
224
464
2898
1564
226
24
444
2825
1516
2216
219
425
2791
1472
2192
233
419

CVD_Age

0-34
35-64
65-84
85+
Year
Age-Adjusted Rate per 100000
43
140
16141
86689
508
1348
15291
82889
45
1338
14891
79536
54
1324
14033
75185
41
1242
13209
69088
48
1283
1291
66011
48
1207
12246
6786
5
1206
1182
66153
43
1175
11619
66406

HD_Age

0-34
35-64
65-84
85+
Year
Age-Adjusted Rate per 100000
345
1158
1247
64879
416
112
11794
61938
35
1103
11529
58746
45
110
10827
56172
313
1048
10086
51609
38
1078
9937
49828
384
1019
9413
51918
42
1008
9174
50961
36
982
904
51209

CHD_Age

0-34
35-64
65-84
85+
Year
Age-Adjusted Rate per 100000
0613
874
7701
4670
0898
818
9012
44369
0889
799
8759
41061
0793
785
8018
38358
0865
757
7421
34644
097
773
7245
32617
088
727
6856
33503
117
709
6585
32727
102
657
6403
32504

Stroke_Age

0-34
35-64
65-84
85+
Year
Age-Adjusted Rate per 100000
068
174
2589
15841
0638
157
2522
1504
072
169
2397
1528
0737
157
2249
13741
0652
138
220
12629
0553
145
2063
11398
0734
127
196
11256
064
1368
1832
10718
047
134
1804
10646

HF_Age

35-64
65-84
85+
Year
Age-Adjusted Rate per 100000
3047
936
8287
2596
88
8285
2648
878
8057
3176
902
7722
2709
863
7586
2955
878
7388
2979
884
8354
274
828
7483
333
85
8102

total

CVD_RG

White Male
Black Male
White Female
Black Female
Year
Age-Adjusted Rate per 100000
4276
5424
3033
4161
4066
5524
2813
4091
3928
5468
2767
4114
3734
518
2638
3887
3448
5079
2432
3643
3366
4983
2375
3545
3276
4994
2313
3477
3236
4845
2223
327
3158
4694
2238
3327

Stroke_RG

White Male
Black Male
White Female
Black Female
Year
Age-Adjusted Rate per 100000
61
768
561
703
575
752
539
681
573
806
528
66
516
662
498
629
463
743
476
562
449
663
429
585
434
63
411
556
415
631
392
494
402
606
392
509
375
616
372
464
372
565
366
513
373
548
366
44
348
587
349
477
347
506
34
462
369
506
352
482

HD_RG

White Male
Black Male
White Female
Black Female
Year
Age-Adjusted Rate per 100000
3393
4298
227
3206
3232
4445
2124
3166
3118
4317
2197
3157
2986
4184
1957
3001
2777
3983
1783
2838
2704
4009
1776
2679
2644
3981
1739
2642
2619
3972
1679
2532
2566
3819
1687
2606

CHD_RG

White Male
Black Male
White Female
Black Female
Year
Age-Adjusted Rate per 100000
2625
329
1608
243
2478
3356
1508
2314
2404
3154
1419
2313
2221
3093
1328
209
2067
2956
119
1983
1989
2885
117
1853
1922
2903
1139
1825
1921
2771
1074
1645
1824
2592
1071
1722

HF_RG

White Male
Black Male
White Female
Black Female
Year
Age-Adjusted Rate per 100000
255
206
245
17
267
225
225
167
242
238
227
203
256
217
222
189
243
167
214
206
24
218
217
172
255
246
229
202
23
225
208
196
25
216
226
185

race_gender

Sheet3

Local Health Department data can be found at wwwmichigangovbrfsSource CDC BRFSS

RISK FACTORMI

2011

MI

2013

MI

2014

MI

2015US 2015

2015 NATIONAL RANKING

Current Smoking 233 214 212 207 175 11

Blood Pressure Ever Told High 342 346 NA 331 309 18

Cholesterol Ever Told High 418 406 NA 382 364 12

Overweight (BMIgt25) 342 347 349 351 355 32tied

Obese (BMIgt30) 313 315 307 312 298 16

No Leisure Time Physical Activity 236 244 255 255 262 27

Diabetes 100 104 104 107 100 18tied

Prevalence of CVD Risk Factors Michigan Adults 1990-2015Compared to 2015 National Prevalence

233214 212 207

175

10

15

20

25

30

MI 2011 MI 2013 MI 2014 MI 2015 US 2015

Current Smoking

342 346331

309

20

25

30

35

40

MI 2011 MI 2013 MI 2014 MI 2015 US 2015

Blood Pressure Ever told high

342 347 349 351 355

20

25

30

35

40

MI 2011 MI 2013 MI 2014 MI 2015 US 2015

Overweight (BMIgt25)

313 315 307 312298

20

25

30

35

40

MI 2011 MI 2013 MI 2014 MI 2015 US 2015

Obese (BMIgt30)

418406

382364

30

35

40

45

50

MI 2011 MI 2013 MI 2014 MI 2015 US 2015

Cholesterol Ever told high

10 104 104 10710

0

3

6

9

12

15

MI 2011 MI 2013 MI 2014 MI 2015 US 2015

Diabetes

236 244255 255 262

10

15

20

25

30

MI 2011 MI 2013 MI 2014 MI 2015 US 2015

No Leisure Time Physical Activity

11 1216 18

2732tied

05

101520253035404550

CurrentSmoking

CholesterolEver told high

Obese(BMIgt30)

BloodPressure Ever

told high

Diabetes No LeisureTime Physical

Activity

Overweight(BMIgt25)

2015 NATIONAL RANKING(1st is worst)

18tied

MOSAIC 2015-2020 Focus of Grant Developing Stroke Systems of

Care Community Awareness EMS In-hospital QI Transition of Care Post-Discharge

12

Pre-hospital Care

A V A I L A B L E D A T A

13

EMSMOSAIC Data Linkage

-The MOSAIC Team continues to link data from the Michigan EMS Information System (MiEMSIS) to MOSAIC Data- Reports have been created for and reviewed by the

Tri-County Area MCA and Detroit East MCA- This work will expand to other MCA regions that

serve hospitals participating in MOSAIC

GWTG Special Initiatives Tab

-A free tab that can be enabled in GWTG-The purpose of the tab is to collect data concerning patient hand-off from EMS

MOSAIC Participating Hospitals

Aspirus Keweenaw Hospital (Laurium)

Aspirus Grand View HospitalAspirus Iron River HospitalAspirus Ontonagon HospitalBixby Medical CenterBronson Methodist HospitalCovenant Health CareDetroit Receiving HospitalGenesys Regional Medical CenterHenry Ford Hospital Herrick Medical CenterHuron Valley-Sinai HospitalLakeland Regional Medical Center McLaren Bay Regional Medical CenterMcLaren Greater Medical Center

McLaren Macomb HospitalMcLaren Northern MI HospitalMcLaren Oakland Medical CenterMcLaren Port Huron HospitalMcLaren Regional Medical CenterMercy Health Saint Maryrsquos HospitalMetro Health HospitalMunson Medical Center

ProMedica Monroe Regional HospitalSparrow HospitalSt Joseph Mercy - Ann ArborSt Joseph Mercy ChelseaSt Joseph Mercy Livingston HospitalSt Mary MercySt Mary of Michigan HospitalU of M Hospital

Hospital Infrastructure19

Among all participating hospitals the average number of

Licensed beds was 374 (range 25 to 1059 beds)

Inpatient discharges was 17076 (range 1064 to 48916 patients)

Acute stroke discharges (primary diagnosis only) was 417 (range 34 to 982 patients)

Case Demographics MOSAIC Registry

VariablesN() or statistics(Total N=68906)

Age at admission (years)Median 710Range 180 - 1060Mean (SE) 697(01)

GenderMale 32886 (477)Female 36015 (523)

RaceAfrican American 9900 (197)AIAN 132 (03)Asian 320 (06)More than one race 44 (01)Unknown 3679 (73)White 36190 (720)Missing 70

EthnicityHispanic or Latino 804 (16)Others 49531 (984)

VariablesN() or statistics(Total N=68906)

Health insuranceMedicaid 2284 (45)MedicaidPrivate 211 (04)Medicare 16863 (336)Medicare Medicaid 2313 (46)

MedicareMedicaidPrivate125 (02)

MedicarePrivate 13640 (272)ND 268(05)No insurance 2123 (42)Private 12356 (246)

Arrival modeEMS 21052 (429)Private

transportationother19313 (393)

Transfer from another hospital

7733(157)

ND or unknown 1021 (21)Missing 1216

Who receives data reports on your stroke quality of care

21

7055

70

10085

65

40

Hos

pita

lC

EO

up

per

man

agem

ent

Hos

pita

lB

oard

Chi

efN

ursi

ngO

ffice

r(C

NO

)

Str

oke

Tea

m

Phy

sici

anS

trok

eC

ham

pion

Chi

ef o

fM

edic

ine

Oth

er

Data Use

1) In the most recent calendar year have you run additional analyses (beyond what was required for reporting) on your hospitalrsquos own stroke data

2)How frequently have you run and used the analyses generated

22

Yes (N=16) 80

No (N=4) 20Weekly (N=2) 125

Monthly (N=8) 500

Less than monthly but more

than 1-2 times(N=6) 375

Data Use

What is the main reason you do not run your own additional analyses (Select one best answer)

23

Not sure how to run analyses

25

Not sure what analyses are needed would be helpful 25

Other 50

Data Use

In the most recent calendar year what reports did you run

24

813 688

Pre-programmedautomated reports in thedata collection tool (eg GWTG)

Additional reports beyond pre-programmed reports from the tool

Data Use

How do you use these analyses reports

25

813 688375

Inform quality improvement (QI) efforts andor plan

ldquoaction itemsrdquo

Report to management administration on our

progress

Other

Data Use

If you run additional analysis what action items QI efforts did you plan as a result of these reports

26

o Discharge education intensive statin use

o Door to tPA time and dysphagia

o Review data between spoke amp hub hospitals regarding transfers IV-tPA administration Mechanical thrombectomy and SAH

o QI efforts were addressed in the department involving calling Stroke Alert on call for cases with FAST symptoms

o ED Medical Director works with team to fix fallouts and problematic areas We have seen improvement

o Process changes (ie fallout emails to RN manager) physician querieso Increased documentation of NIHSS ownership from individual units regarding stroke quality

improvement goalso Daily dysphagia screening determination of whowhat team responsible for documenting initial NIHSS

looking at patients beyond 2h LKW arrival

Hospital Arrival Mode Door-to Needle and Pre-Notification

Reports 2016

Percent of Cases Who Arrived via EMSMOSAIC 2009-2016

Table 1 Arrival Mode among Stroke Cases by Demographics MOSAIC 2016

Demographics N=3496 550 N=2938 450Stroke Type Ischemic 2558 542 2164 458 Hemorrhagic 560 728 209 272 TIA 378 478 413 522Age Group lt 50 Years 233 433 305 567 50-79 Years 1982 497 2008 503 ge 80 Years 1379 688 625 312Sex Female 1933 576 1422 424 Male 1661 523 1516 477Race Black 659 530 584 470 White 2824 557 2248 443 Other Missing 111 512 106 488

MOSAIC AggregateArrival Mode

EMS Private Mode

Table 2 Door-to-Needle Times by Arrival Mode among Stroke Cases MOSAIC 2016

Time Elements (in Minutes)Number of

Patients Mean (Minutes) Median

(Minutes)Range

(Minutes)Door-to-Image 4901 575 400 00-2700 Arrived via EMS 2767 463 270 00-2700 Arrived via Private Transportation 2134 720 570 00-2620

Door-to-Image (among t-PA treated) 492 155 130 00-970 Arrived via EMS 370 125 110 00-840 Arrived via Private Transportation 122 243 215 20-970Image-to Needle 492 500 450 70-2090 Arrived via EMS 370 503 460 70-2090 Arrived via Private Transportation 122 483 420 90-1770Door-to Needle 492 655 570 200-2180 Arrived via EMS 370 629 560 200-2180 Arrived via Private Transportation 122 726 650 290-2060Included ischemic or hemorrhagic cases with times that were less or equal to 270 minutes (45 hours)Transferred cases were excluded

MOSAIC Aggregate

Table 3 Pre-Notification among Stroke Cases Who Arrived Via EMS by Demographics MOSAIC 2016

Demographics N=2015 584 N=1437 416Stroke Type Ischemic 1523 622 924 378 Hemorrhagic 306 566 235 434 TIA 142 381 231 619Age Group lt 50 Years 133 607 86 393 50-79 Years 1105 585 784 415 ge 80 Years 777 578 567 422Sex Female 1075 578 786 422 Male 940 591 651 409Race Black 307 517 287 483 White 1657 602 1097 398 Other 51 490 53 510

All HospitalsPre-Notification

Yes No

MOSAIC Transitions of Care Project

Post-discharge data collection tool is being implemented into Outcome Science as a tab

Post-Discharge amp Transition of Care

Reporting on changes within 30 days of discharge from hospital via follow-up callschart review Interval events Physician follow-up visits Lifestyle changes Lab assessments Medication managementadherence Rehab amp Functional outcomes Falls

MOSAIC Website

wwwMichigangovstroke

Adrienne Nickles MPHnicklesamichigangov

Thank You

  • Michigan and MOSAIC Data Review
  • Overview
  • Age-adjusted Stroke Hospitalization Rates Michigan 2000-2015
  • Slide Number 4
  • Age-adjusted Stroke Mortality Rates Michigan 2000-2014
  • Slide Number 6
  • Slide Number 7
  • Slide Number 8
  • Slide Number 9
  • Slide Number 10
  • Slide Number 11
  • MOSAIC 2015-2020
  • Pre-hospital Care
  • EMSMOSAIC Data Linkage
  • Slide Number 15
  • GWTG Special Initiatives Tab
  • Slide Number 17
  • MOSAIC Participating Hospitals
  • Hospital Infrastructure
  • Case Demographics MOSAIC Registry
  • Who receives data reports on your stroke quality of care
  • 1) In the most recent calendar year have you run additional analyses (beyond what was required for reporting) on your hospitalrsquos own stroke data 2)How frequently have you run and used the analyses generated
  • What is the main reason you do not run your own additional analyses (Select one best answer)
  • In the most recent calendar year what reports did you run
  • How do you use these analyses reports
  • If you run additional analysis what action items QI efforts did you plan as a result of these reports
  • Hospital Arrival Mode Door-to Needle and Pre-Notification Reports 2016
  • Percent of Cases Who Arrived via EMSMOSAIC 2009-2016
  • Table 1 Arrival Mode among Stroke Cases by Demographics MOSAIC 2016
  • Table 2 Door-to-Needle Times by Arrival Mode among Stroke Cases MOSAIC 2016
  • Table 3 Pre-Notification among Stroke Cases Who Arrived Via EMS by Demographics MOSAIC 2016
  • MOSAIC Transitions of Care Project
  • Slide Number 33
  • MOSAIC Website
  • Adrienne Nickles MPHnicklesamichigangov
CVD
Year White Male Black Male White Female Black Female
2000 4276 5424 3033 4161
2001 4066 5524 2813 4091
2002 3928 5468 2767 4114
2003 3734 518 2638 3887
2004 3448 5079 2432 3643
2005 3366 4983 2375 3545
2006 3276 4994 2313 3477
2007 3236 4845 2223 327
2008 3158 4694 2238 3327
change 234 79 237 164
Heart Disease
Year White Male Black Male White Female Black Female
2000 3393 4298 227 3206
2001 3232 4445 2124 3166
2002 3118 4317 2197 3157
2003 2986 4184 1957 3001
2004 2777 3983 1783 2838
2005 2704 4009 1776 2679
2006 2644 3981 1739 2642
2007 2619 3972 1679 2532
2008 2566 3819 1687 2606
Stroke
Year White Male Black Male White Female Black Female
2000 61 768 561 703 176
2001 575 752 539 681 138
2002 573 806 528 66 15
2003 516 662 498 629 147
2004 463 743 476 562
2005 449 663 429 585
2006 434 63 411 556
2007 415 631 392 494
2008 402 606 392 509
2009 375 616 372 464
2010 372 565 366 513
2011 373 548 366 44
2012 348 587 349 477
2013 347 506 34 462
2014 369 506 352 482
Coronary Heart Disease
Year White Male Black Male White Female Black Female
2000 2625 329 1608 243
2001 2478 3356 1508 2314
2002 2404 3154 1419 2313
2003 2221 3093 1328 209
2004 2067 2956 119 1983
2005 1989 2885 117 1853
2006 1922 2903 1139 1825
2007 1921 2771 1074 1645
2008 1824 2592 1071 1722
Heart Failure
Year White Male Black Male White Female Black Female
2000 255 206 245 17
2001 267 225 225 167
2002 242 238 227 203
2003 256 217 222 189
2004 243 167 214 206
2005 24 218 217 172
2006 255 246 229 202
2007 23 225 208 196
2008 25 216 226 185
Not sure what this data is from previously HD Stroke
Year White Female Black Female White Female Black Female
2000 227 3206 561 703
2001 2124 3166 539 681
2002 2197 3157 528 66
2003 1957 3001 498 629
2004 1783 2838 476 562
2005 1776 2679 429 585
2006 1739 2642 411 556
2007
2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2009 2009 2009 2009
2010 2010 2010 2010
2011 2011 2011 2011
2012 2012 2012 2012
2013 2013 2013 2013
2014 2014 2014 2014
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
CVD
Year US Michigan 0-34 35-64 65-84 85+
2000 3397 3694 43 140 16141 86689
2001 3265 3524 508 1348 15291 82889
2002 3174 3421 45 1338 14891 79536
2003 3061 3258 54 1324 14033 75185
2004 2885 3034 41 1242 13209 69088
2005 2773 2972 48 1283 1291 66011
2006 2898 48 1207 12246 6786
2007 2825 5 1206 1182 66153
2008 2791 43 1175 11619 66406
Heart Disease
Year US Michigan 0-34 35-64 65-84 85+
2000 2576 2851 345 1158 1247 64879
2001 2478 2719 416 112 11794 61938
2002 2408 2631 35 1103 11529 58746
2003 2323 2517 45 110 10827 56172
2004 217 2337 313 1048 10086 51609
2005 2111 2308 38 1078 9937 49828
2006 226 384 1019 9413 51918
2007 2216 42 1008 9174 50961
2008 2192 36 982 904 51209
Stroke
Year US Michigan HP 2010 0-34 35-64 65-84 85+
2000 609 603 50 068 174 2589 15841
2001 579 577 50 0638 157 2522 1504
2002 562 571 50 072 169 2397 1528
2003 535 527 50 0737 157 2249 13741
2004 50 496 50 0652 138 220 12629
2005 466 464 50 0553 145 2063 11398
2006 444 50 0734 127 196 11256
2007 425 064 1368 1832 10718
2008 419 047 134 1804 10646
79 27 243 289
Coronary Heart Disease
Year US Michigan HP 2010 0-34 35-64 65-84 85+
2000 1868 2118 162 0613 874 7701 4670
2001 1778 2006 162 0898 818 9012 44369
2002 1709 192 162 0889 799 8759 41061
2003 1628 179 162 0793 785 8018 38358
2004 1502 1656 162 0865 757 7421 34644
2005 1444 1611 162 097 773 7245 32617
2006 1564 162 088 727 6856 33503
2007 1516 117 709 6585 32727
2008 1472 102 657 6403 32504
168 11 283
Heart Failure
Year US Michigan 35-64 65-84 85+
2000 203 245 3047 936 8287
2001 202 237 2596 88 8285
2002 194 233 2648 878 8057
2003 194 233 3176 902 7722
2004 189 224 2709 863 7586
2005 189 224 2955 878 7388
2006 24 2979 884 8354
2007 219 274 828 7483
2008 233 013 333 85 8102
Heart Disease Stroke
Michigan White Michigan Black US White US Black Michigan White Michigan Black US White US Black
1990 334 4315 317 3915 1990 638 733 629 917
1991 3289 4108 3088 3865 1991 626 781 607 894
1992 3126 3987 3011 3777 1992 609 694 598 86
1993 3234 429 3046 3843 1993 614 77 609 866
1994 3134 4156 295 3661 1994 634 875 609 869
1995 3048 4131 2912 3672 1995 638 925 615 879
1996 2997 380 2842 354 1996 617 804 61 852
1997 2851 3683 2764 345 1997 604 77 598 816
1998 2884 3586 2681 3406 1998 598 729 576 803
1999 2781 3692 2634 3367 1999 609 812 598 824
2000 2757 3663 2536 3265 2000 586 737 587 824
2001 261 3695 2435 3169 2001 56 718 558 788
2002 2522 3659 2367 3084 2002 553 729 542 763
2003 2409 350 2282 3002 2003 511 655 514 743
2004 222 3311 2133 2806 2004 477 633 48 699
2005 219 3227 2005 442 616
2006 2144 320 2006 426 589
2007 2007
2008 2008
CVD CHD HD HF Stroke
2000 3694 2118 2851 245 603
2001 3524 2006 2719 237 577
2002 3421 192 2631 233 571
2003 3258 179 2517 233 527
2004 3034 1656 2337 224 496
2005 2972 1611 2308 224 464
2006 2898 1564 226 24 444
2007 2825 1516 2216 219 425
2008 2791 1472 2192 233 419
2000 2000 2000
2001 2001 2001
2002 2002 2002
2003 2003 2003
2004 2004 2004
2005 2005 2005
2006 2006 2006
2007 2007 2007
2008 2008 2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2000 2000 2000 2000 2000
2001 2001 2001 2001 2001
2002 2002 2002 2002 2002
2003 2003 2003 2003 2003
2004 2004 2004 2004 2004
2005 2005 2005 2005 2005
2006 2006 2006 2006 2006
2007 2007 2007 2007 2007
2008 2008 2008 2008 2008
CVD
Year White Male Black Male White Female Black Female
2000 4276 5424 3033 4161
2001 4066 5524 2813 4091
2002 3928 5468 2767 4114
2003 3734 518 2638 3887
2004 3448 5079 2432 3643
2005 3366 4983 2375 3545
2006 3276 4994 2313 3477
2007 3236 4845 2223 327
2008 3158 4694 2238 3327
change 234 79 237 164
Heart Disease
Year White Male Black Male White Female Black Female
2000 3393 4298 227 3206
2001 3232 4445 2124 3166
2002 3118 4317 2197 3157
2003 2986 4184 1957 3001
2004 2777 3983 1783 2838
2005 2704 4009 1776 2679
2006 2644 3981 1739 2642
2007 2619 3972 1679 2532
2008 2566 3819 1687 2606
Stroke
Year White Male Black Male White Female Black Female
2000 61 768 561 703 176
2001 575 752 539 681 138
2002 573 806 528 66 15
2003 516 662 498 629 147
2004 463 743 476 562
2005 449 663 429 585
2006 434 63 411 556
2007 415 631 392 494
2008 402 606 392 509
Coronary Heart Disease
Year White Male Black Male White Female Black Female
2000 2625 329 1608 243
2001 2478 3356 1508 2314
2002 2404 3154 1419 2313
2003 2221 3093 1328 209
2004 2067 2956 119 1983
2005 1989 2885 117 1853
2006 1922 2903 1139 1825
2007 1921 2771 1074 1645
2008 1824 2592 1071 1722
Heart Failure
Year White Male Black Male White Female Black Female
2000 255 206 245 17
2001 267 225 225 167
2002 242 238 227 203
2003 256 217 222 189
2004 243 167 214 206
2005 24 218 217 172
2006 255 246 229 202
2007 23 225 208 196
2008 25 216 226 185
Not sure what this data is from previously HD Stroke
Year White Female Black Female White Female Black Female
2000 227 3206 561 703
2001 2124 3166 539 681
2002 2197 3157 528 66
2003 1957 3001 498 629
2004 1783 2838 476 562
2005 1776 2679 429 585
2006 1739 2642 411 556
2007
2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
CVD
Year US Michigan 0-34 35-64 65-84 85+
2000 3397 3694 43 140 16141 86689
2001 3265 3524 508 1348 15291 82889
2002 3174 3421 45 1338 14891 79536
2003 3061 3258 54 1324 14033 75185
2004 2885 3034 41 1242 13209 69088
2005 2773 2972 48 1283 1291 66011
2006 2898 48 1207 12246 6786
2007 2825 5 1206 1182 66153
2008 2791 43 1175 11619 66406
Heart Disease
Year US Michigan 0-34 35-64 65-84 85+
2000 2576 2851 345 1158 1247 64879
2001 2478 2719 416 112 11794 61938
2002 2408 2631 35 1103 11529 58746
2003 2323 2517 45 110 10827 56172
2004 217 2337 313 1048 10086 51609
2005 2111 2308 38 1078 9937 49828
2006 226 384 1019 9413 51918
2007 2216 42 1008 9174 50961
2008 2192 36 982 904 51209
Stroke
Year US Michigan HP 2010 0-34 35-64 65-84 85+
2000 609 603 50 068 174 2589 15841
2001 579 577 50 0638 157 2522 1504
2002 562 571 50 072 169 2397 1528
2003 535 527 50 0737 157 2249 13741
2004 50 496 50 0652 138 220 12629
2005 466 464 50 0553 145 2063 11398
2006 444 50 0734 127 196 11256
2007 425 064 1368 1832 10718
2008 419 047 134 1804 10646
79 27 243 289
Coronary Heart Disease
Year US Michigan HP 2010 0-34 35-64 65-84 85+
2000 1868 2118 162 0613 874 7701 4670
2001 1778 2006 162 0898 818 9012 44369
2002 1709 192 162 0889 799 8759 41061
2003 1628 179 162 0793 785 8018 38358
2004 1502 1656 162 0865 757 7421 34644
2005 1444 1611 162 097 773 7245 32617
2006 1564 162 088 727 6856 33503
2007 1516 117 709 6585 32727
2008 1472 102 657 6403 32504
168 11 283
Heart Failure
Year US Michigan 35-64 65-84 85+
2000 203 245 3047 936 8287
2001 202 237 2596 88 8285
2002 194 233 2648 878 8057
2003 194 233 3176 902 7722
2004 189 224 2709 863 7586
2005 189 224 2955 878 7388
2006 24 2979 884 8354
2007 219 274 828 7483
2008 233 013 333 85 8102
Heart Disease Stroke
Michigan White Michigan Black US White US Black Michigan White Michigan Black US White US Black
1990 334 4315 317 3915 1990 638 733 629 917
1991 3289 4108 3088 3865 1991 626 781 607 894
1992 3126 3987 3011 3777 1992 609 694 598 86
1993 3234 429 3046 3843 1993 614 77 609 866
1994 3134 4156 295 3661 1994 634 875 609 869
1995 3048 4131 2912 3672 1995 638 925 615 879
1996 2997 380 2842 354 1996 617 804 61 852
1997 2851 3683 2764 345 1997 604 77 598 816
1998 2884 3586 2681 3406 1998 598 729 576 803
1999 2781 3692 2634 3367 1999 609 812 598 824
2000 2757 3663 2536 3265 2000 586 737 587 824
2001 261 3695 2435 3169 2001 56 718 558 788
2002 2522 3659 2367 3084 2002 553 729 542 763
2003 2409 350 2282 3002 2003 511 655 514 743
2004 222 3311 2133 2806 2004 477 633 48 699
2005 219 3227 2005 442 616
2006 2144 320 2006 426 589
2007 2007
2008 2008
Stroke
CVD MI US
2000 3694 606 609
2001 3524 584 584
2002 3421 583 572
2003 3258 539 546
2004 3034 519 512
2005 2972 488 48
2006 2898 449 448
2007 2825 43 435
2008 2791 423 421
2009 262 396 396
2010 394 391
2011 387 379
2012 372 369
2013 363 369
2014 377 365
2000 2000 2000
2001 2001 2001
2002 2002 2002
2003 2003 2003
2004 2004 2004
2005 2005 2005
2006 2006 2006
2007 2007 2007
2008 2008 2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2000 2000
2001 2001
2002 2002
2003 2003
2004 2004
2005 2005
2006 2006
2007 2007
2008 2008
2009 2009
2010 2010
2011 2011
2012 2012
2013 2013
2014 2014
CVD Stroke
2000 2175 303
2001 2178 299
2002 2142 294
2003 2103 284
2004 2061 273
2005 2013 267
2006 2025 267
2007 1904 262
2008 1802 255
2009 1746 251
2010 1665 237
2011 235
2012 227
2013 227
2014 224
2015 233
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
Page 3: Michigan and MOSAIC Data Review...Michigan and MOSAIC Data Review 2017 ANNUAL WORKSHOP 4/26/2017. Adrienne Nickles, MPH. Michigan’s Ongoing Stroke Registry to Accelerate the Improvement

Age-adjusted Stroke Hospitalization Rates Michigan 2000-2015

303 299 294284

273 267 267 262 255 251237 235 227 227 224 233

0

5

10

15

20

25

30

35

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

Rat

e pe

r 10

000

Year

ICD-10

Denominator used from 2000-20014 ICD-9ICD-10 used to calculate hospitalization rates starting in 2015

Overall_Rates

Stroke
Year
Rate per 10000
303
299
294
284
273
267
267
262
255
251
237
235
227
227
224
233

total

Sheet3

Age-adjusted Stroke Mortality Rates Michigan 2000-2014

606584 583

539519

488

44943 423

396 394 387372 363

377

609584 572

546512

48448 435

421396 391 379 369 369 365

0

10

20

30

40

50

60

70

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014

Rat

e pe

r 100

000

Year

MI US

Overall_Rates

MI
US
Year
Rate per 100000
606
609
584
584
583
572
539
546
519
512
488
48
449
448
43
435
423
421
396
396
394
391
387
379
372
369
363
369
377
365

CVD_Age

0-34
35-64
65-84
85+
Year
Age-Adjusted Rate per 100000
43
140
16141
86689
508
1348
15291
82889
45
1338
14891
79536
54
1324
14033
75185
41
1242
13209
69088
48
1283
1291
66011
48
1207
12246
6786
5
1206
1182
66153
43
1175
11619
66406

HD_Age

0-34
35-64
65-84
85+
Year
Age-Adjusted Rate per 100000
345
1158
1247
64879
416
112
11794
61938
35
1103
11529
58746
45
110
10827
56172
313
1048
10086
51609
38
1078
9937
49828
384
1019
9413
51918
42
1008
9174
50961
36
982
904
51209

CHD_Age

0-34
35-64
65-84
85+
Year
Age-Adjusted Rate per 100000
0613
874
7701
4670
0898
818
9012
44369
0889
799
8759
41061
0793
785
8018
38358
0865
757
7421
34644
097
773
7245
32617
088
727
6856
33503
117
709
6585
32727
102
657
6403
32504

Stroke_Age

0-34
35-64
65-84
85+
Year
Age-Adjusted Rate per 100000
068
174
2589
15841
0638
157
2522
1504
072
169
2397
1528
0737
157
2249
13741
0652
138
220
12629
0553
145
2063
11398
0734
127
196
11256
064
1368
1832
10718
047
134
1804
10646

HF_Age

35-64
65-84
85+
Year
Age-Adjusted Rate per 100000
3047
936
8287
2596
88
8285
2648
878
8057
3176
902
7722
2709
863
7586
2955
878
7388
2979
884
8354
274
828
7483
333
85
8102

total

CVD_RG

White Male
Black Male
White Female
Black Female
Year
Age-Adjusted Rate per 100000
4276
5424
3033
4161
4066
5524
2813
4091
3928
5468
2767
4114
3734
518
2638
3887
3448
5079
2432
3643
3366
4983
2375
3545
3276
4994
2313
3477
3236
4845
2223
327
3158
4694
2238
3327

Stroke_RG

White Male
Black Male
White Female
Black Female
Year
Age-Adjusted Rate per 100000
61
768
561
703
575
752
539
681
573
806
528
66
516
662
498
629
463
743
476
562
449
663
429
585
434
63
411
556
415
631
392
494
402
606
392
509

HD_RG

White Male
Black Male
White Female
Black Female
Year
Age-Adjusted Rate per 100000
3393
4298
227
3206
3232
4445
2124
3166
3118
4317
2197
3157
2986
4184
1957
3001
2777
3983
1783
2838
2704
4009
1776
2679
2644
3981
1739
2642
2619
3972
1679
2532
2566
3819
1687
2606

CHD_RG

White Male
Black Male
White Female
Black Female
Year
Age-Adjusted Rate per 100000
2625
329
1608
243
2478
3356
1508
2314
2404
3154
1419
2313
2221
3093
1328
209
2067
2956
119
1983
1989
2885
117
1853
1922
2903
1139
1825
1921
2771
1074
1645
1824
2592
1071
1722

HF_RG

White Male
Black Male
White Female
Black Female
Year
Age-Adjusted Rate per 100000
255
206
245
17
267
225
225
167
242
238
227
203
256
217
222
189
243
167
214
206
24
218
217
172
255
246
229
202
23
225
208
196
25
216
226
185

race_gender

Sheet3

Age-adjusted stroke mortality rates by race and gender Michigan 2000 to 2014

0

10

20

30

40

50

60

70

80

90

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014

Age

-Adj

uste

d R

ate

per 1

000

00

Year

White Male

Black Male

White Female

Black Female

Overall_Rates

CVD
CHD
HD
HF
Stroke
Year
Rate per 10000
3694
2118
2851
245
603
3524
2006
2719
237
577
3421
192
2631
233
571
3258
179
2517
233
527
3034
1656
2337
224
496
2972
1611
2308
224
464
2898
1564
226
24
444
2825
1516
2216
219
425
2791
1472
2192
233
419

CVD_Age

0-34
35-64
65-84
85+
Year
Age-Adjusted Rate per 100000
43
140
16141
86689
508
1348
15291
82889
45
1338
14891
79536
54
1324
14033
75185
41
1242
13209
69088
48
1283
1291
66011
48
1207
12246
6786
5
1206
1182
66153
43
1175
11619
66406

HD_Age

0-34
35-64
65-84
85+
Year
Age-Adjusted Rate per 100000
345
1158
1247
64879
416
112
11794
61938
35
1103
11529
58746
45
110
10827
56172
313
1048
10086
51609
38
1078
9937
49828
384
1019
9413
51918
42
1008
9174
50961
36
982
904
51209

CHD_Age

0-34
35-64
65-84
85+
Year
Age-Adjusted Rate per 100000
0613
874
7701
4670
0898
818
9012
44369
0889
799
8759
41061
0793
785
8018
38358
0865
757
7421
34644
097
773
7245
32617
088
727
6856
33503
117
709
6585
32727
102
657
6403
32504

Stroke_Age

0-34
35-64
65-84
85+
Year
Age-Adjusted Rate per 100000
068
174
2589
15841
0638
157
2522
1504
072
169
2397
1528
0737
157
2249
13741
0652
138
220
12629
0553
145
2063
11398
0734
127
196
11256
064
1368
1832
10718
047
134
1804
10646

HF_Age

35-64
65-84
85+
Year
Age-Adjusted Rate per 100000
3047
936
8287
2596
88
8285
2648
878
8057
3176
902
7722
2709
863
7586
2955
878
7388
2979
884
8354
274
828
7483
333
85
8102

total

CVD_RG

White Male
Black Male
White Female
Black Female
Year
Age-Adjusted Rate per 100000
4276
5424
3033
4161
4066
5524
2813
4091
3928
5468
2767
4114
3734
518
2638
3887
3448
5079
2432
3643
3366
4983
2375
3545
3276
4994
2313
3477
3236
4845
2223
327
3158
4694
2238
3327

Stroke_RG

White Male
Black Male
White Female
Black Female
Year
Age-Adjusted Rate per 100000
61
768
561
703
575
752
539
681
573
806
528
66
516
662
498
629
463
743
476
562
449
663
429
585
434
63
411
556
415
631
392
494
402
606
392
509
375
616
372
464
372
565
366
513
373
548
366
44
348
587
349
477
347
506
34
462
369
506
352
482

HD_RG

White Male
Black Male
White Female
Black Female
Year
Age-Adjusted Rate per 100000
3393
4298
227
3206
3232
4445
2124
3166
3118
4317
2197
3157
2986
4184
1957
3001
2777
3983
1783
2838
2704
4009
1776
2679
2644
3981
1739
2642
2619
3972
1679
2532
2566
3819
1687
2606

CHD_RG

White Male
Black Male
White Female
Black Female
Year
Age-Adjusted Rate per 100000
2625
329
1608
243
2478
3356
1508
2314
2404
3154
1419
2313
2221
3093
1328
209
2067
2956
119
1983
1989
2885
117
1853
1922
2903
1139
1825
1921
2771
1074
1645
1824
2592
1071
1722

HF_RG

White Male
Black Male
White Female
Black Female
Year
Age-Adjusted Rate per 100000
255
206
245
17
267
225
225
167
242
238
227
203
256
217
222
189
243
167
214
206
24
218
217
172
255
246
229
202
23
225
208
196
25
216
226
185

race_gender

Sheet3

Local Health Department data can be found at wwwmichigangovbrfsSource CDC BRFSS

RISK FACTORMI

2011

MI

2013

MI

2014

MI

2015US 2015

2015 NATIONAL RANKING

Current Smoking 233 214 212 207 175 11

Blood Pressure Ever Told High 342 346 NA 331 309 18

Cholesterol Ever Told High 418 406 NA 382 364 12

Overweight (BMIgt25) 342 347 349 351 355 32tied

Obese (BMIgt30) 313 315 307 312 298 16

No Leisure Time Physical Activity 236 244 255 255 262 27

Diabetes 100 104 104 107 100 18tied

Prevalence of CVD Risk Factors Michigan Adults 1990-2015Compared to 2015 National Prevalence

233214 212 207

175

10

15

20

25

30

MI 2011 MI 2013 MI 2014 MI 2015 US 2015

Current Smoking

342 346331

309

20

25

30

35

40

MI 2011 MI 2013 MI 2014 MI 2015 US 2015

Blood Pressure Ever told high

342 347 349 351 355

20

25

30

35

40

MI 2011 MI 2013 MI 2014 MI 2015 US 2015

Overweight (BMIgt25)

313 315 307 312298

20

25

30

35

40

MI 2011 MI 2013 MI 2014 MI 2015 US 2015

Obese (BMIgt30)

418406

382364

30

35

40

45

50

MI 2011 MI 2013 MI 2014 MI 2015 US 2015

Cholesterol Ever told high

10 104 104 10710

0

3

6

9

12

15

MI 2011 MI 2013 MI 2014 MI 2015 US 2015

Diabetes

236 244255 255 262

10

15

20

25

30

MI 2011 MI 2013 MI 2014 MI 2015 US 2015

No Leisure Time Physical Activity

11 1216 18

2732tied

05

101520253035404550

CurrentSmoking

CholesterolEver told high

Obese(BMIgt30)

BloodPressure Ever

told high

Diabetes No LeisureTime Physical

Activity

Overweight(BMIgt25)

2015 NATIONAL RANKING(1st is worst)

18tied

MOSAIC 2015-2020 Focus of Grant Developing Stroke Systems of

Care Community Awareness EMS In-hospital QI Transition of Care Post-Discharge

12

Pre-hospital Care

A V A I L A B L E D A T A

13

EMSMOSAIC Data Linkage

-The MOSAIC Team continues to link data from the Michigan EMS Information System (MiEMSIS) to MOSAIC Data- Reports have been created for and reviewed by the

Tri-County Area MCA and Detroit East MCA- This work will expand to other MCA regions that

serve hospitals participating in MOSAIC

GWTG Special Initiatives Tab

-A free tab that can be enabled in GWTG-The purpose of the tab is to collect data concerning patient hand-off from EMS

MOSAIC Participating Hospitals

Aspirus Keweenaw Hospital (Laurium)

Aspirus Grand View HospitalAspirus Iron River HospitalAspirus Ontonagon HospitalBixby Medical CenterBronson Methodist HospitalCovenant Health CareDetroit Receiving HospitalGenesys Regional Medical CenterHenry Ford Hospital Herrick Medical CenterHuron Valley-Sinai HospitalLakeland Regional Medical Center McLaren Bay Regional Medical CenterMcLaren Greater Medical Center

McLaren Macomb HospitalMcLaren Northern MI HospitalMcLaren Oakland Medical CenterMcLaren Port Huron HospitalMcLaren Regional Medical CenterMercy Health Saint Maryrsquos HospitalMetro Health HospitalMunson Medical Center

ProMedica Monroe Regional HospitalSparrow HospitalSt Joseph Mercy - Ann ArborSt Joseph Mercy ChelseaSt Joseph Mercy Livingston HospitalSt Mary MercySt Mary of Michigan HospitalU of M Hospital

Hospital Infrastructure19

Among all participating hospitals the average number of

Licensed beds was 374 (range 25 to 1059 beds)

Inpatient discharges was 17076 (range 1064 to 48916 patients)

Acute stroke discharges (primary diagnosis only) was 417 (range 34 to 982 patients)

Case Demographics MOSAIC Registry

VariablesN() or statistics(Total N=68906)

Age at admission (years)Median 710Range 180 - 1060Mean (SE) 697(01)

GenderMale 32886 (477)Female 36015 (523)

RaceAfrican American 9900 (197)AIAN 132 (03)Asian 320 (06)More than one race 44 (01)Unknown 3679 (73)White 36190 (720)Missing 70

EthnicityHispanic or Latino 804 (16)Others 49531 (984)

VariablesN() or statistics(Total N=68906)

Health insuranceMedicaid 2284 (45)MedicaidPrivate 211 (04)Medicare 16863 (336)Medicare Medicaid 2313 (46)

MedicareMedicaidPrivate125 (02)

MedicarePrivate 13640 (272)ND 268(05)No insurance 2123 (42)Private 12356 (246)

Arrival modeEMS 21052 (429)Private

transportationother19313 (393)

Transfer from another hospital

7733(157)

ND or unknown 1021 (21)Missing 1216

Who receives data reports on your stroke quality of care

21

7055

70

10085

65

40

Hos

pita

lC

EO

up

per

man

agem

ent

Hos

pita

lB

oard

Chi

efN

ursi

ngO

ffice

r(C

NO

)

Str

oke

Tea

m

Phy

sici

anS

trok

eC

ham

pion

Chi

ef o

fM

edic

ine

Oth

er

Data Use

1) In the most recent calendar year have you run additional analyses (beyond what was required for reporting) on your hospitalrsquos own stroke data

2)How frequently have you run and used the analyses generated

22

Yes (N=16) 80

No (N=4) 20Weekly (N=2) 125

Monthly (N=8) 500

Less than monthly but more

than 1-2 times(N=6) 375

Data Use

What is the main reason you do not run your own additional analyses (Select one best answer)

23

Not sure how to run analyses

25

Not sure what analyses are needed would be helpful 25

Other 50

Data Use

In the most recent calendar year what reports did you run

24

813 688

Pre-programmedautomated reports in thedata collection tool (eg GWTG)

Additional reports beyond pre-programmed reports from the tool

Data Use

How do you use these analyses reports

25

813 688375

Inform quality improvement (QI) efforts andor plan

ldquoaction itemsrdquo

Report to management administration on our

progress

Other

Data Use

If you run additional analysis what action items QI efforts did you plan as a result of these reports

26

o Discharge education intensive statin use

o Door to tPA time and dysphagia

o Review data between spoke amp hub hospitals regarding transfers IV-tPA administration Mechanical thrombectomy and SAH

o QI efforts were addressed in the department involving calling Stroke Alert on call for cases with FAST symptoms

o ED Medical Director works with team to fix fallouts and problematic areas We have seen improvement

o Process changes (ie fallout emails to RN manager) physician querieso Increased documentation of NIHSS ownership from individual units regarding stroke quality

improvement goalso Daily dysphagia screening determination of whowhat team responsible for documenting initial NIHSS

looking at patients beyond 2h LKW arrival

Hospital Arrival Mode Door-to Needle and Pre-Notification

Reports 2016

Percent of Cases Who Arrived via EMSMOSAIC 2009-2016

Table 1 Arrival Mode among Stroke Cases by Demographics MOSAIC 2016

Demographics N=3496 550 N=2938 450Stroke Type Ischemic 2558 542 2164 458 Hemorrhagic 560 728 209 272 TIA 378 478 413 522Age Group lt 50 Years 233 433 305 567 50-79 Years 1982 497 2008 503 ge 80 Years 1379 688 625 312Sex Female 1933 576 1422 424 Male 1661 523 1516 477Race Black 659 530 584 470 White 2824 557 2248 443 Other Missing 111 512 106 488

MOSAIC AggregateArrival Mode

EMS Private Mode

Table 2 Door-to-Needle Times by Arrival Mode among Stroke Cases MOSAIC 2016

Time Elements (in Minutes)Number of

Patients Mean (Minutes) Median

(Minutes)Range

(Minutes)Door-to-Image 4901 575 400 00-2700 Arrived via EMS 2767 463 270 00-2700 Arrived via Private Transportation 2134 720 570 00-2620

Door-to-Image (among t-PA treated) 492 155 130 00-970 Arrived via EMS 370 125 110 00-840 Arrived via Private Transportation 122 243 215 20-970Image-to Needle 492 500 450 70-2090 Arrived via EMS 370 503 460 70-2090 Arrived via Private Transportation 122 483 420 90-1770Door-to Needle 492 655 570 200-2180 Arrived via EMS 370 629 560 200-2180 Arrived via Private Transportation 122 726 650 290-2060Included ischemic or hemorrhagic cases with times that were less or equal to 270 minutes (45 hours)Transferred cases were excluded

MOSAIC Aggregate

Table 3 Pre-Notification among Stroke Cases Who Arrived Via EMS by Demographics MOSAIC 2016

Demographics N=2015 584 N=1437 416Stroke Type Ischemic 1523 622 924 378 Hemorrhagic 306 566 235 434 TIA 142 381 231 619Age Group lt 50 Years 133 607 86 393 50-79 Years 1105 585 784 415 ge 80 Years 777 578 567 422Sex Female 1075 578 786 422 Male 940 591 651 409Race Black 307 517 287 483 White 1657 602 1097 398 Other 51 490 53 510

All HospitalsPre-Notification

Yes No

MOSAIC Transitions of Care Project

Post-discharge data collection tool is being implemented into Outcome Science as a tab

Post-Discharge amp Transition of Care

Reporting on changes within 30 days of discharge from hospital via follow-up callschart review Interval events Physician follow-up visits Lifestyle changes Lab assessments Medication managementadherence Rehab amp Functional outcomes Falls

MOSAIC Website

wwwMichigangovstroke

Adrienne Nickles MPHnicklesamichigangov

Thank You

  • Michigan and MOSAIC Data Review
  • Overview
  • Age-adjusted Stroke Hospitalization Rates Michigan 2000-2015
  • Slide Number 4
  • Age-adjusted Stroke Mortality Rates Michigan 2000-2014
  • Slide Number 6
  • Slide Number 7
  • Slide Number 8
  • Slide Number 9
  • Slide Number 10
  • Slide Number 11
  • MOSAIC 2015-2020
  • Pre-hospital Care
  • EMSMOSAIC Data Linkage
  • Slide Number 15
  • GWTG Special Initiatives Tab
  • Slide Number 17
  • MOSAIC Participating Hospitals
  • Hospital Infrastructure
  • Case Demographics MOSAIC Registry
  • Who receives data reports on your stroke quality of care
  • 1) In the most recent calendar year have you run additional analyses (beyond what was required for reporting) on your hospitalrsquos own stroke data 2)How frequently have you run and used the analyses generated
  • What is the main reason you do not run your own additional analyses (Select one best answer)
  • In the most recent calendar year what reports did you run
  • How do you use these analyses reports
  • If you run additional analysis what action items QI efforts did you plan as a result of these reports
  • Hospital Arrival Mode Door-to Needle and Pre-Notification Reports 2016
  • Percent of Cases Who Arrived via EMSMOSAIC 2009-2016
  • Table 1 Arrival Mode among Stroke Cases by Demographics MOSAIC 2016
  • Table 2 Door-to-Needle Times by Arrival Mode among Stroke Cases MOSAIC 2016
  • Table 3 Pre-Notification among Stroke Cases Who Arrived Via EMS by Demographics MOSAIC 2016
  • MOSAIC Transitions of Care Project
  • Slide Number 33
  • MOSAIC Website
  • Adrienne Nickles MPHnicklesamichigangov
CVD
Year White Male Black Male White Female Black Female
2000 4276 5424 3033 4161
2001 4066 5524 2813 4091
2002 3928 5468 2767 4114
2003 3734 518 2638 3887
2004 3448 5079 2432 3643
2005 3366 4983 2375 3545
2006 3276 4994 2313 3477
2007 3236 4845 2223 327
2008 3158 4694 2238 3327
change 234 79 237 164
Heart Disease
Year White Male Black Male White Female Black Female
2000 3393 4298 227 3206
2001 3232 4445 2124 3166
2002 3118 4317 2197 3157
2003 2986 4184 1957 3001
2004 2777 3983 1783 2838
2005 2704 4009 1776 2679
2006 2644 3981 1739 2642
2007 2619 3972 1679 2532
2008 2566 3819 1687 2606
Stroke
Year White Male Black Male White Female Black Female
2000 61 768 561 703 176
2001 575 752 539 681 138
2002 573 806 528 66 15
2003 516 662 498 629 147
2004 463 743 476 562
2005 449 663 429 585
2006 434 63 411 556
2007 415 631 392 494
2008 402 606 392 509
2009 375 616 372 464
2010 372 565 366 513
2011 373 548 366 44
2012 348 587 349 477
2013 347 506 34 462
2014 369 506 352 482
Coronary Heart Disease
Year White Male Black Male White Female Black Female
2000 2625 329 1608 243
2001 2478 3356 1508 2314
2002 2404 3154 1419 2313
2003 2221 3093 1328 209
2004 2067 2956 119 1983
2005 1989 2885 117 1853
2006 1922 2903 1139 1825
2007 1921 2771 1074 1645
2008 1824 2592 1071 1722
Heart Failure
Year White Male Black Male White Female Black Female
2000 255 206 245 17
2001 267 225 225 167
2002 242 238 227 203
2003 256 217 222 189
2004 243 167 214 206
2005 24 218 217 172
2006 255 246 229 202
2007 23 225 208 196
2008 25 216 226 185
Not sure what this data is from previously HD Stroke
Year White Female Black Female White Female Black Female
2000 227 3206 561 703
2001 2124 3166 539 681
2002 2197 3157 528 66
2003 1957 3001 498 629
2004 1783 2838 476 562
2005 1776 2679 429 585
2006 1739 2642 411 556
2007
2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2009 2009 2009 2009
2010 2010 2010 2010
2011 2011 2011 2011
2012 2012 2012 2012
2013 2013 2013 2013
2014 2014 2014 2014
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
CVD
Year US Michigan 0-34 35-64 65-84 85+
2000 3397 3694 43 140 16141 86689
2001 3265 3524 508 1348 15291 82889
2002 3174 3421 45 1338 14891 79536
2003 3061 3258 54 1324 14033 75185
2004 2885 3034 41 1242 13209 69088
2005 2773 2972 48 1283 1291 66011
2006 2898 48 1207 12246 6786
2007 2825 5 1206 1182 66153
2008 2791 43 1175 11619 66406
Heart Disease
Year US Michigan 0-34 35-64 65-84 85+
2000 2576 2851 345 1158 1247 64879
2001 2478 2719 416 112 11794 61938
2002 2408 2631 35 1103 11529 58746
2003 2323 2517 45 110 10827 56172
2004 217 2337 313 1048 10086 51609
2005 2111 2308 38 1078 9937 49828
2006 226 384 1019 9413 51918
2007 2216 42 1008 9174 50961
2008 2192 36 982 904 51209
Stroke
Year US Michigan HP 2010 0-34 35-64 65-84 85+
2000 609 603 50 068 174 2589 15841
2001 579 577 50 0638 157 2522 1504
2002 562 571 50 072 169 2397 1528
2003 535 527 50 0737 157 2249 13741
2004 50 496 50 0652 138 220 12629
2005 466 464 50 0553 145 2063 11398
2006 444 50 0734 127 196 11256
2007 425 064 1368 1832 10718
2008 419 047 134 1804 10646
79 27 243 289
Coronary Heart Disease
Year US Michigan HP 2010 0-34 35-64 65-84 85+
2000 1868 2118 162 0613 874 7701 4670
2001 1778 2006 162 0898 818 9012 44369
2002 1709 192 162 0889 799 8759 41061
2003 1628 179 162 0793 785 8018 38358
2004 1502 1656 162 0865 757 7421 34644
2005 1444 1611 162 097 773 7245 32617
2006 1564 162 088 727 6856 33503
2007 1516 117 709 6585 32727
2008 1472 102 657 6403 32504
168 11 283
Heart Failure
Year US Michigan 35-64 65-84 85+
2000 203 245 3047 936 8287
2001 202 237 2596 88 8285
2002 194 233 2648 878 8057
2003 194 233 3176 902 7722
2004 189 224 2709 863 7586
2005 189 224 2955 878 7388
2006 24 2979 884 8354
2007 219 274 828 7483
2008 233 013 333 85 8102
Heart Disease Stroke
Michigan White Michigan Black US White US Black Michigan White Michigan Black US White US Black
1990 334 4315 317 3915 1990 638 733 629 917
1991 3289 4108 3088 3865 1991 626 781 607 894
1992 3126 3987 3011 3777 1992 609 694 598 86
1993 3234 429 3046 3843 1993 614 77 609 866
1994 3134 4156 295 3661 1994 634 875 609 869
1995 3048 4131 2912 3672 1995 638 925 615 879
1996 2997 380 2842 354 1996 617 804 61 852
1997 2851 3683 2764 345 1997 604 77 598 816
1998 2884 3586 2681 3406 1998 598 729 576 803
1999 2781 3692 2634 3367 1999 609 812 598 824
2000 2757 3663 2536 3265 2000 586 737 587 824
2001 261 3695 2435 3169 2001 56 718 558 788
2002 2522 3659 2367 3084 2002 553 729 542 763
2003 2409 350 2282 3002 2003 511 655 514 743
2004 222 3311 2133 2806 2004 477 633 48 699
2005 219 3227 2005 442 616
2006 2144 320 2006 426 589
2007 2007
2008 2008
CVD CHD HD HF Stroke
2000 3694 2118 2851 245 603
2001 3524 2006 2719 237 577
2002 3421 192 2631 233 571
2003 3258 179 2517 233 527
2004 3034 1656 2337 224 496
2005 2972 1611 2308 224 464
2006 2898 1564 226 24 444
2007 2825 1516 2216 219 425
2008 2791 1472 2192 233 419
2000 2000 2000
2001 2001 2001
2002 2002 2002
2003 2003 2003
2004 2004 2004
2005 2005 2005
2006 2006 2006
2007 2007 2007
2008 2008 2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2000 2000 2000 2000 2000
2001 2001 2001 2001 2001
2002 2002 2002 2002 2002
2003 2003 2003 2003 2003
2004 2004 2004 2004 2004
2005 2005 2005 2005 2005
2006 2006 2006 2006 2006
2007 2007 2007 2007 2007
2008 2008 2008 2008 2008
CVD
Year White Male Black Male White Female Black Female
2000 4276 5424 3033 4161
2001 4066 5524 2813 4091
2002 3928 5468 2767 4114
2003 3734 518 2638 3887
2004 3448 5079 2432 3643
2005 3366 4983 2375 3545
2006 3276 4994 2313 3477
2007 3236 4845 2223 327
2008 3158 4694 2238 3327
change 234 79 237 164
Heart Disease
Year White Male Black Male White Female Black Female
2000 3393 4298 227 3206
2001 3232 4445 2124 3166
2002 3118 4317 2197 3157
2003 2986 4184 1957 3001
2004 2777 3983 1783 2838
2005 2704 4009 1776 2679
2006 2644 3981 1739 2642
2007 2619 3972 1679 2532
2008 2566 3819 1687 2606
Stroke
Year White Male Black Male White Female Black Female
2000 61 768 561 703 176
2001 575 752 539 681 138
2002 573 806 528 66 15
2003 516 662 498 629 147
2004 463 743 476 562
2005 449 663 429 585
2006 434 63 411 556
2007 415 631 392 494
2008 402 606 392 509
Coronary Heart Disease
Year White Male Black Male White Female Black Female
2000 2625 329 1608 243
2001 2478 3356 1508 2314
2002 2404 3154 1419 2313
2003 2221 3093 1328 209
2004 2067 2956 119 1983
2005 1989 2885 117 1853
2006 1922 2903 1139 1825
2007 1921 2771 1074 1645
2008 1824 2592 1071 1722
Heart Failure
Year White Male Black Male White Female Black Female
2000 255 206 245 17
2001 267 225 225 167
2002 242 238 227 203
2003 256 217 222 189
2004 243 167 214 206
2005 24 218 217 172
2006 255 246 229 202
2007 23 225 208 196
2008 25 216 226 185
Not sure what this data is from previously HD Stroke
Year White Female Black Female White Female Black Female
2000 227 3206 561 703
2001 2124 3166 539 681
2002 2197 3157 528 66
2003 1957 3001 498 629
2004 1783 2838 476 562
2005 1776 2679 429 585
2006 1739 2642 411 556
2007
2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
CVD
Year US Michigan 0-34 35-64 65-84 85+
2000 3397 3694 43 140 16141 86689
2001 3265 3524 508 1348 15291 82889
2002 3174 3421 45 1338 14891 79536
2003 3061 3258 54 1324 14033 75185
2004 2885 3034 41 1242 13209 69088
2005 2773 2972 48 1283 1291 66011
2006 2898 48 1207 12246 6786
2007 2825 5 1206 1182 66153
2008 2791 43 1175 11619 66406
Heart Disease
Year US Michigan 0-34 35-64 65-84 85+
2000 2576 2851 345 1158 1247 64879
2001 2478 2719 416 112 11794 61938
2002 2408 2631 35 1103 11529 58746
2003 2323 2517 45 110 10827 56172
2004 217 2337 313 1048 10086 51609
2005 2111 2308 38 1078 9937 49828
2006 226 384 1019 9413 51918
2007 2216 42 1008 9174 50961
2008 2192 36 982 904 51209
Stroke
Year US Michigan HP 2010 0-34 35-64 65-84 85+
2000 609 603 50 068 174 2589 15841
2001 579 577 50 0638 157 2522 1504
2002 562 571 50 072 169 2397 1528
2003 535 527 50 0737 157 2249 13741
2004 50 496 50 0652 138 220 12629
2005 466 464 50 0553 145 2063 11398
2006 444 50 0734 127 196 11256
2007 425 064 1368 1832 10718
2008 419 047 134 1804 10646
79 27 243 289
Coronary Heart Disease
Year US Michigan HP 2010 0-34 35-64 65-84 85+
2000 1868 2118 162 0613 874 7701 4670
2001 1778 2006 162 0898 818 9012 44369
2002 1709 192 162 0889 799 8759 41061
2003 1628 179 162 0793 785 8018 38358
2004 1502 1656 162 0865 757 7421 34644
2005 1444 1611 162 097 773 7245 32617
2006 1564 162 088 727 6856 33503
2007 1516 117 709 6585 32727
2008 1472 102 657 6403 32504
168 11 283
Heart Failure
Year US Michigan 35-64 65-84 85+
2000 203 245 3047 936 8287
2001 202 237 2596 88 8285
2002 194 233 2648 878 8057
2003 194 233 3176 902 7722
2004 189 224 2709 863 7586
2005 189 224 2955 878 7388
2006 24 2979 884 8354
2007 219 274 828 7483
2008 233 013 333 85 8102
Heart Disease Stroke
Michigan White Michigan Black US White US Black Michigan White Michigan Black US White US Black
1990 334 4315 317 3915 1990 638 733 629 917
1991 3289 4108 3088 3865 1991 626 781 607 894
1992 3126 3987 3011 3777 1992 609 694 598 86
1993 3234 429 3046 3843 1993 614 77 609 866
1994 3134 4156 295 3661 1994 634 875 609 869
1995 3048 4131 2912 3672 1995 638 925 615 879
1996 2997 380 2842 354 1996 617 804 61 852
1997 2851 3683 2764 345 1997 604 77 598 816
1998 2884 3586 2681 3406 1998 598 729 576 803
1999 2781 3692 2634 3367 1999 609 812 598 824
2000 2757 3663 2536 3265 2000 586 737 587 824
2001 261 3695 2435 3169 2001 56 718 558 788
2002 2522 3659 2367 3084 2002 553 729 542 763
2003 2409 350 2282 3002 2003 511 655 514 743
2004 222 3311 2133 2806 2004 477 633 48 699
2005 219 3227 2005 442 616
2006 2144 320 2006 426 589
2007 2007
2008 2008
Stroke
CVD MI US
2000 3694 606 609
2001 3524 584 584
2002 3421 583 572
2003 3258 539 546
2004 3034 519 512
2005 2972 488 48
2006 2898 449 448
2007 2825 43 435
2008 2791 423 421
2009 262 396 396
2010 394 391
2011 387 379
2012 372 369
2013 363 369
2014 377 365
2000 2000 2000
2001 2001 2001
2002 2002 2002
2003 2003 2003
2004 2004 2004
2005 2005 2005
2006 2006 2006
2007 2007 2007
2008 2008 2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2000 2000
2001 2001
2002 2002
2003 2003
2004 2004
2005 2005
2006 2006
2007 2007
2008 2008
2009 2009
2010 2010
2011 2011
2012 2012
2013 2013
2014 2014
CVD Stroke
2000 2175 303
2001 2178 299
2002 2142 294
2003 2103 284
2004 2061 273
2005 2013 267
2006 2025 267
2007 1904 262
2008 1802 255
2009 1746 251
2010 1665 237
2011 235
2012 227
2013 227
2014 224
2015 233
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
Page 4: Michigan and MOSAIC Data Review...Michigan and MOSAIC Data Review 2017 ANNUAL WORKSHOP 4/26/2017. Adrienne Nickles, MPH. Michigan’s Ongoing Stroke Registry to Accelerate the Improvement

Overall_Rates

Stroke
Year
Rate per 10000
303
299
294
284
273
267
267
262
255
251
237
235
227
227
224
233

total

Sheet3

Age-adjusted Stroke Mortality Rates Michigan 2000-2014

606584 583

539519

488

44943 423

396 394 387372 363

377

609584 572

546512

48448 435

421396 391 379 369 369 365

0

10

20

30

40

50

60

70

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014

Rat

e pe

r 100

000

Year

MI US

Overall_Rates

MI
US
Year
Rate per 100000
606
609
584
584
583
572
539
546
519
512
488
48
449
448
43
435
423
421
396
396
394
391
387
379
372
369
363
369
377
365

CVD_Age

0-34
35-64
65-84
85+
Year
Age-Adjusted Rate per 100000
43
140
16141
86689
508
1348
15291
82889
45
1338
14891
79536
54
1324
14033
75185
41
1242
13209
69088
48
1283
1291
66011
48
1207
12246
6786
5
1206
1182
66153
43
1175
11619
66406

HD_Age

0-34
35-64
65-84
85+
Year
Age-Adjusted Rate per 100000
345
1158
1247
64879
416
112
11794
61938
35
1103
11529
58746
45
110
10827
56172
313
1048
10086
51609
38
1078
9937
49828
384
1019
9413
51918
42
1008
9174
50961
36
982
904
51209

CHD_Age

0-34
35-64
65-84
85+
Year
Age-Adjusted Rate per 100000
0613
874
7701
4670
0898
818
9012
44369
0889
799
8759
41061
0793
785
8018
38358
0865
757
7421
34644
097
773
7245
32617
088
727
6856
33503
117
709
6585
32727
102
657
6403
32504

Stroke_Age

0-34
35-64
65-84
85+
Year
Age-Adjusted Rate per 100000
068
174
2589
15841
0638
157
2522
1504
072
169
2397
1528
0737
157
2249
13741
0652
138
220
12629
0553
145
2063
11398
0734
127
196
11256
064
1368
1832
10718
047
134
1804
10646

HF_Age

35-64
65-84
85+
Year
Age-Adjusted Rate per 100000
3047
936
8287
2596
88
8285
2648
878
8057
3176
902
7722
2709
863
7586
2955
878
7388
2979
884
8354
274
828
7483
333
85
8102

total

CVD_RG

White Male
Black Male
White Female
Black Female
Year
Age-Adjusted Rate per 100000
4276
5424
3033
4161
4066
5524
2813
4091
3928
5468
2767
4114
3734
518
2638
3887
3448
5079
2432
3643
3366
4983
2375
3545
3276
4994
2313
3477
3236
4845
2223
327
3158
4694
2238
3327

Stroke_RG

White Male
Black Male
White Female
Black Female
Year
Age-Adjusted Rate per 100000
61
768
561
703
575
752
539
681
573
806
528
66
516
662
498
629
463
743
476
562
449
663
429
585
434
63
411
556
415
631
392
494
402
606
392
509

HD_RG

White Male
Black Male
White Female
Black Female
Year
Age-Adjusted Rate per 100000
3393
4298
227
3206
3232
4445
2124
3166
3118
4317
2197
3157
2986
4184
1957
3001
2777
3983
1783
2838
2704
4009
1776
2679
2644
3981
1739
2642
2619
3972
1679
2532
2566
3819
1687
2606

CHD_RG

White Male
Black Male
White Female
Black Female
Year
Age-Adjusted Rate per 100000
2625
329
1608
243
2478
3356
1508
2314
2404
3154
1419
2313
2221
3093
1328
209
2067
2956
119
1983
1989
2885
117
1853
1922
2903
1139
1825
1921
2771
1074
1645
1824
2592
1071
1722

HF_RG

White Male
Black Male
White Female
Black Female
Year
Age-Adjusted Rate per 100000
255
206
245
17
267
225
225
167
242
238
227
203
256
217
222
189
243
167
214
206
24
218
217
172
255
246
229
202
23
225
208
196
25
216
226
185

race_gender

Sheet3

Age-adjusted stroke mortality rates by race and gender Michigan 2000 to 2014

0

10

20

30

40

50

60

70

80

90

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014

Age

-Adj

uste

d R

ate

per 1

000

00

Year

White Male

Black Male

White Female

Black Female

Overall_Rates

CVD
CHD
HD
HF
Stroke
Year
Rate per 10000
3694
2118
2851
245
603
3524
2006
2719
237
577
3421
192
2631
233
571
3258
179
2517
233
527
3034
1656
2337
224
496
2972
1611
2308
224
464
2898
1564
226
24
444
2825
1516
2216
219
425
2791
1472
2192
233
419

CVD_Age

0-34
35-64
65-84
85+
Year
Age-Adjusted Rate per 100000
43
140
16141
86689
508
1348
15291
82889
45
1338
14891
79536
54
1324
14033
75185
41
1242
13209
69088
48
1283
1291
66011
48
1207
12246
6786
5
1206
1182
66153
43
1175
11619
66406

HD_Age

0-34
35-64
65-84
85+
Year
Age-Adjusted Rate per 100000
345
1158
1247
64879
416
112
11794
61938
35
1103
11529
58746
45
110
10827
56172
313
1048
10086
51609
38
1078
9937
49828
384
1019
9413
51918
42
1008
9174
50961
36
982
904
51209

CHD_Age

0-34
35-64
65-84
85+
Year
Age-Adjusted Rate per 100000
0613
874
7701
4670
0898
818
9012
44369
0889
799
8759
41061
0793
785
8018
38358
0865
757
7421
34644
097
773
7245
32617
088
727
6856
33503
117
709
6585
32727
102
657
6403
32504

Stroke_Age

0-34
35-64
65-84
85+
Year
Age-Adjusted Rate per 100000
068
174
2589
15841
0638
157
2522
1504
072
169
2397
1528
0737
157
2249
13741
0652
138
220
12629
0553
145
2063
11398
0734
127
196
11256
064
1368
1832
10718
047
134
1804
10646

HF_Age

35-64
65-84
85+
Year
Age-Adjusted Rate per 100000
3047
936
8287
2596
88
8285
2648
878
8057
3176
902
7722
2709
863
7586
2955
878
7388
2979
884
8354
274
828
7483
333
85
8102

total

CVD_RG

White Male
Black Male
White Female
Black Female
Year
Age-Adjusted Rate per 100000
4276
5424
3033
4161
4066
5524
2813
4091
3928
5468
2767
4114
3734
518
2638
3887
3448
5079
2432
3643
3366
4983
2375
3545
3276
4994
2313
3477
3236
4845
2223
327
3158
4694
2238
3327

Stroke_RG

White Male
Black Male
White Female
Black Female
Year
Age-Adjusted Rate per 100000
61
768
561
703
575
752
539
681
573
806
528
66
516
662
498
629
463
743
476
562
449
663
429
585
434
63
411
556
415
631
392
494
402
606
392
509
375
616
372
464
372
565
366
513
373
548
366
44
348
587
349
477
347
506
34
462
369
506
352
482

HD_RG

White Male
Black Male
White Female
Black Female
Year
Age-Adjusted Rate per 100000
3393
4298
227
3206
3232
4445
2124
3166
3118
4317
2197
3157
2986
4184
1957
3001
2777
3983
1783
2838
2704
4009
1776
2679
2644
3981
1739
2642
2619
3972
1679
2532
2566
3819
1687
2606

CHD_RG

White Male
Black Male
White Female
Black Female
Year
Age-Adjusted Rate per 100000
2625
329
1608
243
2478
3356
1508
2314
2404
3154
1419
2313
2221
3093
1328
209
2067
2956
119
1983
1989
2885
117
1853
1922
2903
1139
1825
1921
2771
1074
1645
1824
2592
1071
1722

HF_RG

White Male
Black Male
White Female
Black Female
Year
Age-Adjusted Rate per 100000
255
206
245
17
267
225
225
167
242
238
227
203
256
217
222
189
243
167
214
206
24
218
217
172
255
246
229
202
23
225
208
196
25
216
226
185

race_gender

Sheet3

Local Health Department data can be found at wwwmichigangovbrfsSource CDC BRFSS

RISK FACTORMI

2011

MI

2013

MI

2014

MI

2015US 2015

2015 NATIONAL RANKING

Current Smoking 233 214 212 207 175 11

Blood Pressure Ever Told High 342 346 NA 331 309 18

Cholesterol Ever Told High 418 406 NA 382 364 12

Overweight (BMIgt25) 342 347 349 351 355 32tied

Obese (BMIgt30) 313 315 307 312 298 16

No Leisure Time Physical Activity 236 244 255 255 262 27

Diabetes 100 104 104 107 100 18tied

Prevalence of CVD Risk Factors Michigan Adults 1990-2015Compared to 2015 National Prevalence

233214 212 207

175

10

15

20

25

30

MI 2011 MI 2013 MI 2014 MI 2015 US 2015

Current Smoking

342 346331

309

20

25

30

35

40

MI 2011 MI 2013 MI 2014 MI 2015 US 2015

Blood Pressure Ever told high

342 347 349 351 355

20

25

30

35

40

MI 2011 MI 2013 MI 2014 MI 2015 US 2015

Overweight (BMIgt25)

313 315 307 312298

20

25

30

35

40

MI 2011 MI 2013 MI 2014 MI 2015 US 2015

Obese (BMIgt30)

418406

382364

30

35

40

45

50

MI 2011 MI 2013 MI 2014 MI 2015 US 2015

Cholesterol Ever told high

10 104 104 10710

0

3

6

9

12

15

MI 2011 MI 2013 MI 2014 MI 2015 US 2015

Diabetes

236 244255 255 262

10

15

20

25

30

MI 2011 MI 2013 MI 2014 MI 2015 US 2015

No Leisure Time Physical Activity

11 1216 18

2732tied

05

101520253035404550

CurrentSmoking

CholesterolEver told high

Obese(BMIgt30)

BloodPressure Ever

told high

Diabetes No LeisureTime Physical

Activity

Overweight(BMIgt25)

2015 NATIONAL RANKING(1st is worst)

18tied

MOSAIC 2015-2020 Focus of Grant Developing Stroke Systems of

Care Community Awareness EMS In-hospital QI Transition of Care Post-Discharge

12

Pre-hospital Care

A V A I L A B L E D A T A

13

EMSMOSAIC Data Linkage

-The MOSAIC Team continues to link data from the Michigan EMS Information System (MiEMSIS) to MOSAIC Data- Reports have been created for and reviewed by the

Tri-County Area MCA and Detroit East MCA- This work will expand to other MCA regions that

serve hospitals participating in MOSAIC

GWTG Special Initiatives Tab

-A free tab that can be enabled in GWTG-The purpose of the tab is to collect data concerning patient hand-off from EMS

MOSAIC Participating Hospitals

Aspirus Keweenaw Hospital (Laurium)

Aspirus Grand View HospitalAspirus Iron River HospitalAspirus Ontonagon HospitalBixby Medical CenterBronson Methodist HospitalCovenant Health CareDetroit Receiving HospitalGenesys Regional Medical CenterHenry Ford Hospital Herrick Medical CenterHuron Valley-Sinai HospitalLakeland Regional Medical Center McLaren Bay Regional Medical CenterMcLaren Greater Medical Center

McLaren Macomb HospitalMcLaren Northern MI HospitalMcLaren Oakland Medical CenterMcLaren Port Huron HospitalMcLaren Regional Medical CenterMercy Health Saint Maryrsquos HospitalMetro Health HospitalMunson Medical Center

ProMedica Monroe Regional HospitalSparrow HospitalSt Joseph Mercy - Ann ArborSt Joseph Mercy ChelseaSt Joseph Mercy Livingston HospitalSt Mary MercySt Mary of Michigan HospitalU of M Hospital

Hospital Infrastructure19

Among all participating hospitals the average number of

Licensed beds was 374 (range 25 to 1059 beds)

Inpatient discharges was 17076 (range 1064 to 48916 patients)

Acute stroke discharges (primary diagnosis only) was 417 (range 34 to 982 patients)

Case Demographics MOSAIC Registry

VariablesN() or statistics(Total N=68906)

Age at admission (years)Median 710Range 180 - 1060Mean (SE) 697(01)

GenderMale 32886 (477)Female 36015 (523)

RaceAfrican American 9900 (197)AIAN 132 (03)Asian 320 (06)More than one race 44 (01)Unknown 3679 (73)White 36190 (720)Missing 70

EthnicityHispanic or Latino 804 (16)Others 49531 (984)

VariablesN() or statistics(Total N=68906)

Health insuranceMedicaid 2284 (45)MedicaidPrivate 211 (04)Medicare 16863 (336)Medicare Medicaid 2313 (46)

MedicareMedicaidPrivate125 (02)

MedicarePrivate 13640 (272)ND 268(05)No insurance 2123 (42)Private 12356 (246)

Arrival modeEMS 21052 (429)Private

transportationother19313 (393)

Transfer from another hospital

7733(157)

ND or unknown 1021 (21)Missing 1216

Who receives data reports on your stroke quality of care

21

7055

70

10085

65

40

Hos

pita

lC

EO

up

per

man

agem

ent

Hos

pita

lB

oard

Chi

efN

ursi

ngO

ffice

r(C

NO

)

Str

oke

Tea

m

Phy

sici

anS

trok

eC

ham

pion

Chi

ef o

fM

edic

ine

Oth

er

Data Use

1) In the most recent calendar year have you run additional analyses (beyond what was required for reporting) on your hospitalrsquos own stroke data

2)How frequently have you run and used the analyses generated

22

Yes (N=16) 80

No (N=4) 20Weekly (N=2) 125

Monthly (N=8) 500

Less than monthly but more

than 1-2 times(N=6) 375

Data Use

What is the main reason you do not run your own additional analyses (Select one best answer)

23

Not sure how to run analyses

25

Not sure what analyses are needed would be helpful 25

Other 50

Data Use

In the most recent calendar year what reports did you run

24

813 688

Pre-programmedautomated reports in thedata collection tool (eg GWTG)

Additional reports beyond pre-programmed reports from the tool

Data Use

How do you use these analyses reports

25

813 688375

Inform quality improvement (QI) efforts andor plan

ldquoaction itemsrdquo

Report to management administration on our

progress

Other

Data Use

If you run additional analysis what action items QI efforts did you plan as a result of these reports

26

o Discharge education intensive statin use

o Door to tPA time and dysphagia

o Review data between spoke amp hub hospitals regarding transfers IV-tPA administration Mechanical thrombectomy and SAH

o QI efforts were addressed in the department involving calling Stroke Alert on call for cases with FAST symptoms

o ED Medical Director works with team to fix fallouts and problematic areas We have seen improvement

o Process changes (ie fallout emails to RN manager) physician querieso Increased documentation of NIHSS ownership from individual units regarding stroke quality

improvement goalso Daily dysphagia screening determination of whowhat team responsible for documenting initial NIHSS

looking at patients beyond 2h LKW arrival

Hospital Arrival Mode Door-to Needle and Pre-Notification

Reports 2016

Percent of Cases Who Arrived via EMSMOSAIC 2009-2016

Table 1 Arrival Mode among Stroke Cases by Demographics MOSAIC 2016

Demographics N=3496 550 N=2938 450Stroke Type Ischemic 2558 542 2164 458 Hemorrhagic 560 728 209 272 TIA 378 478 413 522Age Group lt 50 Years 233 433 305 567 50-79 Years 1982 497 2008 503 ge 80 Years 1379 688 625 312Sex Female 1933 576 1422 424 Male 1661 523 1516 477Race Black 659 530 584 470 White 2824 557 2248 443 Other Missing 111 512 106 488

MOSAIC AggregateArrival Mode

EMS Private Mode

Table 2 Door-to-Needle Times by Arrival Mode among Stroke Cases MOSAIC 2016

Time Elements (in Minutes)Number of

Patients Mean (Minutes) Median

(Minutes)Range

(Minutes)Door-to-Image 4901 575 400 00-2700 Arrived via EMS 2767 463 270 00-2700 Arrived via Private Transportation 2134 720 570 00-2620

Door-to-Image (among t-PA treated) 492 155 130 00-970 Arrived via EMS 370 125 110 00-840 Arrived via Private Transportation 122 243 215 20-970Image-to Needle 492 500 450 70-2090 Arrived via EMS 370 503 460 70-2090 Arrived via Private Transportation 122 483 420 90-1770Door-to Needle 492 655 570 200-2180 Arrived via EMS 370 629 560 200-2180 Arrived via Private Transportation 122 726 650 290-2060Included ischemic or hemorrhagic cases with times that were less or equal to 270 minutes (45 hours)Transferred cases were excluded

MOSAIC Aggregate

Table 3 Pre-Notification among Stroke Cases Who Arrived Via EMS by Demographics MOSAIC 2016

Demographics N=2015 584 N=1437 416Stroke Type Ischemic 1523 622 924 378 Hemorrhagic 306 566 235 434 TIA 142 381 231 619Age Group lt 50 Years 133 607 86 393 50-79 Years 1105 585 784 415 ge 80 Years 777 578 567 422Sex Female 1075 578 786 422 Male 940 591 651 409Race Black 307 517 287 483 White 1657 602 1097 398 Other 51 490 53 510

All HospitalsPre-Notification

Yes No

MOSAIC Transitions of Care Project

Post-discharge data collection tool is being implemented into Outcome Science as a tab

Post-Discharge amp Transition of Care

Reporting on changes within 30 days of discharge from hospital via follow-up callschart review Interval events Physician follow-up visits Lifestyle changes Lab assessments Medication managementadherence Rehab amp Functional outcomes Falls

MOSAIC Website

wwwMichigangovstroke

Adrienne Nickles MPHnicklesamichigangov

Thank You

  • Michigan and MOSAIC Data Review
  • Overview
  • Age-adjusted Stroke Hospitalization Rates Michigan 2000-2015
  • Slide Number 4
  • Age-adjusted Stroke Mortality Rates Michigan 2000-2014
  • Slide Number 6
  • Slide Number 7
  • Slide Number 8
  • Slide Number 9
  • Slide Number 10
  • Slide Number 11
  • MOSAIC 2015-2020
  • Pre-hospital Care
  • EMSMOSAIC Data Linkage
  • Slide Number 15
  • GWTG Special Initiatives Tab
  • Slide Number 17
  • MOSAIC Participating Hospitals
  • Hospital Infrastructure
  • Case Demographics MOSAIC Registry
  • Who receives data reports on your stroke quality of care
  • 1) In the most recent calendar year have you run additional analyses (beyond what was required for reporting) on your hospitalrsquos own stroke data 2)How frequently have you run and used the analyses generated
  • What is the main reason you do not run your own additional analyses (Select one best answer)
  • In the most recent calendar year what reports did you run
  • How do you use these analyses reports
  • If you run additional analysis what action items QI efforts did you plan as a result of these reports
  • Hospital Arrival Mode Door-to Needle and Pre-Notification Reports 2016
  • Percent of Cases Who Arrived via EMSMOSAIC 2009-2016
  • Table 1 Arrival Mode among Stroke Cases by Demographics MOSAIC 2016
  • Table 2 Door-to-Needle Times by Arrival Mode among Stroke Cases MOSAIC 2016
  • Table 3 Pre-Notification among Stroke Cases Who Arrived Via EMS by Demographics MOSAIC 2016
  • MOSAIC Transitions of Care Project
  • Slide Number 33
  • MOSAIC Website
  • Adrienne Nickles MPHnicklesamichigangov
CVD
Year White Male Black Male White Female Black Female
2000 4276 5424 3033 4161
2001 4066 5524 2813 4091
2002 3928 5468 2767 4114
2003 3734 518 2638 3887
2004 3448 5079 2432 3643
2005 3366 4983 2375 3545
2006 3276 4994 2313 3477
2007 3236 4845 2223 327
2008 3158 4694 2238 3327
change 234 79 237 164
Heart Disease
Year White Male Black Male White Female Black Female
2000 3393 4298 227 3206
2001 3232 4445 2124 3166
2002 3118 4317 2197 3157
2003 2986 4184 1957 3001
2004 2777 3983 1783 2838
2005 2704 4009 1776 2679
2006 2644 3981 1739 2642
2007 2619 3972 1679 2532
2008 2566 3819 1687 2606
Stroke
Year White Male Black Male White Female Black Female
2000 61 768 561 703 176
2001 575 752 539 681 138
2002 573 806 528 66 15
2003 516 662 498 629 147
2004 463 743 476 562
2005 449 663 429 585
2006 434 63 411 556
2007 415 631 392 494
2008 402 606 392 509
2009 375 616 372 464
2010 372 565 366 513
2011 373 548 366 44
2012 348 587 349 477
2013 347 506 34 462
2014 369 506 352 482
Coronary Heart Disease
Year White Male Black Male White Female Black Female
2000 2625 329 1608 243
2001 2478 3356 1508 2314
2002 2404 3154 1419 2313
2003 2221 3093 1328 209
2004 2067 2956 119 1983
2005 1989 2885 117 1853
2006 1922 2903 1139 1825
2007 1921 2771 1074 1645
2008 1824 2592 1071 1722
Heart Failure
Year White Male Black Male White Female Black Female
2000 255 206 245 17
2001 267 225 225 167
2002 242 238 227 203
2003 256 217 222 189
2004 243 167 214 206
2005 24 218 217 172
2006 255 246 229 202
2007 23 225 208 196
2008 25 216 226 185
Not sure what this data is from previously HD Stroke
Year White Female Black Female White Female Black Female
2000 227 3206 561 703
2001 2124 3166 539 681
2002 2197 3157 528 66
2003 1957 3001 498 629
2004 1783 2838 476 562
2005 1776 2679 429 585
2006 1739 2642 411 556
2007
2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2009 2009 2009 2009
2010 2010 2010 2010
2011 2011 2011 2011
2012 2012 2012 2012
2013 2013 2013 2013
2014 2014 2014 2014
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
CVD
Year US Michigan 0-34 35-64 65-84 85+
2000 3397 3694 43 140 16141 86689
2001 3265 3524 508 1348 15291 82889
2002 3174 3421 45 1338 14891 79536
2003 3061 3258 54 1324 14033 75185
2004 2885 3034 41 1242 13209 69088
2005 2773 2972 48 1283 1291 66011
2006 2898 48 1207 12246 6786
2007 2825 5 1206 1182 66153
2008 2791 43 1175 11619 66406
Heart Disease
Year US Michigan 0-34 35-64 65-84 85+
2000 2576 2851 345 1158 1247 64879
2001 2478 2719 416 112 11794 61938
2002 2408 2631 35 1103 11529 58746
2003 2323 2517 45 110 10827 56172
2004 217 2337 313 1048 10086 51609
2005 2111 2308 38 1078 9937 49828
2006 226 384 1019 9413 51918
2007 2216 42 1008 9174 50961
2008 2192 36 982 904 51209
Stroke
Year US Michigan HP 2010 0-34 35-64 65-84 85+
2000 609 603 50 068 174 2589 15841
2001 579 577 50 0638 157 2522 1504
2002 562 571 50 072 169 2397 1528
2003 535 527 50 0737 157 2249 13741
2004 50 496 50 0652 138 220 12629
2005 466 464 50 0553 145 2063 11398
2006 444 50 0734 127 196 11256
2007 425 064 1368 1832 10718
2008 419 047 134 1804 10646
79 27 243 289
Coronary Heart Disease
Year US Michigan HP 2010 0-34 35-64 65-84 85+
2000 1868 2118 162 0613 874 7701 4670
2001 1778 2006 162 0898 818 9012 44369
2002 1709 192 162 0889 799 8759 41061
2003 1628 179 162 0793 785 8018 38358
2004 1502 1656 162 0865 757 7421 34644
2005 1444 1611 162 097 773 7245 32617
2006 1564 162 088 727 6856 33503
2007 1516 117 709 6585 32727
2008 1472 102 657 6403 32504
168 11 283
Heart Failure
Year US Michigan 35-64 65-84 85+
2000 203 245 3047 936 8287
2001 202 237 2596 88 8285
2002 194 233 2648 878 8057
2003 194 233 3176 902 7722
2004 189 224 2709 863 7586
2005 189 224 2955 878 7388
2006 24 2979 884 8354
2007 219 274 828 7483
2008 233 013 333 85 8102
Heart Disease Stroke
Michigan White Michigan Black US White US Black Michigan White Michigan Black US White US Black
1990 334 4315 317 3915 1990 638 733 629 917
1991 3289 4108 3088 3865 1991 626 781 607 894
1992 3126 3987 3011 3777 1992 609 694 598 86
1993 3234 429 3046 3843 1993 614 77 609 866
1994 3134 4156 295 3661 1994 634 875 609 869
1995 3048 4131 2912 3672 1995 638 925 615 879
1996 2997 380 2842 354 1996 617 804 61 852
1997 2851 3683 2764 345 1997 604 77 598 816
1998 2884 3586 2681 3406 1998 598 729 576 803
1999 2781 3692 2634 3367 1999 609 812 598 824
2000 2757 3663 2536 3265 2000 586 737 587 824
2001 261 3695 2435 3169 2001 56 718 558 788
2002 2522 3659 2367 3084 2002 553 729 542 763
2003 2409 350 2282 3002 2003 511 655 514 743
2004 222 3311 2133 2806 2004 477 633 48 699
2005 219 3227 2005 442 616
2006 2144 320 2006 426 589
2007 2007
2008 2008
CVD CHD HD HF Stroke
2000 3694 2118 2851 245 603
2001 3524 2006 2719 237 577
2002 3421 192 2631 233 571
2003 3258 179 2517 233 527
2004 3034 1656 2337 224 496
2005 2972 1611 2308 224 464
2006 2898 1564 226 24 444
2007 2825 1516 2216 219 425
2008 2791 1472 2192 233 419
2000 2000 2000
2001 2001 2001
2002 2002 2002
2003 2003 2003
2004 2004 2004
2005 2005 2005
2006 2006 2006
2007 2007 2007
2008 2008 2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2000 2000 2000 2000 2000
2001 2001 2001 2001 2001
2002 2002 2002 2002 2002
2003 2003 2003 2003 2003
2004 2004 2004 2004 2004
2005 2005 2005 2005 2005
2006 2006 2006 2006 2006
2007 2007 2007 2007 2007
2008 2008 2008 2008 2008
CVD
Year White Male Black Male White Female Black Female
2000 4276 5424 3033 4161
2001 4066 5524 2813 4091
2002 3928 5468 2767 4114
2003 3734 518 2638 3887
2004 3448 5079 2432 3643
2005 3366 4983 2375 3545
2006 3276 4994 2313 3477
2007 3236 4845 2223 327
2008 3158 4694 2238 3327
change 234 79 237 164
Heart Disease
Year White Male Black Male White Female Black Female
2000 3393 4298 227 3206
2001 3232 4445 2124 3166
2002 3118 4317 2197 3157
2003 2986 4184 1957 3001
2004 2777 3983 1783 2838
2005 2704 4009 1776 2679
2006 2644 3981 1739 2642
2007 2619 3972 1679 2532
2008 2566 3819 1687 2606
Stroke
Year White Male Black Male White Female Black Female
2000 61 768 561 703 176
2001 575 752 539 681 138
2002 573 806 528 66 15
2003 516 662 498 629 147
2004 463 743 476 562
2005 449 663 429 585
2006 434 63 411 556
2007 415 631 392 494
2008 402 606 392 509
Coronary Heart Disease
Year White Male Black Male White Female Black Female
2000 2625 329 1608 243
2001 2478 3356 1508 2314
2002 2404 3154 1419 2313
2003 2221 3093 1328 209
2004 2067 2956 119 1983
2005 1989 2885 117 1853
2006 1922 2903 1139 1825
2007 1921 2771 1074 1645
2008 1824 2592 1071 1722
Heart Failure
Year White Male Black Male White Female Black Female
2000 255 206 245 17
2001 267 225 225 167
2002 242 238 227 203
2003 256 217 222 189
2004 243 167 214 206
2005 24 218 217 172
2006 255 246 229 202
2007 23 225 208 196
2008 25 216 226 185
Not sure what this data is from previously HD Stroke
Year White Female Black Female White Female Black Female
2000 227 3206 561 703
2001 2124 3166 539 681
2002 2197 3157 528 66
2003 1957 3001 498 629
2004 1783 2838 476 562
2005 1776 2679 429 585
2006 1739 2642 411 556
2007
2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
CVD
Year US Michigan 0-34 35-64 65-84 85+
2000 3397 3694 43 140 16141 86689
2001 3265 3524 508 1348 15291 82889
2002 3174 3421 45 1338 14891 79536
2003 3061 3258 54 1324 14033 75185
2004 2885 3034 41 1242 13209 69088
2005 2773 2972 48 1283 1291 66011
2006 2898 48 1207 12246 6786
2007 2825 5 1206 1182 66153
2008 2791 43 1175 11619 66406
Heart Disease
Year US Michigan 0-34 35-64 65-84 85+
2000 2576 2851 345 1158 1247 64879
2001 2478 2719 416 112 11794 61938
2002 2408 2631 35 1103 11529 58746
2003 2323 2517 45 110 10827 56172
2004 217 2337 313 1048 10086 51609
2005 2111 2308 38 1078 9937 49828
2006 226 384 1019 9413 51918
2007 2216 42 1008 9174 50961
2008 2192 36 982 904 51209
Stroke
Year US Michigan HP 2010 0-34 35-64 65-84 85+
2000 609 603 50 068 174 2589 15841
2001 579 577 50 0638 157 2522 1504
2002 562 571 50 072 169 2397 1528
2003 535 527 50 0737 157 2249 13741
2004 50 496 50 0652 138 220 12629
2005 466 464 50 0553 145 2063 11398
2006 444 50 0734 127 196 11256
2007 425 064 1368 1832 10718
2008 419 047 134 1804 10646
79 27 243 289
Coronary Heart Disease
Year US Michigan HP 2010 0-34 35-64 65-84 85+
2000 1868 2118 162 0613 874 7701 4670
2001 1778 2006 162 0898 818 9012 44369
2002 1709 192 162 0889 799 8759 41061
2003 1628 179 162 0793 785 8018 38358
2004 1502 1656 162 0865 757 7421 34644
2005 1444 1611 162 097 773 7245 32617
2006 1564 162 088 727 6856 33503
2007 1516 117 709 6585 32727
2008 1472 102 657 6403 32504
168 11 283
Heart Failure
Year US Michigan 35-64 65-84 85+
2000 203 245 3047 936 8287
2001 202 237 2596 88 8285
2002 194 233 2648 878 8057
2003 194 233 3176 902 7722
2004 189 224 2709 863 7586
2005 189 224 2955 878 7388
2006 24 2979 884 8354
2007 219 274 828 7483
2008 233 013 333 85 8102
Heart Disease Stroke
Michigan White Michigan Black US White US Black Michigan White Michigan Black US White US Black
1990 334 4315 317 3915 1990 638 733 629 917
1991 3289 4108 3088 3865 1991 626 781 607 894
1992 3126 3987 3011 3777 1992 609 694 598 86
1993 3234 429 3046 3843 1993 614 77 609 866
1994 3134 4156 295 3661 1994 634 875 609 869
1995 3048 4131 2912 3672 1995 638 925 615 879
1996 2997 380 2842 354 1996 617 804 61 852
1997 2851 3683 2764 345 1997 604 77 598 816
1998 2884 3586 2681 3406 1998 598 729 576 803
1999 2781 3692 2634 3367 1999 609 812 598 824
2000 2757 3663 2536 3265 2000 586 737 587 824
2001 261 3695 2435 3169 2001 56 718 558 788
2002 2522 3659 2367 3084 2002 553 729 542 763
2003 2409 350 2282 3002 2003 511 655 514 743
2004 222 3311 2133 2806 2004 477 633 48 699
2005 219 3227 2005 442 616
2006 2144 320 2006 426 589
2007 2007
2008 2008
Stroke
CVD MI US
2000 3694 606 609
2001 3524 584 584
2002 3421 583 572
2003 3258 539 546
2004 3034 519 512
2005 2972 488 48
2006 2898 449 448
2007 2825 43 435
2008 2791 423 421
2009 262 396 396
2010 394 391
2011 387 379
2012 372 369
2013 363 369
2014 377 365
2000 2000 2000
2001 2001 2001
2002 2002 2002
2003 2003 2003
2004 2004 2004
2005 2005 2005
2006 2006 2006
2007 2007 2007
2008 2008 2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2000 2000
2001 2001
2002 2002
2003 2003
2004 2004
2005 2005
2006 2006
2007 2007
2008 2008
2009 2009
2010 2010
2011 2011
2012 2012
2013 2013
2014 2014
CVD Stroke
2000 2175 303
2001 2178 299
2002 2142 294
2003 2103 284
2004 2061 273
2005 2013 267
2006 2025 267
2007 1904 262
2008 1802 255
2009 1746 251
2010 1665 237
2011 235
2012 227
2013 227
2014 224
2015 233
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
Page 5: Michigan and MOSAIC Data Review...Michigan and MOSAIC Data Review 2017 ANNUAL WORKSHOP 4/26/2017. Adrienne Nickles, MPH. Michigan’s Ongoing Stroke Registry to Accelerate the Improvement

total

Sheet3

Age-adjusted Stroke Mortality Rates Michigan 2000-2014

606584 583

539519

488

44943 423

396 394 387372 363

377

609584 572

546512

48448 435

421396 391 379 369 369 365

0

10

20

30

40

50

60

70

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014

Rat

e pe

r 100

000

Year

MI US

Overall_Rates

MI
US
Year
Rate per 100000
606
609
584
584
583
572
539
546
519
512
488
48
449
448
43
435
423
421
396
396
394
391
387
379
372
369
363
369
377
365

CVD_Age

0-34
35-64
65-84
85+
Year
Age-Adjusted Rate per 100000
43
140
16141
86689
508
1348
15291
82889
45
1338
14891
79536
54
1324
14033
75185
41
1242
13209
69088
48
1283
1291
66011
48
1207
12246
6786
5
1206
1182
66153
43
1175
11619
66406

HD_Age

0-34
35-64
65-84
85+
Year
Age-Adjusted Rate per 100000
345
1158
1247
64879
416
112
11794
61938
35
1103
11529
58746
45
110
10827
56172
313
1048
10086
51609
38
1078
9937
49828
384
1019
9413
51918
42
1008
9174
50961
36
982
904
51209

CHD_Age

0-34
35-64
65-84
85+
Year
Age-Adjusted Rate per 100000
0613
874
7701
4670
0898
818
9012
44369
0889
799
8759
41061
0793
785
8018
38358
0865
757
7421
34644
097
773
7245
32617
088
727
6856
33503
117
709
6585
32727
102
657
6403
32504

Stroke_Age

0-34
35-64
65-84
85+
Year
Age-Adjusted Rate per 100000
068
174
2589
15841
0638
157
2522
1504
072
169
2397
1528
0737
157
2249
13741
0652
138
220
12629
0553
145
2063
11398
0734
127
196
11256
064
1368
1832
10718
047
134
1804
10646

HF_Age

35-64
65-84
85+
Year
Age-Adjusted Rate per 100000
3047
936
8287
2596
88
8285
2648
878
8057
3176
902
7722
2709
863
7586
2955
878
7388
2979
884
8354
274
828
7483
333
85
8102

total

CVD_RG

White Male
Black Male
White Female
Black Female
Year
Age-Adjusted Rate per 100000
4276
5424
3033
4161
4066
5524
2813
4091
3928
5468
2767
4114
3734
518
2638
3887
3448
5079
2432
3643
3366
4983
2375
3545
3276
4994
2313
3477
3236
4845
2223
327
3158
4694
2238
3327

Stroke_RG

White Male
Black Male
White Female
Black Female
Year
Age-Adjusted Rate per 100000
61
768
561
703
575
752
539
681
573
806
528
66
516
662
498
629
463
743
476
562
449
663
429
585
434
63
411
556
415
631
392
494
402
606
392
509

HD_RG

White Male
Black Male
White Female
Black Female
Year
Age-Adjusted Rate per 100000
3393
4298
227
3206
3232
4445
2124
3166
3118
4317
2197
3157
2986
4184
1957
3001
2777
3983
1783
2838
2704
4009
1776
2679
2644
3981
1739
2642
2619
3972
1679
2532
2566
3819
1687
2606

CHD_RG

White Male
Black Male
White Female
Black Female
Year
Age-Adjusted Rate per 100000
2625
329
1608
243
2478
3356
1508
2314
2404
3154
1419
2313
2221
3093
1328
209
2067
2956
119
1983
1989
2885
117
1853
1922
2903
1139
1825
1921
2771
1074
1645
1824
2592
1071
1722

HF_RG

White Male
Black Male
White Female
Black Female
Year
Age-Adjusted Rate per 100000
255
206
245
17
267
225
225
167
242
238
227
203
256
217
222
189
243
167
214
206
24
218
217
172
255
246
229
202
23
225
208
196
25
216
226
185

race_gender

Sheet3

Age-adjusted stroke mortality rates by race and gender Michigan 2000 to 2014

0

10

20

30

40

50

60

70

80

90

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014

Age

-Adj

uste

d R

ate

per 1

000

00

Year

White Male

Black Male

White Female

Black Female

Overall_Rates

CVD
CHD
HD
HF
Stroke
Year
Rate per 10000
3694
2118
2851
245
603
3524
2006
2719
237
577
3421
192
2631
233
571
3258
179
2517
233
527
3034
1656
2337
224
496
2972
1611
2308
224
464
2898
1564
226
24
444
2825
1516
2216
219
425
2791
1472
2192
233
419

CVD_Age

0-34
35-64
65-84
85+
Year
Age-Adjusted Rate per 100000
43
140
16141
86689
508
1348
15291
82889
45
1338
14891
79536
54
1324
14033
75185
41
1242
13209
69088
48
1283
1291
66011
48
1207
12246
6786
5
1206
1182
66153
43
1175
11619
66406

HD_Age

0-34
35-64
65-84
85+
Year
Age-Adjusted Rate per 100000
345
1158
1247
64879
416
112
11794
61938
35
1103
11529
58746
45
110
10827
56172
313
1048
10086
51609
38
1078
9937
49828
384
1019
9413
51918
42
1008
9174
50961
36
982
904
51209

CHD_Age

0-34
35-64
65-84
85+
Year
Age-Adjusted Rate per 100000
0613
874
7701
4670
0898
818
9012
44369
0889
799
8759
41061
0793
785
8018
38358
0865
757
7421
34644
097
773
7245
32617
088
727
6856
33503
117
709
6585
32727
102
657
6403
32504

Stroke_Age

0-34
35-64
65-84
85+
Year
Age-Adjusted Rate per 100000
068
174
2589
15841
0638
157
2522
1504
072
169
2397
1528
0737
157
2249
13741
0652
138
220
12629
0553
145
2063
11398
0734
127
196
11256
064
1368
1832
10718
047
134
1804
10646

HF_Age

35-64
65-84
85+
Year
Age-Adjusted Rate per 100000
3047
936
8287
2596
88
8285
2648
878
8057
3176
902
7722
2709
863
7586
2955
878
7388
2979
884
8354
274
828
7483
333
85
8102

total

CVD_RG

White Male
Black Male
White Female
Black Female
Year
Age-Adjusted Rate per 100000
4276
5424
3033
4161
4066
5524
2813
4091
3928
5468
2767
4114
3734
518
2638
3887
3448
5079
2432
3643
3366
4983
2375
3545
3276
4994
2313
3477
3236
4845
2223
327
3158
4694
2238
3327

Stroke_RG

White Male
Black Male
White Female
Black Female
Year
Age-Adjusted Rate per 100000
61
768
561
703
575
752
539
681
573
806
528
66
516
662
498
629
463
743
476
562
449
663
429
585
434
63
411
556
415
631
392
494
402
606
392
509
375
616
372
464
372
565
366
513
373
548
366
44
348
587
349
477
347
506
34
462
369
506
352
482

HD_RG

White Male
Black Male
White Female
Black Female
Year
Age-Adjusted Rate per 100000
3393
4298
227
3206
3232
4445
2124
3166
3118
4317
2197
3157
2986
4184
1957
3001
2777
3983
1783
2838
2704
4009
1776
2679
2644
3981
1739
2642
2619
3972
1679
2532
2566
3819
1687
2606

CHD_RG

White Male
Black Male
White Female
Black Female
Year
Age-Adjusted Rate per 100000
2625
329
1608
243
2478
3356
1508
2314
2404
3154
1419
2313
2221
3093
1328
209
2067
2956
119
1983
1989
2885
117
1853
1922
2903
1139
1825
1921
2771
1074
1645
1824
2592
1071
1722

HF_RG

White Male
Black Male
White Female
Black Female
Year
Age-Adjusted Rate per 100000
255
206
245
17
267
225
225
167
242
238
227
203
256
217
222
189
243
167
214
206
24
218
217
172
255
246
229
202
23
225
208
196
25
216
226
185

race_gender

Sheet3

Local Health Department data can be found at wwwmichigangovbrfsSource CDC BRFSS

RISK FACTORMI

2011

MI

2013

MI

2014

MI

2015US 2015

2015 NATIONAL RANKING

Current Smoking 233 214 212 207 175 11

Blood Pressure Ever Told High 342 346 NA 331 309 18

Cholesterol Ever Told High 418 406 NA 382 364 12

Overweight (BMIgt25) 342 347 349 351 355 32tied

Obese (BMIgt30) 313 315 307 312 298 16

No Leisure Time Physical Activity 236 244 255 255 262 27

Diabetes 100 104 104 107 100 18tied

Prevalence of CVD Risk Factors Michigan Adults 1990-2015Compared to 2015 National Prevalence

233214 212 207

175

10

15

20

25

30

MI 2011 MI 2013 MI 2014 MI 2015 US 2015

Current Smoking

342 346331

309

20

25

30

35

40

MI 2011 MI 2013 MI 2014 MI 2015 US 2015

Blood Pressure Ever told high

342 347 349 351 355

20

25

30

35

40

MI 2011 MI 2013 MI 2014 MI 2015 US 2015

Overweight (BMIgt25)

313 315 307 312298

20

25

30

35

40

MI 2011 MI 2013 MI 2014 MI 2015 US 2015

Obese (BMIgt30)

418406

382364

30

35

40

45

50

MI 2011 MI 2013 MI 2014 MI 2015 US 2015

Cholesterol Ever told high

10 104 104 10710

0

3

6

9

12

15

MI 2011 MI 2013 MI 2014 MI 2015 US 2015

Diabetes

236 244255 255 262

10

15

20

25

30

MI 2011 MI 2013 MI 2014 MI 2015 US 2015

No Leisure Time Physical Activity

11 1216 18

2732tied

05

101520253035404550

CurrentSmoking

CholesterolEver told high

Obese(BMIgt30)

BloodPressure Ever

told high

Diabetes No LeisureTime Physical

Activity

Overweight(BMIgt25)

2015 NATIONAL RANKING(1st is worst)

18tied

MOSAIC 2015-2020 Focus of Grant Developing Stroke Systems of

Care Community Awareness EMS In-hospital QI Transition of Care Post-Discharge

12

Pre-hospital Care

A V A I L A B L E D A T A

13

EMSMOSAIC Data Linkage

-The MOSAIC Team continues to link data from the Michigan EMS Information System (MiEMSIS) to MOSAIC Data- Reports have been created for and reviewed by the

Tri-County Area MCA and Detroit East MCA- This work will expand to other MCA regions that

serve hospitals participating in MOSAIC

GWTG Special Initiatives Tab

-A free tab that can be enabled in GWTG-The purpose of the tab is to collect data concerning patient hand-off from EMS

MOSAIC Participating Hospitals

Aspirus Keweenaw Hospital (Laurium)

Aspirus Grand View HospitalAspirus Iron River HospitalAspirus Ontonagon HospitalBixby Medical CenterBronson Methodist HospitalCovenant Health CareDetroit Receiving HospitalGenesys Regional Medical CenterHenry Ford Hospital Herrick Medical CenterHuron Valley-Sinai HospitalLakeland Regional Medical Center McLaren Bay Regional Medical CenterMcLaren Greater Medical Center

McLaren Macomb HospitalMcLaren Northern MI HospitalMcLaren Oakland Medical CenterMcLaren Port Huron HospitalMcLaren Regional Medical CenterMercy Health Saint Maryrsquos HospitalMetro Health HospitalMunson Medical Center

ProMedica Monroe Regional HospitalSparrow HospitalSt Joseph Mercy - Ann ArborSt Joseph Mercy ChelseaSt Joseph Mercy Livingston HospitalSt Mary MercySt Mary of Michigan HospitalU of M Hospital

Hospital Infrastructure19

Among all participating hospitals the average number of

Licensed beds was 374 (range 25 to 1059 beds)

Inpatient discharges was 17076 (range 1064 to 48916 patients)

Acute stroke discharges (primary diagnosis only) was 417 (range 34 to 982 patients)

Case Demographics MOSAIC Registry

VariablesN() or statistics(Total N=68906)

Age at admission (years)Median 710Range 180 - 1060Mean (SE) 697(01)

GenderMale 32886 (477)Female 36015 (523)

RaceAfrican American 9900 (197)AIAN 132 (03)Asian 320 (06)More than one race 44 (01)Unknown 3679 (73)White 36190 (720)Missing 70

EthnicityHispanic or Latino 804 (16)Others 49531 (984)

VariablesN() or statistics(Total N=68906)

Health insuranceMedicaid 2284 (45)MedicaidPrivate 211 (04)Medicare 16863 (336)Medicare Medicaid 2313 (46)

MedicareMedicaidPrivate125 (02)

MedicarePrivate 13640 (272)ND 268(05)No insurance 2123 (42)Private 12356 (246)

Arrival modeEMS 21052 (429)Private

transportationother19313 (393)

Transfer from another hospital

7733(157)

ND or unknown 1021 (21)Missing 1216

Who receives data reports on your stroke quality of care

21

7055

70

10085

65

40

Hos

pita

lC

EO

up

per

man

agem

ent

Hos

pita

lB

oard

Chi

efN

ursi

ngO

ffice

r(C

NO

)

Str

oke

Tea

m

Phy

sici

anS

trok

eC

ham

pion

Chi

ef o

fM

edic

ine

Oth

er

Data Use

1) In the most recent calendar year have you run additional analyses (beyond what was required for reporting) on your hospitalrsquos own stroke data

2)How frequently have you run and used the analyses generated

22

Yes (N=16) 80

No (N=4) 20Weekly (N=2) 125

Monthly (N=8) 500

Less than monthly but more

than 1-2 times(N=6) 375

Data Use

What is the main reason you do not run your own additional analyses (Select one best answer)

23

Not sure how to run analyses

25

Not sure what analyses are needed would be helpful 25

Other 50

Data Use

In the most recent calendar year what reports did you run

24

813 688

Pre-programmedautomated reports in thedata collection tool (eg GWTG)

Additional reports beyond pre-programmed reports from the tool

Data Use

How do you use these analyses reports

25

813 688375

Inform quality improvement (QI) efforts andor plan

ldquoaction itemsrdquo

Report to management administration on our

progress

Other

Data Use

If you run additional analysis what action items QI efforts did you plan as a result of these reports

26

o Discharge education intensive statin use

o Door to tPA time and dysphagia

o Review data between spoke amp hub hospitals regarding transfers IV-tPA administration Mechanical thrombectomy and SAH

o QI efforts were addressed in the department involving calling Stroke Alert on call for cases with FAST symptoms

o ED Medical Director works with team to fix fallouts and problematic areas We have seen improvement

o Process changes (ie fallout emails to RN manager) physician querieso Increased documentation of NIHSS ownership from individual units regarding stroke quality

improvement goalso Daily dysphagia screening determination of whowhat team responsible for documenting initial NIHSS

looking at patients beyond 2h LKW arrival

Hospital Arrival Mode Door-to Needle and Pre-Notification

Reports 2016

Percent of Cases Who Arrived via EMSMOSAIC 2009-2016

Table 1 Arrival Mode among Stroke Cases by Demographics MOSAIC 2016

Demographics N=3496 550 N=2938 450Stroke Type Ischemic 2558 542 2164 458 Hemorrhagic 560 728 209 272 TIA 378 478 413 522Age Group lt 50 Years 233 433 305 567 50-79 Years 1982 497 2008 503 ge 80 Years 1379 688 625 312Sex Female 1933 576 1422 424 Male 1661 523 1516 477Race Black 659 530 584 470 White 2824 557 2248 443 Other Missing 111 512 106 488

MOSAIC AggregateArrival Mode

EMS Private Mode

Table 2 Door-to-Needle Times by Arrival Mode among Stroke Cases MOSAIC 2016

Time Elements (in Minutes)Number of

Patients Mean (Minutes) Median

(Minutes)Range

(Minutes)Door-to-Image 4901 575 400 00-2700 Arrived via EMS 2767 463 270 00-2700 Arrived via Private Transportation 2134 720 570 00-2620

Door-to-Image (among t-PA treated) 492 155 130 00-970 Arrived via EMS 370 125 110 00-840 Arrived via Private Transportation 122 243 215 20-970Image-to Needle 492 500 450 70-2090 Arrived via EMS 370 503 460 70-2090 Arrived via Private Transportation 122 483 420 90-1770Door-to Needle 492 655 570 200-2180 Arrived via EMS 370 629 560 200-2180 Arrived via Private Transportation 122 726 650 290-2060Included ischemic or hemorrhagic cases with times that were less or equal to 270 minutes (45 hours)Transferred cases were excluded

MOSAIC Aggregate

Table 3 Pre-Notification among Stroke Cases Who Arrived Via EMS by Demographics MOSAIC 2016

Demographics N=2015 584 N=1437 416Stroke Type Ischemic 1523 622 924 378 Hemorrhagic 306 566 235 434 TIA 142 381 231 619Age Group lt 50 Years 133 607 86 393 50-79 Years 1105 585 784 415 ge 80 Years 777 578 567 422Sex Female 1075 578 786 422 Male 940 591 651 409Race Black 307 517 287 483 White 1657 602 1097 398 Other 51 490 53 510

All HospitalsPre-Notification

Yes No

MOSAIC Transitions of Care Project

Post-discharge data collection tool is being implemented into Outcome Science as a tab

Post-Discharge amp Transition of Care

Reporting on changes within 30 days of discharge from hospital via follow-up callschart review Interval events Physician follow-up visits Lifestyle changes Lab assessments Medication managementadherence Rehab amp Functional outcomes Falls

MOSAIC Website

wwwMichigangovstroke

Adrienne Nickles MPHnicklesamichigangov

Thank You

  • Michigan and MOSAIC Data Review
  • Overview
  • Age-adjusted Stroke Hospitalization Rates Michigan 2000-2015
  • Slide Number 4
  • Age-adjusted Stroke Mortality Rates Michigan 2000-2014
  • Slide Number 6
  • Slide Number 7
  • Slide Number 8
  • Slide Number 9
  • Slide Number 10
  • Slide Number 11
  • MOSAIC 2015-2020
  • Pre-hospital Care
  • EMSMOSAIC Data Linkage
  • Slide Number 15
  • GWTG Special Initiatives Tab
  • Slide Number 17
  • MOSAIC Participating Hospitals
  • Hospital Infrastructure
  • Case Demographics MOSAIC Registry
  • Who receives data reports on your stroke quality of care
  • 1) In the most recent calendar year have you run additional analyses (beyond what was required for reporting) on your hospitalrsquos own stroke data 2)How frequently have you run and used the analyses generated
  • What is the main reason you do not run your own additional analyses (Select one best answer)
  • In the most recent calendar year what reports did you run
  • How do you use these analyses reports
  • If you run additional analysis what action items QI efforts did you plan as a result of these reports
  • Hospital Arrival Mode Door-to Needle and Pre-Notification Reports 2016
  • Percent of Cases Who Arrived via EMSMOSAIC 2009-2016
  • Table 1 Arrival Mode among Stroke Cases by Demographics MOSAIC 2016
  • Table 2 Door-to-Needle Times by Arrival Mode among Stroke Cases MOSAIC 2016
  • Table 3 Pre-Notification among Stroke Cases Who Arrived Via EMS by Demographics MOSAIC 2016
  • MOSAIC Transitions of Care Project
  • Slide Number 33
  • MOSAIC Website
  • Adrienne Nickles MPHnicklesamichigangov
CVD
Year White Male Black Male White Female Black Female
2000 4276 5424 3033 4161
2001 4066 5524 2813 4091
2002 3928 5468 2767 4114
2003 3734 518 2638 3887
2004 3448 5079 2432 3643
2005 3366 4983 2375 3545
2006 3276 4994 2313 3477
2007 3236 4845 2223 327
2008 3158 4694 2238 3327
change 234 79 237 164
Heart Disease
Year White Male Black Male White Female Black Female
2000 3393 4298 227 3206
2001 3232 4445 2124 3166
2002 3118 4317 2197 3157
2003 2986 4184 1957 3001
2004 2777 3983 1783 2838
2005 2704 4009 1776 2679
2006 2644 3981 1739 2642
2007 2619 3972 1679 2532
2008 2566 3819 1687 2606
Stroke
Year White Male Black Male White Female Black Female
2000 61 768 561 703 176
2001 575 752 539 681 138
2002 573 806 528 66 15
2003 516 662 498 629 147
2004 463 743 476 562
2005 449 663 429 585
2006 434 63 411 556
2007 415 631 392 494
2008 402 606 392 509
2009 375 616 372 464
2010 372 565 366 513
2011 373 548 366 44
2012 348 587 349 477
2013 347 506 34 462
2014 369 506 352 482
Coronary Heart Disease
Year White Male Black Male White Female Black Female
2000 2625 329 1608 243
2001 2478 3356 1508 2314
2002 2404 3154 1419 2313
2003 2221 3093 1328 209
2004 2067 2956 119 1983
2005 1989 2885 117 1853
2006 1922 2903 1139 1825
2007 1921 2771 1074 1645
2008 1824 2592 1071 1722
Heart Failure
Year White Male Black Male White Female Black Female
2000 255 206 245 17
2001 267 225 225 167
2002 242 238 227 203
2003 256 217 222 189
2004 243 167 214 206
2005 24 218 217 172
2006 255 246 229 202
2007 23 225 208 196
2008 25 216 226 185
Not sure what this data is from previously HD Stroke
Year White Female Black Female White Female Black Female
2000 227 3206 561 703
2001 2124 3166 539 681
2002 2197 3157 528 66
2003 1957 3001 498 629
2004 1783 2838 476 562
2005 1776 2679 429 585
2006 1739 2642 411 556
2007
2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2009 2009 2009 2009
2010 2010 2010 2010
2011 2011 2011 2011
2012 2012 2012 2012
2013 2013 2013 2013
2014 2014 2014 2014
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
CVD
Year US Michigan 0-34 35-64 65-84 85+
2000 3397 3694 43 140 16141 86689
2001 3265 3524 508 1348 15291 82889
2002 3174 3421 45 1338 14891 79536
2003 3061 3258 54 1324 14033 75185
2004 2885 3034 41 1242 13209 69088
2005 2773 2972 48 1283 1291 66011
2006 2898 48 1207 12246 6786
2007 2825 5 1206 1182 66153
2008 2791 43 1175 11619 66406
Heart Disease
Year US Michigan 0-34 35-64 65-84 85+
2000 2576 2851 345 1158 1247 64879
2001 2478 2719 416 112 11794 61938
2002 2408 2631 35 1103 11529 58746
2003 2323 2517 45 110 10827 56172
2004 217 2337 313 1048 10086 51609
2005 2111 2308 38 1078 9937 49828
2006 226 384 1019 9413 51918
2007 2216 42 1008 9174 50961
2008 2192 36 982 904 51209
Stroke
Year US Michigan HP 2010 0-34 35-64 65-84 85+
2000 609 603 50 068 174 2589 15841
2001 579 577 50 0638 157 2522 1504
2002 562 571 50 072 169 2397 1528
2003 535 527 50 0737 157 2249 13741
2004 50 496 50 0652 138 220 12629
2005 466 464 50 0553 145 2063 11398
2006 444 50 0734 127 196 11256
2007 425 064 1368 1832 10718
2008 419 047 134 1804 10646
79 27 243 289
Coronary Heart Disease
Year US Michigan HP 2010 0-34 35-64 65-84 85+
2000 1868 2118 162 0613 874 7701 4670
2001 1778 2006 162 0898 818 9012 44369
2002 1709 192 162 0889 799 8759 41061
2003 1628 179 162 0793 785 8018 38358
2004 1502 1656 162 0865 757 7421 34644
2005 1444 1611 162 097 773 7245 32617
2006 1564 162 088 727 6856 33503
2007 1516 117 709 6585 32727
2008 1472 102 657 6403 32504
168 11 283
Heart Failure
Year US Michigan 35-64 65-84 85+
2000 203 245 3047 936 8287
2001 202 237 2596 88 8285
2002 194 233 2648 878 8057
2003 194 233 3176 902 7722
2004 189 224 2709 863 7586
2005 189 224 2955 878 7388
2006 24 2979 884 8354
2007 219 274 828 7483
2008 233 013 333 85 8102
Heart Disease Stroke
Michigan White Michigan Black US White US Black Michigan White Michigan Black US White US Black
1990 334 4315 317 3915 1990 638 733 629 917
1991 3289 4108 3088 3865 1991 626 781 607 894
1992 3126 3987 3011 3777 1992 609 694 598 86
1993 3234 429 3046 3843 1993 614 77 609 866
1994 3134 4156 295 3661 1994 634 875 609 869
1995 3048 4131 2912 3672 1995 638 925 615 879
1996 2997 380 2842 354 1996 617 804 61 852
1997 2851 3683 2764 345 1997 604 77 598 816
1998 2884 3586 2681 3406 1998 598 729 576 803
1999 2781 3692 2634 3367 1999 609 812 598 824
2000 2757 3663 2536 3265 2000 586 737 587 824
2001 261 3695 2435 3169 2001 56 718 558 788
2002 2522 3659 2367 3084 2002 553 729 542 763
2003 2409 350 2282 3002 2003 511 655 514 743
2004 222 3311 2133 2806 2004 477 633 48 699
2005 219 3227 2005 442 616
2006 2144 320 2006 426 589
2007 2007
2008 2008
CVD CHD HD HF Stroke
2000 3694 2118 2851 245 603
2001 3524 2006 2719 237 577
2002 3421 192 2631 233 571
2003 3258 179 2517 233 527
2004 3034 1656 2337 224 496
2005 2972 1611 2308 224 464
2006 2898 1564 226 24 444
2007 2825 1516 2216 219 425
2008 2791 1472 2192 233 419
2000 2000 2000
2001 2001 2001
2002 2002 2002
2003 2003 2003
2004 2004 2004
2005 2005 2005
2006 2006 2006
2007 2007 2007
2008 2008 2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2000 2000 2000 2000 2000
2001 2001 2001 2001 2001
2002 2002 2002 2002 2002
2003 2003 2003 2003 2003
2004 2004 2004 2004 2004
2005 2005 2005 2005 2005
2006 2006 2006 2006 2006
2007 2007 2007 2007 2007
2008 2008 2008 2008 2008
CVD
Year White Male Black Male White Female Black Female
2000 4276 5424 3033 4161
2001 4066 5524 2813 4091
2002 3928 5468 2767 4114
2003 3734 518 2638 3887
2004 3448 5079 2432 3643
2005 3366 4983 2375 3545
2006 3276 4994 2313 3477
2007 3236 4845 2223 327
2008 3158 4694 2238 3327
change 234 79 237 164
Heart Disease
Year White Male Black Male White Female Black Female
2000 3393 4298 227 3206
2001 3232 4445 2124 3166
2002 3118 4317 2197 3157
2003 2986 4184 1957 3001
2004 2777 3983 1783 2838
2005 2704 4009 1776 2679
2006 2644 3981 1739 2642
2007 2619 3972 1679 2532
2008 2566 3819 1687 2606
Stroke
Year White Male Black Male White Female Black Female
2000 61 768 561 703 176
2001 575 752 539 681 138
2002 573 806 528 66 15
2003 516 662 498 629 147
2004 463 743 476 562
2005 449 663 429 585
2006 434 63 411 556
2007 415 631 392 494
2008 402 606 392 509
Coronary Heart Disease
Year White Male Black Male White Female Black Female
2000 2625 329 1608 243
2001 2478 3356 1508 2314
2002 2404 3154 1419 2313
2003 2221 3093 1328 209
2004 2067 2956 119 1983
2005 1989 2885 117 1853
2006 1922 2903 1139 1825
2007 1921 2771 1074 1645
2008 1824 2592 1071 1722
Heart Failure
Year White Male Black Male White Female Black Female
2000 255 206 245 17
2001 267 225 225 167
2002 242 238 227 203
2003 256 217 222 189
2004 243 167 214 206
2005 24 218 217 172
2006 255 246 229 202
2007 23 225 208 196
2008 25 216 226 185
Not sure what this data is from previously HD Stroke
Year White Female Black Female White Female Black Female
2000 227 3206 561 703
2001 2124 3166 539 681
2002 2197 3157 528 66
2003 1957 3001 498 629
2004 1783 2838 476 562
2005 1776 2679 429 585
2006 1739 2642 411 556
2007
2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
CVD
Year US Michigan 0-34 35-64 65-84 85+
2000 3397 3694 43 140 16141 86689
2001 3265 3524 508 1348 15291 82889
2002 3174 3421 45 1338 14891 79536
2003 3061 3258 54 1324 14033 75185
2004 2885 3034 41 1242 13209 69088
2005 2773 2972 48 1283 1291 66011
2006 2898 48 1207 12246 6786
2007 2825 5 1206 1182 66153
2008 2791 43 1175 11619 66406
Heart Disease
Year US Michigan 0-34 35-64 65-84 85+
2000 2576 2851 345 1158 1247 64879
2001 2478 2719 416 112 11794 61938
2002 2408 2631 35 1103 11529 58746
2003 2323 2517 45 110 10827 56172
2004 217 2337 313 1048 10086 51609
2005 2111 2308 38 1078 9937 49828
2006 226 384 1019 9413 51918
2007 2216 42 1008 9174 50961
2008 2192 36 982 904 51209
Stroke
Year US Michigan HP 2010 0-34 35-64 65-84 85+
2000 609 603 50 068 174 2589 15841
2001 579 577 50 0638 157 2522 1504
2002 562 571 50 072 169 2397 1528
2003 535 527 50 0737 157 2249 13741
2004 50 496 50 0652 138 220 12629
2005 466 464 50 0553 145 2063 11398
2006 444 50 0734 127 196 11256
2007 425 064 1368 1832 10718
2008 419 047 134 1804 10646
79 27 243 289
Coronary Heart Disease
Year US Michigan HP 2010 0-34 35-64 65-84 85+
2000 1868 2118 162 0613 874 7701 4670
2001 1778 2006 162 0898 818 9012 44369
2002 1709 192 162 0889 799 8759 41061
2003 1628 179 162 0793 785 8018 38358
2004 1502 1656 162 0865 757 7421 34644
2005 1444 1611 162 097 773 7245 32617
2006 1564 162 088 727 6856 33503
2007 1516 117 709 6585 32727
2008 1472 102 657 6403 32504
168 11 283
Heart Failure
Year US Michigan 35-64 65-84 85+
2000 203 245 3047 936 8287
2001 202 237 2596 88 8285
2002 194 233 2648 878 8057
2003 194 233 3176 902 7722
2004 189 224 2709 863 7586
2005 189 224 2955 878 7388
2006 24 2979 884 8354
2007 219 274 828 7483
2008 233 013 333 85 8102
Heart Disease Stroke
Michigan White Michigan Black US White US Black Michigan White Michigan Black US White US Black
1990 334 4315 317 3915 1990 638 733 629 917
1991 3289 4108 3088 3865 1991 626 781 607 894
1992 3126 3987 3011 3777 1992 609 694 598 86
1993 3234 429 3046 3843 1993 614 77 609 866
1994 3134 4156 295 3661 1994 634 875 609 869
1995 3048 4131 2912 3672 1995 638 925 615 879
1996 2997 380 2842 354 1996 617 804 61 852
1997 2851 3683 2764 345 1997 604 77 598 816
1998 2884 3586 2681 3406 1998 598 729 576 803
1999 2781 3692 2634 3367 1999 609 812 598 824
2000 2757 3663 2536 3265 2000 586 737 587 824
2001 261 3695 2435 3169 2001 56 718 558 788
2002 2522 3659 2367 3084 2002 553 729 542 763
2003 2409 350 2282 3002 2003 511 655 514 743
2004 222 3311 2133 2806 2004 477 633 48 699
2005 219 3227 2005 442 616
2006 2144 320 2006 426 589
2007 2007
2008 2008
Stroke
CVD MI US
2000 3694 606 609
2001 3524 584 584
2002 3421 583 572
2003 3258 539 546
2004 3034 519 512
2005 2972 488 48
2006 2898 449 448
2007 2825 43 435
2008 2791 423 421
2009 262 396 396
2010 394 391
2011 387 379
2012 372 369
2013 363 369
2014 377 365
2000 2000 2000
2001 2001 2001
2002 2002 2002
2003 2003 2003
2004 2004 2004
2005 2005 2005
2006 2006 2006
2007 2007 2007
2008 2008 2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2000 2000
2001 2001
2002 2002
2003 2003
2004 2004
2005 2005
2006 2006
2007 2007
2008 2008
2009 2009
2010 2010
2011 2011
2012 2012
2013 2013
2014 2014
CVD Stroke
2000 2175 303
2001 2178 299
2002 2142 294
2003 2103 284
2004 2061 273
2005 2013 267
2006 2025 267
2007 1904 262
2008 1802 255
2009 1746 251
2010 1665 237
2011 235
2012 227
2013 227
2014 224
2015 233
Page 6: Michigan and MOSAIC Data Review...Michigan and MOSAIC Data Review 2017 ANNUAL WORKSHOP 4/26/2017. Adrienne Nickles, MPH. Michigan’s Ongoing Stroke Registry to Accelerate the Improvement

Sheet3

Age-adjusted Stroke Mortality Rates Michigan 2000-2014

606584 583

539519

488

44943 423

396 394 387372 363

377

609584 572

546512

48448 435

421396 391 379 369 369 365

0

10

20

30

40

50

60

70

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014

Rat

e pe

r 100

000

Year

MI US

Overall_Rates

MI
US
Year
Rate per 100000
606
609
584
584
583
572
539
546
519
512
488
48
449
448
43
435
423
421
396
396
394
391
387
379
372
369
363
369
377
365

CVD_Age

0-34
35-64
65-84
85+
Year
Age-Adjusted Rate per 100000
43
140
16141
86689
508
1348
15291
82889
45
1338
14891
79536
54
1324
14033
75185
41
1242
13209
69088
48
1283
1291
66011
48
1207
12246
6786
5
1206
1182
66153
43
1175
11619
66406

HD_Age

0-34
35-64
65-84
85+
Year
Age-Adjusted Rate per 100000
345
1158
1247
64879
416
112
11794
61938
35
1103
11529
58746
45
110
10827
56172
313
1048
10086
51609
38
1078
9937
49828
384
1019
9413
51918
42
1008
9174
50961
36
982
904
51209

CHD_Age

0-34
35-64
65-84
85+
Year
Age-Adjusted Rate per 100000
0613
874
7701
4670
0898
818
9012
44369
0889
799
8759
41061
0793
785
8018
38358
0865
757
7421
34644
097
773
7245
32617
088
727
6856
33503
117
709
6585
32727
102
657
6403
32504

Stroke_Age

0-34
35-64
65-84
85+
Year
Age-Adjusted Rate per 100000
068
174
2589
15841
0638
157
2522
1504
072
169
2397
1528
0737
157
2249
13741
0652
138
220
12629
0553
145
2063
11398
0734
127
196
11256
064
1368
1832
10718
047
134
1804
10646

HF_Age

35-64
65-84
85+
Year
Age-Adjusted Rate per 100000
3047
936
8287
2596
88
8285
2648
878
8057
3176
902
7722
2709
863
7586
2955
878
7388
2979
884
8354
274
828
7483
333
85
8102

total

CVD_RG

White Male
Black Male
White Female
Black Female
Year
Age-Adjusted Rate per 100000
4276
5424
3033
4161
4066
5524
2813
4091
3928
5468
2767
4114
3734
518
2638
3887
3448
5079
2432
3643
3366
4983
2375
3545
3276
4994
2313
3477
3236
4845
2223
327
3158
4694
2238
3327

Stroke_RG

White Male
Black Male
White Female
Black Female
Year
Age-Adjusted Rate per 100000
61
768
561
703
575
752
539
681
573
806
528
66
516
662
498
629
463
743
476
562
449
663
429
585
434
63
411
556
415
631
392
494
402
606
392
509

HD_RG

White Male
Black Male
White Female
Black Female
Year
Age-Adjusted Rate per 100000
3393
4298
227
3206
3232
4445
2124
3166
3118
4317
2197
3157
2986
4184
1957
3001
2777
3983
1783
2838
2704
4009
1776
2679
2644
3981
1739
2642
2619
3972
1679
2532
2566
3819
1687
2606

CHD_RG

White Male
Black Male
White Female
Black Female
Year
Age-Adjusted Rate per 100000
2625
329
1608
243
2478
3356
1508
2314
2404
3154
1419
2313
2221
3093
1328
209
2067
2956
119
1983
1989
2885
117
1853
1922
2903
1139
1825
1921
2771
1074
1645
1824
2592
1071
1722

HF_RG

White Male
Black Male
White Female
Black Female
Year
Age-Adjusted Rate per 100000
255
206
245
17
267
225
225
167
242
238
227
203
256
217
222
189
243
167
214
206
24
218
217
172
255
246
229
202
23
225
208
196
25
216
226
185

race_gender

Sheet3

Age-adjusted stroke mortality rates by race and gender Michigan 2000 to 2014

0

10

20

30

40

50

60

70

80

90

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014

Age

-Adj

uste

d R

ate

per 1

000

00

Year

White Male

Black Male

White Female

Black Female

Overall_Rates

CVD
CHD
HD
HF
Stroke
Year
Rate per 10000
3694
2118
2851
245
603
3524
2006
2719
237
577
3421
192
2631
233
571
3258
179
2517
233
527
3034
1656
2337
224
496
2972
1611
2308
224
464
2898
1564
226
24
444
2825
1516
2216
219
425
2791
1472
2192
233
419

CVD_Age

0-34
35-64
65-84
85+
Year
Age-Adjusted Rate per 100000
43
140
16141
86689
508
1348
15291
82889
45
1338
14891
79536
54
1324
14033
75185
41
1242
13209
69088
48
1283
1291
66011
48
1207
12246
6786
5
1206
1182
66153
43
1175
11619
66406

HD_Age

0-34
35-64
65-84
85+
Year
Age-Adjusted Rate per 100000
345
1158
1247
64879
416
112
11794
61938
35
1103
11529
58746
45
110
10827
56172
313
1048
10086
51609
38
1078
9937
49828
384
1019
9413
51918
42
1008
9174
50961
36
982
904
51209

CHD_Age

0-34
35-64
65-84
85+
Year
Age-Adjusted Rate per 100000
0613
874
7701
4670
0898
818
9012
44369
0889
799
8759
41061
0793
785
8018
38358
0865
757
7421
34644
097
773
7245
32617
088
727
6856
33503
117
709
6585
32727
102
657
6403
32504

Stroke_Age

0-34
35-64
65-84
85+
Year
Age-Adjusted Rate per 100000
068
174
2589
15841
0638
157
2522
1504
072
169
2397
1528
0737
157
2249
13741
0652
138
220
12629
0553
145
2063
11398
0734
127
196
11256
064
1368
1832
10718
047
134
1804
10646

HF_Age

35-64
65-84
85+
Year
Age-Adjusted Rate per 100000
3047
936
8287
2596
88
8285
2648
878
8057
3176
902
7722
2709
863
7586
2955
878
7388
2979
884
8354
274
828
7483
333
85
8102

total

CVD_RG

White Male
Black Male
White Female
Black Female
Year
Age-Adjusted Rate per 100000
4276
5424
3033
4161
4066
5524
2813
4091
3928
5468
2767
4114
3734
518
2638
3887
3448
5079
2432
3643
3366
4983
2375
3545
3276
4994
2313
3477
3236
4845
2223
327
3158
4694
2238
3327

Stroke_RG

White Male
Black Male
White Female
Black Female
Year
Age-Adjusted Rate per 100000
61
768
561
703
575
752
539
681
573
806
528
66
516
662
498
629
463
743
476
562
449
663
429
585
434
63
411
556
415
631
392
494
402
606
392
509
375
616
372
464
372
565
366
513
373
548
366
44
348
587
349
477
347
506
34
462
369
506
352
482

HD_RG

White Male
Black Male
White Female
Black Female
Year
Age-Adjusted Rate per 100000
3393
4298
227
3206
3232
4445
2124
3166
3118
4317
2197
3157
2986
4184
1957
3001
2777
3983
1783
2838
2704
4009
1776
2679
2644
3981
1739
2642
2619
3972
1679
2532
2566
3819
1687
2606

CHD_RG

White Male
Black Male
White Female
Black Female
Year
Age-Adjusted Rate per 100000
2625
329
1608
243
2478
3356
1508
2314
2404
3154
1419
2313
2221
3093
1328
209
2067
2956
119
1983
1989
2885
117
1853
1922
2903
1139
1825
1921
2771
1074
1645
1824
2592
1071
1722

HF_RG

White Male
Black Male
White Female
Black Female
Year
Age-Adjusted Rate per 100000
255
206
245
17
267
225
225
167
242
238
227
203
256
217
222
189
243
167
214
206
24
218
217
172
255
246
229
202
23
225
208
196
25
216
226
185

race_gender

Sheet3

Local Health Department data can be found at wwwmichigangovbrfsSource CDC BRFSS

RISK FACTORMI

2011

MI

2013

MI

2014

MI

2015US 2015

2015 NATIONAL RANKING

Current Smoking 233 214 212 207 175 11

Blood Pressure Ever Told High 342 346 NA 331 309 18

Cholesterol Ever Told High 418 406 NA 382 364 12

Overweight (BMIgt25) 342 347 349 351 355 32tied

Obese (BMIgt30) 313 315 307 312 298 16

No Leisure Time Physical Activity 236 244 255 255 262 27

Diabetes 100 104 104 107 100 18tied

Prevalence of CVD Risk Factors Michigan Adults 1990-2015Compared to 2015 National Prevalence

233214 212 207

175

10

15

20

25

30

MI 2011 MI 2013 MI 2014 MI 2015 US 2015

Current Smoking

342 346331

309

20

25

30

35

40

MI 2011 MI 2013 MI 2014 MI 2015 US 2015

Blood Pressure Ever told high

342 347 349 351 355

20

25

30

35

40

MI 2011 MI 2013 MI 2014 MI 2015 US 2015

Overweight (BMIgt25)

313 315 307 312298

20

25

30

35

40

MI 2011 MI 2013 MI 2014 MI 2015 US 2015

Obese (BMIgt30)

418406

382364

30

35

40

45

50

MI 2011 MI 2013 MI 2014 MI 2015 US 2015

Cholesterol Ever told high

10 104 104 10710

0

3

6

9

12

15

MI 2011 MI 2013 MI 2014 MI 2015 US 2015

Diabetes

236 244255 255 262

10

15

20

25

30

MI 2011 MI 2013 MI 2014 MI 2015 US 2015

No Leisure Time Physical Activity

11 1216 18

2732tied

05

101520253035404550

CurrentSmoking

CholesterolEver told high

Obese(BMIgt30)

BloodPressure Ever

told high

Diabetes No LeisureTime Physical

Activity

Overweight(BMIgt25)

2015 NATIONAL RANKING(1st is worst)

18tied

MOSAIC 2015-2020 Focus of Grant Developing Stroke Systems of

Care Community Awareness EMS In-hospital QI Transition of Care Post-Discharge

12

Pre-hospital Care

A V A I L A B L E D A T A

13

EMSMOSAIC Data Linkage

-The MOSAIC Team continues to link data from the Michigan EMS Information System (MiEMSIS) to MOSAIC Data- Reports have been created for and reviewed by the

Tri-County Area MCA and Detroit East MCA- This work will expand to other MCA regions that

serve hospitals participating in MOSAIC

GWTG Special Initiatives Tab

-A free tab that can be enabled in GWTG-The purpose of the tab is to collect data concerning patient hand-off from EMS

MOSAIC Participating Hospitals

Aspirus Keweenaw Hospital (Laurium)

Aspirus Grand View HospitalAspirus Iron River HospitalAspirus Ontonagon HospitalBixby Medical CenterBronson Methodist HospitalCovenant Health CareDetroit Receiving HospitalGenesys Regional Medical CenterHenry Ford Hospital Herrick Medical CenterHuron Valley-Sinai HospitalLakeland Regional Medical Center McLaren Bay Regional Medical CenterMcLaren Greater Medical Center

McLaren Macomb HospitalMcLaren Northern MI HospitalMcLaren Oakland Medical CenterMcLaren Port Huron HospitalMcLaren Regional Medical CenterMercy Health Saint Maryrsquos HospitalMetro Health HospitalMunson Medical Center

ProMedica Monroe Regional HospitalSparrow HospitalSt Joseph Mercy - Ann ArborSt Joseph Mercy ChelseaSt Joseph Mercy Livingston HospitalSt Mary MercySt Mary of Michigan HospitalU of M Hospital

Hospital Infrastructure19

Among all participating hospitals the average number of

Licensed beds was 374 (range 25 to 1059 beds)

Inpatient discharges was 17076 (range 1064 to 48916 patients)

Acute stroke discharges (primary diagnosis only) was 417 (range 34 to 982 patients)

Case Demographics MOSAIC Registry

VariablesN() or statistics(Total N=68906)

Age at admission (years)Median 710Range 180 - 1060Mean (SE) 697(01)

GenderMale 32886 (477)Female 36015 (523)

RaceAfrican American 9900 (197)AIAN 132 (03)Asian 320 (06)More than one race 44 (01)Unknown 3679 (73)White 36190 (720)Missing 70

EthnicityHispanic or Latino 804 (16)Others 49531 (984)

VariablesN() or statistics(Total N=68906)

Health insuranceMedicaid 2284 (45)MedicaidPrivate 211 (04)Medicare 16863 (336)Medicare Medicaid 2313 (46)

MedicareMedicaidPrivate125 (02)

MedicarePrivate 13640 (272)ND 268(05)No insurance 2123 (42)Private 12356 (246)

Arrival modeEMS 21052 (429)Private

transportationother19313 (393)

Transfer from another hospital

7733(157)

ND or unknown 1021 (21)Missing 1216

Who receives data reports on your stroke quality of care

21

7055

70

10085

65

40

Hos

pita

lC

EO

up

per

man

agem

ent

Hos

pita

lB

oard

Chi

efN

ursi

ngO

ffice

r(C

NO

)

Str

oke

Tea

m

Phy

sici

anS

trok

eC

ham

pion

Chi

ef o

fM

edic

ine

Oth

er

Data Use

1) In the most recent calendar year have you run additional analyses (beyond what was required for reporting) on your hospitalrsquos own stroke data

2)How frequently have you run and used the analyses generated

22

Yes (N=16) 80

No (N=4) 20Weekly (N=2) 125

Monthly (N=8) 500

Less than monthly but more

than 1-2 times(N=6) 375

Data Use

What is the main reason you do not run your own additional analyses (Select one best answer)

23

Not sure how to run analyses

25

Not sure what analyses are needed would be helpful 25

Other 50

Data Use

In the most recent calendar year what reports did you run

24

813 688

Pre-programmedautomated reports in thedata collection tool (eg GWTG)

Additional reports beyond pre-programmed reports from the tool

Data Use

How do you use these analyses reports

25

813 688375

Inform quality improvement (QI) efforts andor plan

ldquoaction itemsrdquo

Report to management administration on our

progress

Other

Data Use

If you run additional analysis what action items QI efforts did you plan as a result of these reports

26

o Discharge education intensive statin use

o Door to tPA time and dysphagia

o Review data between spoke amp hub hospitals regarding transfers IV-tPA administration Mechanical thrombectomy and SAH

o QI efforts were addressed in the department involving calling Stroke Alert on call for cases with FAST symptoms

o ED Medical Director works with team to fix fallouts and problematic areas We have seen improvement

o Process changes (ie fallout emails to RN manager) physician querieso Increased documentation of NIHSS ownership from individual units regarding stroke quality

improvement goalso Daily dysphagia screening determination of whowhat team responsible for documenting initial NIHSS

looking at patients beyond 2h LKW arrival

Hospital Arrival Mode Door-to Needle and Pre-Notification

Reports 2016

Percent of Cases Who Arrived via EMSMOSAIC 2009-2016

Table 1 Arrival Mode among Stroke Cases by Demographics MOSAIC 2016

Demographics N=3496 550 N=2938 450Stroke Type Ischemic 2558 542 2164 458 Hemorrhagic 560 728 209 272 TIA 378 478 413 522Age Group lt 50 Years 233 433 305 567 50-79 Years 1982 497 2008 503 ge 80 Years 1379 688 625 312Sex Female 1933 576 1422 424 Male 1661 523 1516 477Race Black 659 530 584 470 White 2824 557 2248 443 Other Missing 111 512 106 488

MOSAIC AggregateArrival Mode

EMS Private Mode

Table 2 Door-to-Needle Times by Arrival Mode among Stroke Cases MOSAIC 2016

Time Elements (in Minutes)Number of

Patients Mean (Minutes) Median

(Minutes)Range

(Minutes)Door-to-Image 4901 575 400 00-2700 Arrived via EMS 2767 463 270 00-2700 Arrived via Private Transportation 2134 720 570 00-2620

Door-to-Image (among t-PA treated) 492 155 130 00-970 Arrived via EMS 370 125 110 00-840 Arrived via Private Transportation 122 243 215 20-970Image-to Needle 492 500 450 70-2090 Arrived via EMS 370 503 460 70-2090 Arrived via Private Transportation 122 483 420 90-1770Door-to Needle 492 655 570 200-2180 Arrived via EMS 370 629 560 200-2180 Arrived via Private Transportation 122 726 650 290-2060Included ischemic or hemorrhagic cases with times that were less or equal to 270 minutes (45 hours)Transferred cases were excluded

MOSAIC Aggregate

Table 3 Pre-Notification among Stroke Cases Who Arrived Via EMS by Demographics MOSAIC 2016

Demographics N=2015 584 N=1437 416Stroke Type Ischemic 1523 622 924 378 Hemorrhagic 306 566 235 434 TIA 142 381 231 619Age Group lt 50 Years 133 607 86 393 50-79 Years 1105 585 784 415 ge 80 Years 777 578 567 422Sex Female 1075 578 786 422 Male 940 591 651 409Race Black 307 517 287 483 White 1657 602 1097 398 Other 51 490 53 510

All HospitalsPre-Notification

Yes No

MOSAIC Transitions of Care Project

Post-discharge data collection tool is being implemented into Outcome Science as a tab

Post-Discharge amp Transition of Care

Reporting on changes within 30 days of discharge from hospital via follow-up callschart review Interval events Physician follow-up visits Lifestyle changes Lab assessments Medication managementadherence Rehab amp Functional outcomes Falls

MOSAIC Website

wwwMichigangovstroke

Adrienne Nickles MPHnicklesamichigangov

Thank You

  • Michigan and MOSAIC Data Review
  • Overview
  • Age-adjusted Stroke Hospitalization Rates Michigan 2000-2015
  • Slide Number 4
  • Age-adjusted Stroke Mortality Rates Michigan 2000-2014
  • Slide Number 6
  • Slide Number 7
  • Slide Number 8
  • Slide Number 9
  • Slide Number 10
  • Slide Number 11
  • MOSAIC 2015-2020
  • Pre-hospital Care
  • EMSMOSAIC Data Linkage
  • Slide Number 15
  • GWTG Special Initiatives Tab
  • Slide Number 17
  • MOSAIC Participating Hospitals
  • Hospital Infrastructure
  • Case Demographics MOSAIC Registry
  • Who receives data reports on your stroke quality of care
  • 1) In the most recent calendar year have you run additional analyses (beyond what was required for reporting) on your hospitalrsquos own stroke data 2)How frequently have you run and used the analyses generated
  • What is the main reason you do not run your own additional analyses (Select one best answer)
  • In the most recent calendar year what reports did you run
  • How do you use these analyses reports
  • If you run additional analysis what action items QI efforts did you plan as a result of these reports
  • Hospital Arrival Mode Door-to Needle and Pre-Notification Reports 2016
  • Percent of Cases Who Arrived via EMSMOSAIC 2009-2016
  • Table 1 Arrival Mode among Stroke Cases by Demographics MOSAIC 2016
  • Table 2 Door-to-Needle Times by Arrival Mode among Stroke Cases MOSAIC 2016
  • Table 3 Pre-Notification among Stroke Cases Who Arrived Via EMS by Demographics MOSAIC 2016
  • MOSAIC Transitions of Care Project
  • Slide Number 33
  • MOSAIC Website
  • Adrienne Nickles MPHnicklesamichigangov
CVD
Year White Male Black Male White Female Black Female
2000 4276 5424 3033 4161
2001 4066 5524 2813 4091
2002 3928 5468 2767 4114
2003 3734 518 2638 3887
2004 3448 5079 2432 3643
2005 3366 4983 2375 3545
2006 3276 4994 2313 3477
2007 3236 4845 2223 327
2008 3158 4694 2238 3327
change 234 79 237 164
Heart Disease
Year White Male Black Male White Female Black Female
2000 3393 4298 227 3206
2001 3232 4445 2124 3166
2002 3118 4317 2197 3157
2003 2986 4184 1957 3001
2004 2777 3983 1783 2838
2005 2704 4009 1776 2679
2006 2644 3981 1739 2642
2007 2619 3972 1679 2532
2008 2566 3819 1687 2606
Stroke
Year White Male Black Male White Female Black Female
2000 61 768 561 703 176
2001 575 752 539 681 138
2002 573 806 528 66 15
2003 516 662 498 629 147
2004 463 743 476 562
2005 449 663 429 585
2006 434 63 411 556
2007 415 631 392 494
2008 402 606 392 509
2009 375 616 372 464
2010 372 565 366 513
2011 373 548 366 44
2012 348 587 349 477
2013 347 506 34 462
2014 369 506 352 482
Coronary Heart Disease
Year White Male Black Male White Female Black Female
2000 2625 329 1608 243
2001 2478 3356 1508 2314
2002 2404 3154 1419 2313
2003 2221 3093 1328 209
2004 2067 2956 119 1983
2005 1989 2885 117 1853
2006 1922 2903 1139 1825
2007 1921 2771 1074 1645
2008 1824 2592 1071 1722
Heart Failure
Year White Male Black Male White Female Black Female
2000 255 206 245 17
2001 267 225 225 167
2002 242 238 227 203
2003 256 217 222 189
2004 243 167 214 206
2005 24 218 217 172
2006 255 246 229 202
2007 23 225 208 196
2008 25 216 226 185
Not sure what this data is from previously HD Stroke
Year White Female Black Female White Female Black Female
2000 227 3206 561 703
2001 2124 3166 539 681
2002 2197 3157 528 66
2003 1957 3001 498 629
2004 1783 2838 476 562
2005 1776 2679 429 585
2006 1739 2642 411 556
2007
2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2009 2009 2009 2009
2010 2010 2010 2010
2011 2011 2011 2011
2012 2012 2012 2012
2013 2013 2013 2013
2014 2014 2014 2014
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
CVD
Year US Michigan 0-34 35-64 65-84 85+
2000 3397 3694 43 140 16141 86689
2001 3265 3524 508 1348 15291 82889
2002 3174 3421 45 1338 14891 79536
2003 3061 3258 54 1324 14033 75185
2004 2885 3034 41 1242 13209 69088
2005 2773 2972 48 1283 1291 66011
2006 2898 48 1207 12246 6786
2007 2825 5 1206 1182 66153
2008 2791 43 1175 11619 66406
Heart Disease
Year US Michigan 0-34 35-64 65-84 85+
2000 2576 2851 345 1158 1247 64879
2001 2478 2719 416 112 11794 61938
2002 2408 2631 35 1103 11529 58746
2003 2323 2517 45 110 10827 56172
2004 217 2337 313 1048 10086 51609
2005 2111 2308 38 1078 9937 49828
2006 226 384 1019 9413 51918
2007 2216 42 1008 9174 50961
2008 2192 36 982 904 51209
Stroke
Year US Michigan HP 2010 0-34 35-64 65-84 85+
2000 609 603 50 068 174 2589 15841
2001 579 577 50 0638 157 2522 1504
2002 562 571 50 072 169 2397 1528
2003 535 527 50 0737 157 2249 13741
2004 50 496 50 0652 138 220 12629
2005 466 464 50 0553 145 2063 11398
2006 444 50 0734 127 196 11256
2007 425 064 1368 1832 10718
2008 419 047 134 1804 10646
79 27 243 289
Coronary Heart Disease
Year US Michigan HP 2010 0-34 35-64 65-84 85+
2000 1868 2118 162 0613 874 7701 4670
2001 1778 2006 162 0898 818 9012 44369
2002 1709 192 162 0889 799 8759 41061
2003 1628 179 162 0793 785 8018 38358
2004 1502 1656 162 0865 757 7421 34644
2005 1444 1611 162 097 773 7245 32617
2006 1564 162 088 727 6856 33503
2007 1516 117 709 6585 32727
2008 1472 102 657 6403 32504
168 11 283
Heart Failure
Year US Michigan 35-64 65-84 85+
2000 203 245 3047 936 8287
2001 202 237 2596 88 8285
2002 194 233 2648 878 8057
2003 194 233 3176 902 7722
2004 189 224 2709 863 7586
2005 189 224 2955 878 7388
2006 24 2979 884 8354
2007 219 274 828 7483
2008 233 013 333 85 8102
Heart Disease Stroke
Michigan White Michigan Black US White US Black Michigan White Michigan Black US White US Black
1990 334 4315 317 3915 1990 638 733 629 917
1991 3289 4108 3088 3865 1991 626 781 607 894
1992 3126 3987 3011 3777 1992 609 694 598 86
1993 3234 429 3046 3843 1993 614 77 609 866
1994 3134 4156 295 3661 1994 634 875 609 869
1995 3048 4131 2912 3672 1995 638 925 615 879
1996 2997 380 2842 354 1996 617 804 61 852
1997 2851 3683 2764 345 1997 604 77 598 816
1998 2884 3586 2681 3406 1998 598 729 576 803
1999 2781 3692 2634 3367 1999 609 812 598 824
2000 2757 3663 2536 3265 2000 586 737 587 824
2001 261 3695 2435 3169 2001 56 718 558 788
2002 2522 3659 2367 3084 2002 553 729 542 763
2003 2409 350 2282 3002 2003 511 655 514 743
2004 222 3311 2133 2806 2004 477 633 48 699
2005 219 3227 2005 442 616
2006 2144 320 2006 426 589
2007 2007
2008 2008
CVD CHD HD HF Stroke
2000 3694 2118 2851 245 603
2001 3524 2006 2719 237 577
2002 3421 192 2631 233 571
2003 3258 179 2517 233 527
2004 3034 1656 2337 224 496
2005 2972 1611 2308 224 464
2006 2898 1564 226 24 444
2007 2825 1516 2216 219 425
2008 2791 1472 2192 233 419
2000 2000 2000
2001 2001 2001
2002 2002 2002
2003 2003 2003
2004 2004 2004
2005 2005 2005
2006 2006 2006
2007 2007 2007
2008 2008 2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2000 2000 2000 2000 2000
2001 2001 2001 2001 2001
2002 2002 2002 2002 2002
2003 2003 2003 2003 2003
2004 2004 2004 2004 2004
2005 2005 2005 2005 2005
2006 2006 2006 2006 2006
2007 2007 2007 2007 2007
2008 2008 2008 2008 2008
CVD
Year White Male Black Male White Female Black Female
2000 4276 5424 3033 4161
2001 4066 5524 2813 4091
2002 3928 5468 2767 4114
2003 3734 518 2638 3887
2004 3448 5079 2432 3643
2005 3366 4983 2375 3545
2006 3276 4994 2313 3477
2007 3236 4845 2223 327
2008 3158 4694 2238 3327
change 234 79 237 164
Heart Disease
Year White Male Black Male White Female Black Female
2000 3393 4298 227 3206
2001 3232 4445 2124 3166
2002 3118 4317 2197 3157
2003 2986 4184 1957 3001
2004 2777 3983 1783 2838
2005 2704 4009 1776 2679
2006 2644 3981 1739 2642
2007 2619 3972 1679 2532
2008 2566 3819 1687 2606
Stroke
Year White Male Black Male White Female Black Female
2000 61 768 561 703 176
2001 575 752 539 681 138
2002 573 806 528 66 15
2003 516 662 498 629 147
2004 463 743 476 562
2005 449 663 429 585
2006 434 63 411 556
2007 415 631 392 494
2008 402 606 392 509
Coronary Heart Disease
Year White Male Black Male White Female Black Female
2000 2625 329 1608 243
2001 2478 3356 1508 2314
2002 2404 3154 1419 2313
2003 2221 3093 1328 209
2004 2067 2956 119 1983
2005 1989 2885 117 1853
2006 1922 2903 1139 1825
2007 1921 2771 1074 1645
2008 1824 2592 1071 1722
Heart Failure
Year White Male Black Male White Female Black Female
2000 255 206 245 17
2001 267 225 225 167
2002 242 238 227 203
2003 256 217 222 189
2004 243 167 214 206
2005 24 218 217 172
2006 255 246 229 202
2007 23 225 208 196
2008 25 216 226 185
Not sure what this data is from previously HD Stroke
Year White Female Black Female White Female Black Female
2000 227 3206 561 703
2001 2124 3166 539 681
2002 2197 3157 528 66
2003 1957 3001 498 629
2004 1783 2838 476 562
2005 1776 2679 429 585
2006 1739 2642 411 556
2007
2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
CVD
Year US Michigan 0-34 35-64 65-84 85+
2000 3397 3694 43 140 16141 86689
2001 3265 3524 508 1348 15291 82889
2002 3174 3421 45 1338 14891 79536
2003 3061 3258 54 1324 14033 75185
2004 2885 3034 41 1242 13209 69088
2005 2773 2972 48 1283 1291 66011
2006 2898 48 1207 12246 6786
2007 2825 5 1206 1182 66153
2008 2791 43 1175 11619 66406
Heart Disease
Year US Michigan 0-34 35-64 65-84 85+
2000 2576 2851 345 1158 1247 64879
2001 2478 2719 416 112 11794 61938
2002 2408 2631 35 1103 11529 58746
2003 2323 2517 45 110 10827 56172
2004 217 2337 313 1048 10086 51609
2005 2111 2308 38 1078 9937 49828
2006 226 384 1019 9413 51918
2007 2216 42 1008 9174 50961
2008 2192 36 982 904 51209
Stroke
Year US Michigan HP 2010 0-34 35-64 65-84 85+
2000 609 603 50 068 174 2589 15841
2001 579 577 50 0638 157 2522 1504
2002 562 571 50 072 169 2397 1528
2003 535 527 50 0737 157 2249 13741
2004 50 496 50 0652 138 220 12629
2005 466 464 50 0553 145 2063 11398
2006 444 50 0734 127 196 11256
2007 425 064 1368 1832 10718
2008 419 047 134 1804 10646
79 27 243 289
Coronary Heart Disease
Year US Michigan HP 2010 0-34 35-64 65-84 85+
2000 1868 2118 162 0613 874 7701 4670
2001 1778 2006 162 0898 818 9012 44369
2002 1709 192 162 0889 799 8759 41061
2003 1628 179 162 0793 785 8018 38358
2004 1502 1656 162 0865 757 7421 34644
2005 1444 1611 162 097 773 7245 32617
2006 1564 162 088 727 6856 33503
2007 1516 117 709 6585 32727
2008 1472 102 657 6403 32504
168 11 283
Heart Failure
Year US Michigan 35-64 65-84 85+
2000 203 245 3047 936 8287
2001 202 237 2596 88 8285
2002 194 233 2648 878 8057
2003 194 233 3176 902 7722
2004 189 224 2709 863 7586
2005 189 224 2955 878 7388
2006 24 2979 884 8354
2007 219 274 828 7483
2008 233 013 333 85 8102
Heart Disease Stroke
Michigan White Michigan Black US White US Black Michigan White Michigan Black US White US Black
1990 334 4315 317 3915 1990 638 733 629 917
1991 3289 4108 3088 3865 1991 626 781 607 894
1992 3126 3987 3011 3777 1992 609 694 598 86
1993 3234 429 3046 3843 1993 614 77 609 866
1994 3134 4156 295 3661 1994 634 875 609 869
1995 3048 4131 2912 3672 1995 638 925 615 879
1996 2997 380 2842 354 1996 617 804 61 852
1997 2851 3683 2764 345 1997 604 77 598 816
1998 2884 3586 2681 3406 1998 598 729 576 803
1999 2781 3692 2634 3367 1999 609 812 598 824
2000 2757 3663 2536 3265 2000 586 737 587 824
2001 261 3695 2435 3169 2001 56 718 558 788
2002 2522 3659 2367 3084 2002 553 729 542 763
2003 2409 350 2282 3002 2003 511 655 514 743
2004 222 3311 2133 2806 2004 477 633 48 699
2005 219 3227 2005 442 616
2006 2144 320 2006 426 589
2007 2007
2008 2008
Stroke
CVD MI US
2000 3694 606 609
2001 3524 584 584
2002 3421 583 572
2003 3258 539 546
2004 3034 519 512
2005 2972 488 48
2006 2898 449 448
2007 2825 43 435
2008 2791 423 421
2009 262 396 396
2010 394 391
2011 387 379
2012 372 369
2013 363 369
2014 377 365
2000 2000 2000
2001 2001 2001
2002 2002 2002
2003 2003 2003
2004 2004 2004
2005 2005 2005
2006 2006 2006
2007 2007 2007
2008 2008 2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2000 2000
2001 2001
2002 2002
2003 2003
2004 2004
2005 2005
2006 2006
2007 2007
2008 2008
2009 2009
2010 2010
2011 2011
2012 2012
2013 2013
2014 2014
Page 7: Michigan and MOSAIC Data Review...Michigan and MOSAIC Data Review 2017 ANNUAL WORKSHOP 4/26/2017. Adrienne Nickles, MPH. Michigan’s Ongoing Stroke Registry to Accelerate the Improvement

Age-adjusted Stroke Mortality Rates Michigan 2000-2014

606584 583

539519

488

44943 423

396 394 387372 363

377

609584 572

546512

48448 435

421396 391 379 369 369 365

0

10

20

30

40

50

60

70

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014

Rat

e pe

r 100

000

Year

MI US

Overall_Rates

MI
US
Year
Rate per 100000
606
609
584
584
583
572
539
546
519
512
488
48
449
448
43
435
423
421
396
396
394
391
387
379
372
369
363
369
377
365

CVD_Age

0-34
35-64
65-84
85+
Year
Age-Adjusted Rate per 100000
43
140
16141
86689
508
1348
15291
82889
45
1338
14891
79536
54
1324
14033
75185
41
1242
13209
69088
48
1283
1291
66011
48
1207
12246
6786
5
1206
1182
66153
43
1175
11619
66406

HD_Age

0-34
35-64
65-84
85+
Year
Age-Adjusted Rate per 100000
345
1158
1247
64879
416
112
11794
61938
35
1103
11529
58746
45
110
10827
56172
313
1048
10086
51609
38
1078
9937
49828
384
1019
9413
51918
42
1008
9174
50961
36
982
904
51209

CHD_Age

0-34
35-64
65-84
85+
Year
Age-Adjusted Rate per 100000
0613
874
7701
4670
0898
818
9012
44369
0889
799
8759
41061
0793
785
8018
38358
0865
757
7421
34644
097
773
7245
32617
088
727
6856
33503
117
709
6585
32727
102
657
6403
32504

Stroke_Age

0-34
35-64
65-84
85+
Year
Age-Adjusted Rate per 100000
068
174
2589
15841
0638
157
2522
1504
072
169
2397
1528
0737
157
2249
13741
0652
138
220
12629
0553
145
2063
11398
0734
127
196
11256
064
1368
1832
10718
047
134
1804
10646

HF_Age

35-64
65-84
85+
Year
Age-Adjusted Rate per 100000
3047
936
8287
2596
88
8285
2648
878
8057
3176
902
7722
2709
863
7586
2955
878
7388
2979
884
8354
274
828
7483
333
85
8102

total

CVD_RG

White Male
Black Male
White Female
Black Female
Year
Age-Adjusted Rate per 100000
4276
5424
3033
4161
4066
5524
2813
4091
3928
5468
2767
4114
3734
518
2638
3887
3448
5079
2432
3643
3366
4983
2375
3545
3276
4994
2313
3477
3236
4845
2223
327
3158
4694
2238
3327

Stroke_RG

White Male
Black Male
White Female
Black Female
Year
Age-Adjusted Rate per 100000
61
768
561
703
575
752
539
681
573
806
528
66
516
662
498
629
463
743
476
562
449
663
429
585
434
63
411
556
415
631
392
494
402
606
392
509

HD_RG

White Male
Black Male
White Female
Black Female
Year
Age-Adjusted Rate per 100000
3393
4298
227
3206
3232
4445
2124
3166
3118
4317
2197
3157
2986
4184
1957
3001
2777
3983
1783
2838
2704
4009
1776
2679
2644
3981
1739
2642
2619
3972
1679
2532
2566
3819
1687
2606

CHD_RG

White Male
Black Male
White Female
Black Female
Year
Age-Adjusted Rate per 100000
2625
329
1608
243
2478
3356
1508
2314
2404
3154
1419
2313
2221
3093
1328
209
2067
2956
119
1983
1989
2885
117
1853
1922
2903
1139
1825
1921
2771
1074
1645
1824
2592
1071
1722

HF_RG

White Male
Black Male
White Female
Black Female
Year
Age-Adjusted Rate per 100000
255
206
245
17
267
225
225
167
242
238
227
203
256
217
222
189
243
167
214
206
24
218
217
172
255
246
229
202
23
225
208
196
25
216
226
185

race_gender

Sheet3

Age-adjusted stroke mortality rates by race and gender Michigan 2000 to 2014

0

10

20

30

40

50

60

70

80

90

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014

Age

-Adj

uste

d R

ate

per 1

000

00

Year

White Male

Black Male

White Female

Black Female

Overall_Rates

CVD
CHD
HD
HF
Stroke
Year
Rate per 10000
3694
2118
2851
245
603
3524
2006
2719
237
577
3421
192
2631
233
571
3258
179
2517
233
527
3034
1656
2337
224
496
2972
1611
2308
224
464
2898
1564
226
24
444
2825
1516
2216
219
425
2791
1472
2192
233
419

CVD_Age

0-34
35-64
65-84
85+
Year
Age-Adjusted Rate per 100000
43
140
16141
86689
508
1348
15291
82889
45
1338
14891
79536
54
1324
14033
75185
41
1242
13209
69088
48
1283
1291
66011
48
1207
12246
6786
5
1206
1182
66153
43
1175
11619
66406

HD_Age

0-34
35-64
65-84
85+
Year
Age-Adjusted Rate per 100000
345
1158
1247
64879
416
112
11794
61938
35
1103
11529
58746
45
110
10827
56172
313
1048
10086
51609
38
1078
9937
49828
384
1019
9413
51918
42
1008
9174
50961
36
982
904
51209

CHD_Age

0-34
35-64
65-84
85+
Year
Age-Adjusted Rate per 100000
0613
874
7701
4670
0898
818
9012
44369
0889
799
8759
41061
0793
785
8018
38358
0865
757
7421
34644
097
773
7245
32617
088
727
6856
33503
117
709
6585
32727
102
657
6403
32504

Stroke_Age

0-34
35-64
65-84
85+
Year
Age-Adjusted Rate per 100000
068
174
2589
15841
0638
157
2522
1504
072
169
2397
1528
0737
157
2249
13741
0652
138
220
12629
0553
145
2063
11398
0734
127
196
11256
064
1368
1832
10718
047
134
1804
10646

HF_Age

35-64
65-84
85+
Year
Age-Adjusted Rate per 100000
3047
936
8287
2596
88
8285
2648
878
8057
3176
902
7722
2709
863
7586
2955
878
7388
2979
884
8354
274
828
7483
333
85
8102

total

CVD_RG

White Male
Black Male
White Female
Black Female
Year
Age-Adjusted Rate per 100000
4276
5424
3033
4161
4066
5524
2813
4091
3928
5468
2767
4114
3734
518
2638
3887
3448
5079
2432
3643
3366
4983
2375
3545
3276
4994
2313
3477
3236
4845
2223
327
3158
4694
2238
3327

Stroke_RG

White Male
Black Male
White Female
Black Female
Year
Age-Adjusted Rate per 100000
61
768
561
703
575
752
539
681
573
806
528
66
516
662
498
629
463
743
476
562
449
663
429
585
434
63
411
556
415
631
392
494
402
606
392
509
375
616
372
464
372
565
366
513
373
548
366
44
348
587
349
477
347
506
34
462
369
506
352
482

HD_RG

White Male
Black Male
White Female
Black Female
Year
Age-Adjusted Rate per 100000
3393
4298
227
3206
3232
4445
2124
3166
3118
4317
2197
3157
2986
4184
1957
3001
2777
3983
1783
2838
2704
4009
1776
2679
2644
3981
1739
2642
2619
3972
1679
2532
2566
3819
1687
2606

CHD_RG

White Male
Black Male
White Female
Black Female
Year
Age-Adjusted Rate per 100000
2625
329
1608
243
2478
3356
1508
2314
2404
3154
1419
2313
2221
3093
1328
209
2067
2956
119
1983
1989
2885
117
1853
1922
2903
1139
1825
1921
2771
1074
1645
1824
2592
1071
1722

HF_RG

White Male
Black Male
White Female
Black Female
Year
Age-Adjusted Rate per 100000
255
206
245
17
267
225
225
167
242
238
227
203
256
217
222
189
243
167
214
206
24
218
217
172
255
246
229
202
23
225
208
196
25
216
226
185

race_gender

Sheet3

Local Health Department data can be found at wwwmichigangovbrfsSource CDC BRFSS

RISK FACTORMI

2011

MI

2013

MI

2014

MI

2015US 2015

2015 NATIONAL RANKING

Current Smoking 233 214 212 207 175 11

Blood Pressure Ever Told High 342 346 NA 331 309 18

Cholesterol Ever Told High 418 406 NA 382 364 12

Overweight (BMIgt25) 342 347 349 351 355 32tied

Obese (BMIgt30) 313 315 307 312 298 16

No Leisure Time Physical Activity 236 244 255 255 262 27

Diabetes 100 104 104 107 100 18tied

Prevalence of CVD Risk Factors Michigan Adults 1990-2015Compared to 2015 National Prevalence

233214 212 207

175

10

15

20

25

30

MI 2011 MI 2013 MI 2014 MI 2015 US 2015

Current Smoking

342 346331

309

20

25

30

35

40

MI 2011 MI 2013 MI 2014 MI 2015 US 2015

Blood Pressure Ever told high

342 347 349 351 355

20

25

30

35

40

MI 2011 MI 2013 MI 2014 MI 2015 US 2015

Overweight (BMIgt25)

313 315 307 312298

20

25

30

35

40

MI 2011 MI 2013 MI 2014 MI 2015 US 2015

Obese (BMIgt30)

418406

382364

30

35

40

45

50

MI 2011 MI 2013 MI 2014 MI 2015 US 2015

Cholesterol Ever told high

10 104 104 10710

0

3

6

9

12

15

MI 2011 MI 2013 MI 2014 MI 2015 US 2015

Diabetes

236 244255 255 262

10

15

20

25

30

MI 2011 MI 2013 MI 2014 MI 2015 US 2015

No Leisure Time Physical Activity

11 1216 18

2732tied

05

101520253035404550

CurrentSmoking

CholesterolEver told high

Obese(BMIgt30)

BloodPressure Ever

told high

Diabetes No LeisureTime Physical

Activity

Overweight(BMIgt25)

2015 NATIONAL RANKING(1st is worst)

18tied

MOSAIC 2015-2020 Focus of Grant Developing Stroke Systems of

Care Community Awareness EMS In-hospital QI Transition of Care Post-Discharge

12

Pre-hospital Care

A V A I L A B L E D A T A

13

EMSMOSAIC Data Linkage

-The MOSAIC Team continues to link data from the Michigan EMS Information System (MiEMSIS) to MOSAIC Data- Reports have been created for and reviewed by the

Tri-County Area MCA and Detroit East MCA- This work will expand to other MCA regions that

serve hospitals participating in MOSAIC

GWTG Special Initiatives Tab

-A free tab that can be enabled in GWTG-The purpose of the tab is to collect data concerning patient hand-off from EMS

MOSAIC Participating Hospitals

Aspirus Keweenaw Hospital (Laurium)

Aspirus Grand View HospitalAspirus Iron River HospitalAspirus Ontonagon HospitalBixby Medical CenterBronson Methodist HospitalCovenant Health CareDetroit Receiving HospitalGenesys Regional Medical CenterHenry Ford Hospital Herrick Medical CenterHuron Valley-Sinai HospitalLakeland Regional Medical Center McLaren Bay Regional Medical CenterMcLaren Greater Medical Center

McLaren Macomb HospitalMcLaren Northern MI HospitalMcLaren Oakland Medical CenterMcLaren Port Huron HospitalMcLaren Regional Medical CenterMercy Health Saint Maryrsquos HospitalMetro Health HospitalMunson Medical Center

ProMedica Monroe Regional HospitalSparrow HospitalSt Joseph Mercy - Ann ArborSt Joseph Mercy ChelseaSt Joseph Mercy Livingston HospitalSt Mary MercySt Mary of Michigan HospitalU of M Hospital

Hospital Infrastructure19

Among all participating hospitals the average number of

Licensed beds was 374 (range 25 to 1059 beds)

Inpatient discharges was 17076 (range 1064 to 48916 patients)

Acute stroke discharges (primary diagnosis only) was 417 (range 34 to 982 patients)

Case Demographics MOSAIC Registry

VariablesN() or statistics(Total N=68906)

Age at admission (years)Median 710Range 180 - 1060Mean (SE) 697(01)

GenderMale 32886 (477)Female 36015 (523)

RaceAfrican American 9900 (197)AIAN 132 (03)Asian 320 (06)More than one race 44 (01)Unknown 3679 (73)White 36190 (720)Missing 70

EthnicityHispanic or Latino 804 (16)Others 49531 (984)

VariablesN() or statistics(Total N=68906)

Health insuranceMedicaid 2284 (45)MedicaidPrivate 211 (04)Medicare 16863 (336)Medicare Medicaid 2313 (46)

MedicareMedicaidPrivate125 (02)

MedicarePrivate 13640 (272)ND 268(05)No insurance 2123 (42)Private 12356 (246)

Arrival modeEMS 21052 (429)Private

transportationother19313 (393)

Transfer from another hospital

7733(157)

ND or unknown 1021 (21)Missing 1216

Who receives data reports on your stroke quality of care

21

7055

70

10085

65

40

Hos

pita

lC

EO

up

per

man

agem

ent

Hos

pita

lB

oard

Chi

efN

ursi

ngO

ffice

r(C

NO

)

Str

oke

Tea

m

Phy

sici

anS

trok

eC

ham

pion

Chi

ef o

fM

edic

ine

Oth

er

Data Use

1) In the most recent calendar year have you run additional analyses (beyond what was required for reporting) on your hospitalrsquos own stroke data

2)How frequently have you run and used the analyses generated

22

Yes (N=16) 80

No (N=4) 20Weekly (N=2) 125

Monthly (N=8) 500

Less than monthly but more

than 1-2 times(N=6) 375

Data Use

What is the main reason you do not run your own additional analyses (Select one best answer)

23

Not sure how to run analyses

25

Not sure what analyses are needed would be helpful 25

Other 50

Data Use

In the most recent calendar year what reports did you run

24

813 688

Pre-programmedautomated reports in thedata collection tool (eg GWTG)

Additional reports beyond pre-programmed reports from the tool

Data Use

How do you use these analyses reports

25

813 688375

Inform quality improvement (QI) efforts andor plan

ldquoaction itemsrdquo

Report to management administration on our

progress

Other

Data Use

If you run additional analysis what action items QI efforts did you plan as a result of these reports

26

o Discharge education intensive statin use

o Door to tPA time and dysphagia

o Review data between spoke amp hub hospitals regarding transfers IV-tPA administration Mechanical thrombectomy and SAH

o QI efforts were addressed in the department involving calling Stroke Alert on call for cases with FAST symptoms

o ED Medical Director works with team to fix fallouts and problematic areas We have seen improvement

o Process changes (ie fallout emails to RN manager) physician querieso Increased documentation of NIHSS ownership from individual units regarding stroke quality

improvement goalso Daily dysphagia screening determination of whowhat team responsible for documenting initial NIHSS

looking at patients beyond 2h LKW arrival

Hospital Arrival Mode Door-to Needle and Pre-Notification

Reports 2016

Percent of Cases Who Arrived via EMSMOSAIC 2009-2016

Table 1 Arrival Mode among Stroke Cases by Demographics MOSAIC 2016

Demographics N=3496 550 N=2938 450Stroke Type Ischemic 2558 542 2164 458 Hemorrhagic 560 728 209 272 TIA 378 478 413 522Age Group lt 50 Years 233 433 305 567 50-79 Years 1982 497 2008 503 ge 80 Years 1379 688 625 312Sex Female 1933 576 1422 424 Male 1661 523 1516 477Race Black 659 530 584 470 White 2824 557 2248 443 Other Missing 111 512 106 488

MOSAIC AggregateArrival Mode

EMS Private Mode

Table 2 Door-to-Needle Times by Arrival Mode among Stroke Cases MOSAIC 2016

Time Elements (in Minutes)Number of

Patients Mean (Minutes) Median

(Minutes)Range

(Minutes)Door-to-Image 4901 575 400 00-2700 Arrived via EMS 2767 463 270 00-2700 Arrived via Private Transportation 2134 720 570 00-2620

Door-to-Image (among t-PA treated) 492 155 130 00-970 Arrived via EMS 370 125 110 00-840 Arrived via Private Transportation 122 243 215 20-970Image-to Needle 492 500 450 70-2090 Arrived via EMS 370 503 460 70-2090 Arrived via Private Transportation 122 483 420 90-1770Door-to Needle 492 655 570 200-2180 Arrived via EMS 370 629 560 200-2180 Arrived via Private Transportation 122 726 650 290-2060Included ischemic or hemorrhagic cases with times that were less or equal to 270 minutes (45 hours)Transferred cases were excluded

MOSAIC Aggregate

Table 3 Pre-Notification among Stroke Cases Who Arrived Via EMS by Demographics MOSAIC 2016

Demographics N=2015 584 N=1437 416Stroke Type Ischemic 1523 622 924 378 Hemorrhagic 306 566 235 434 TIA 142 381 231 619Age Group lt 50 Years 133 607 86 393 50-79 Years 1105 585 784 415 ge 80 Years 777 578 567 422Sex Female 1075 578 786 422 Male 940 591 651 409Race Black 307 517 287 483 White 1657 602 1097 398 Other 51 490 53 510

All HospitalsPre-Notification

Yes No

MOSAIC Transitions of Care Project

Post-discharge data collection tool is being implemented into Outcome Science as a tab

Post-Discharge amp Transition of Care

Reporting on changes within 30 days of discharge from hospital via follow-up callschart review Interval events Physician follow-up visits Lifestyle changes Lab assessments Medication managementadherence Rehab amp Functional outcomes Falls

MOSAIC Website

wwwMichigangovstroke

Adrienne Nickles MPHnicklesamichigangov

Thank You

  • Michigan and MOSAIC Data Review
  • Overview
  • Age-adjusted Stroke Hospitalization Rates Michigan 2000-2015
  • Slide Number 4
  • Age-adjusted Stroke Mortality Rates Michigan 2000-2014
  • Slide Number 6
  • Slide Number 7
  • Slide Number 8
  • Slide Number 9
  • Slide Number 10
  • Slide Number 11
  • MOSAIC 2015-2020
  • Pre-hospital Care
  • EMSMOSAIC Data Linkage
  • Slide Number 15
  • GWTG Special Initiatives Tab
  • Slide Number 17
  • MOSAIC Participating Hospitals
  • Hospital Infrastructure
  • Case Demographics MOSAIC Registry
  • Who receives data reports on your stroke quality of care
  • 1) In the most recent calendar year have you run additional analyses (beyond what was required for reporting) on your hospitalrsquos own stroke data 2)How frequently have you run and used the analyses generated
  • What is the main reason you do not run your own additional analyses (Select one best answer)
  • In the most recent calendar year what reports did you run
  • How do you use these analyses reports
  • If you run additional analysis what action items QI efforts did you plan as a result of these reports
  • Hospital Arrival Mode Door-to Needle and Pre-Notification Reports 2016
  • Percent of Cases Who Arrived via EMSMOSAIC 2009-2016
  • Table 1 Arrival Mode among Stroke Cases by Demographics MOSAIC 2016
  • Table 2 Door-to-Needle Times by Arrival Mode among Stroke Cases MOSAIC 2016
  • Table 3 Pre-Notification among Stroke Cases Who Arrived Via EMS by Demographics MOSAIC 2016
  • MOSAIC Transitions of Care Project
  • Slide Number 33
  • MOSAIC Website
  • Adrienne Nickles MPHnicklesamichigangov
CVD
Year White Male Black Male White Female Black Female
2000 4276 5424 3033 4161
2001 4066 5524 2813 4091
2002 3928 5468 2767 4114
2003 3734 518 2638 3887
2004 3448 5079 2432 3643
2005 3366 4983 2375 3545
2006 3276 4994 2313 3477
2007 3236 4845 2223 327
2008 3158 4694 2238 3327
change 234 79 237 164
Heart Disease
Year White Male Black Male White Female Black Female
2000 3393 4298 227 3206
2001 3232 4445 2124 3166
2002 3118 4317 2197 3157
2003 2986 4184 1957 3001
2004 2777 3983 1783 2838
2005 2704 4009 1776 2679
2006 2644 3981 1739 2642
2007 2619 3972 1679 2532
2008 2566 3819 1687 2606
Stroke
Year White Male Black Male White Female Black Female
2000 61 768 561 703 176
2001 575 752 539 681 138
2002 573 806 528 66 15
2003 516 662 498 629 147
2004 463 743 476 562
2005 449 663 429 585
2006 434 63 411 556
2007 415 631 392 494
2008 402 606 392 509
2009 375 616 372 464
2010 372 565 366 513
2011 373 548 366 44
2012 348 587 349 477
2013 347 506 34 462
2014 369 506 352 482
Coronary Heart Disease
Year White Male Black Male White Female Black Female
2000 2625 329 1608 243
2001 2478 3356 1508 2314
2002 2404 3154 1419 2313
2003 2221 3093 1328 209
2004 2067 2956 119 1983
2005 1989 2885 117 1853
2006 1922 2903 1139 1825
2007 1921 2771 1074 1645
2008 1824 2592 1071 1722
Heart Failure
Year White Male Black Male White Female Black Female
2000 255 206 245 17
2001 267 225 225 167
2002 242 238 227 203
2003 256 217 222 189
2004 243 167 214 206
2005 24 218 217 172
2006 255 246 229 202
2007 23 225 208 196
2008 25 216 226 185
Not sure what this data is from previously HD Stroke
Year White Female Black Female White Female Black Female
2000 227 3206 561 703
2001 2124 3166 539 681
2002 2197 3157 528 66
2003 1957 3001 498 629
2004 1783 2838 476 562
2005 1776 2679 429 585
2006 1739 2642 411 556
2007
2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2009 2009 2009 2009
2010 2010 2010 2010
2011 2011 2011 2011
2012 2012 2012 2012
2013 2013 2013 2013
2014 2014 2014 2014
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
CVD
Year US Michigan 0-34 35-64 65-84 85+
2000 3397 3694 43 140 16141 86689
2001 3265 3524 508 1348 15291 82889
2002 3174 3421 45 1338 14891 79536
2003 3061 3258 54 1324 14033 75185
2004 2885 3034 41 1242 13209 69088
2005 2773 2972 48 1283 1291 66011
2006 2898 48 1207 12246 6786
2007 2825 5 1206 1182 66153
2008 2791 43 1175 11619 66406
Heart Disease
Year US Michigan 0-34 35-64 65-84 85+
2000 2576 2851 345 1158 1247 64879
2001 2478 2719 416 112 11794 61938
2002 2408 2631 35 1103 11529 58746
2003 2323 2517 45 110 10827 56172
2004 217 2337 313 1048 10086 51609
2005 2111 2308 38 1078 9937 49828
2006 226 384 1019 9413 51918
2007 2216 42 1008 9174 50961
2008 2192 36 982 904 51209
Stroke
Year US Michigan HP 2010 0-34 35-64 65-84 85+
2000 609 603 50 068 174 2589 15841
2001 579 577 50 0638 157 2522 1504
2002 562 571 50 072 169 2397 1528
2003 535 527 50 0737 157 2249 13741
2004 50 496 50 0652 138 220 12629
2005 466 464 50 0553 145 2063 11398
2006 444 50 0734 127 196 11256
2007 425 064 1368 1832 10718
2008 419 047 134 1804 10646
79 27 243 289
Coronary Heart Disease
Year US Michigan HP 2010 0-34 35-64 65-84 85+
2000 1868 2118 162 0613 874 7701 4670
2001 1778 2006 162 0898 818 9012 44369
2002 1709 192 162 0889 799 8759 41061
2003 1628 179 162 0793 785 8018 38358
2004 1502 1656 162 0865 757 7421 34644
2005 1444 1611 162 097 773 7245 32617
2006 1564 162 088 727 6856 33503
2007 1516 117 709 6585 32727
2008 1472 102 657 6403 32504
168 11 283
Heart Failure
Year US Michigan 35-64 65-84 85+
2000 203 245 3047 936 8287
2001 202 237 2596 88 8285
2002 194 233 2648 878 8057
2003 194 233 3176 902 7722
2004 189 224 2709 863 7586
2005 189 224 2955 878 7388
2006 24 2979 884 8354
2007 219 274 828 7483
2008 233 013 333 85 8102
Heart Disease Stroke
Michigan White Michigan Black US White US Black Michigan White Michigan Black US White US Black
1990 334 4315 317 3915 1990 638 733 629 917
1991 3289 4108 3088 3865 1991 626 781 607 894
1992 3126 3987 3011 3777 1992 609 694 598 86
1993 3234 429 3046 3843 1993 614 77 609 866
1994 3134 4156 295 3661 1994 634 875 609 869
1995 3048 4131 2912 3672 1995 638 925 615 879
1996 2997 380 2842 354 1996 617 804 61 852
1997 2851 3683 2764 345 1997 604 77 598 816
1998 2884 3586 2681 3406 1998 598 729 576 803
1999 2781 3692 2634 3367 1999 609 812 598 824
2000 2757 3663 2536 3265 2000 586 737 587 824
2001 261 3695 2435 3169 2001 56 718 558 788
2002 2522 3659 2367 3084 2002 553 729 542 763
2003 2409 350 2282 3002 2003 511 655 514 743
2004 222 3311 2133 2806 2004 477 633 48 699
2005 219 3227 2005 442 616
2006 2144 320 2006 426 589
2007 2007
2008 2008
CVD CHD HD HF Stroke
2000 3694 2118 2851 245 603
2001 3524 2006 2719 237 577
2002 3421 192 2631 233 571
2003 3258 179 2517 233 527
2004 3034 1656 2337 224 496
2005 2972 1611 2308 224 464
2006 2898 1564 226 24 444
2007 2825 1516 2216 219 425
2008 2791 1472 2192 233 419
2000 2000 2000
2001 2001 2001
2002 2002 2002
2003 2003 2003
2004 2004 2004
2005 2005 2005
2006 2006 2006
2007 2007 2007
2008 2008 2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2000 2000 2000 2000 2000
2001 2001 2001 2001 2001
2002 2002 2002 2002 2002
2003 2003 2003 2003 2003
2004 2004 2004 2004 2004
2005 2005 2005 2005 2005
2006 2006 2006 2006 2006
2007 2007 2007 2007 2007
2008 2008 2008 2008 2008
CVD
Year White Male Black Male White Female Black Female
2000 4276 5424 3033 4161
2001 4066 5524 2813 4091
2002 3928 5468 2767 4114
2003 3734 518 2638 3887
2004 3448 5079 2432 3643
2005 3366 4983 2375 3545
2006 3276 4994 2313 3477
2007 3236 4845 2223 327
2008 3158 4694 2238 3327
change 234 79 237 164
Heart Disease
Year White Male Black Male White Female Black Female
2000 3393 4298 227 3206
2001 3232 4445 2124 3166
2002 3118 4317 2197 3157
2003 2986 4184 1957 3001
2004 2777 3983 1783 2838
2005 2704 4009 1776 2679
2006 2644 3981 1739 2642
2007 2619 3972 1679 2532
2008 2566 3819 1687 2606
Stroke
Year White Male Black Male White Female Black Female
2000 61 768 561 703 176
2001 575 752 539 681 138
2002 573 806 528 66 15
2003 516 662 498 629 147
2004 463 743 476 562
2005 449 663 429 585
2006 434 63 411 556
2007 415 631 392 494
2008 402 606 392 509
Coronary Heart Disease
Year White Male Black Male White Female Black Female
2000 2625 329 1608 243
2001 2478 3356 1508 2314
2002 2404 3154 1419 2313
2003 2221 3093 1328 209
2004 2067 2956 119 1983
2005 1989 2885 117 1853
2006 1922 2903 1139 1825
2007 1921 2771 1074 1645
2008 1824 2592 1071 1722
Heart Failure
Year White Male Black Male White Female Black Female
2000 255 206 245 17
2001 267 225 225 167
2002 242 238 227 203
2003 256 217 222 189
2004 243 167 214 206
2005 24 218 217 172
2006 255 246 229 202
2007 23 225 208 196
2008 25 216 226 185
Not sure what this data is from previously HD Stroke
Year White Female Black Female White Female Black Female
2000 227 3206 561 703
2001 2124 3166 539 681
2002 2197 3157 528 66
2003 1957 3001 498 629
2004 1783 2838 476 562
2005 1776 2679 429 585
2006 1739 2642 411 556
2007
2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
CVD
Year US Michigan 0-34 35-64 65-84 85+
2000 3397 3694 43 140 16141 86689
2001 3265 3524 508 1348 15291 82889
2002 3174 3421 45 1338 14891 79536
2003 3061 3258 54 1324 14033 75185
2004 2885 3034 41 1242 13209 69088
2005 2773 2972 48 1283 1291 66011
2006 2898 48 1207 12246 6786
2007 2825 5 1206 1182 66153
2008 2791 43 1175 11619 66406
Heart Disease
Year US Michigan 0-34 35-64 65-84 85+
2000 2576 2851 345 1158 1247 64879
2001 2478 2719 416 112 11794 61938
2002 2408 2631 35 1103 11529 58746
2003 2323 2517 45 110 10827 56172
2004 217 2337 313 1048 10086 51609
2005 2111 2308 38 1078 9937 49828
2006 226 384 1019 9413 51918
2007 2216 42 1008 9174 50961
2008 2192 36 982 904 51209
Stroke
Year US Michigan HP 2010 0-34 35-64 65-84 85+
2000 609 603 50 068 174 2589 15841
2001 579 577 50 0638 157 2522 1504
2002 562 571 50 072 169 2397 1528
2003 535 527 50 0737 157 2249 13741
2004 50 496 50 0652 138 220 12629
2005 466 464 50 0553 145 2063 11398
2006 444 50 0734 127 196 11256
2007 425 064 1368 1832 10718
2008 419 047 134 1804 10646
79 27 243 289
Coronary Heart Disease
Year US Michigan HP 2010 0-34 35-64 65-84 85+
2000 1868 2118 162 0613 874 7701 4670
2001 1778 2006 162 0898 818 9012 44369
2002 1709 192 162 0889 799 8759 41061
2003 1628 179 162 0793 785 8018 38358
2004 1502 1656 162 0865 757 7421 34644
2005 1444 1611 162 097 773 7245 32617
2006 1564 162 088 727 6856 33503
2007 1516 117 709 6585 32727
2008 1472 102 657 6403 32504
168 11 283
Heart Failure
Year US Michigan 35-64 65-84 85+
2000 203 245 3047 936 8287
2001 202 237 2596 88 8285
2002 194 233 2648 878 8057
2003 194 233 3176 902 7722
2004 189 224 2709 863 7586
2005 189 224 2955 878 7388
2006 24 2979 884 8354
2007 219 274 828 7483
2008 233 013 333 85 8102
Heart Disease Stroke
Michigan White Michigan Black US White US Black Michigan White Michigan Black US White US Black
1990 334 4315 317 3915 1990 638 733 629 917
1991 3289 4108 3088 3865 1991 626 781 607 894
1992 3126 3987 3011 3777 1992 609 694 598 86
1993 3234 429 3046 3843 1993 614 77 609 866
1994 3134 4156 295 3661 1994 634 875 609 869
1995 3048 4131 2912 3672 1995 638 925 615 879
1996 2997 380 2842 354 1996 617 804 61 852
1997 2851 3683 2764 345 1997 604 77 598 816
1998 2884 3586 2681 3406 1998 598 729 576 803
1999 2781 3692 2634 3367 1999 609 812 598 824
2000 2757 3663 2536 3265 2000 586 737 587 824
2001 261 3695 2435 3169 2001 56 718 558 788
2002 2522 3659 2367 3084 2002 553 729 542 763
2003 2409 350 2282 3002 2003 511 655 514 743
2004 222 3311 2133 2806 2004 477 633 48 699
2005 219 3227 2005 442 616
2006 2144 320 2006 426 589
2007 2007
2008 2008
Stroke
CVD MI US
2000 3694 606 609
2001 3524 584 584
2002 3421 583 572
2003 3258 539 546
2004 3034 519 512
2005 2972 488 48
2006 2898 449 448
2007 2825 43 435
2008 2791 423 421
2009 262 396 396
2010 394 391
2011 387 379
2012 372 369
2013 363 369
2014 377 365
2000 2000 2000
2001 2001 2001
2002 2002 2002
2003 2003 2003
2004 2004 2004
2005 2005 2005
2006 2006 2006
2007 2007 2007
2008 2008 2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2000 2000
2001 2001
2002 2002
2003 2003
2004 2004
2005 2005
2006 2006
2007 2007
2008 2008
2009 2009
2010 2010
2011 2011
2012 2012
2013 2013
2014 2014
Page 8: Michigan and MOSAIC Data Review...Michigan and MOSAIC Data Review 2017 ANNUAL WORKSHOP 4/26/2017. Adrienne Nickles, MPH. Michigan’s Ongoing Stroke Registry to Accelerate the Improvement

Overall_Rates

MI
US
Year
Rate per 100000
606
609
584
584
583
572
539
546
519
512
488
48
449
448
43
435
423
421
396
396
394
391
387
379
372
369
363
369
377
365

CVD_Age

0-34
35-64
65-84
85+
Year
Age-Adjusted Rate per 100000
43
140
16141
86689
508
1348
15291
82889
45
1338
14891
79536
54
1324
14033
75185
41
1242
13209
69088
48
1283
1291
66011
48
1207
12246
6786
5
1206
1182
66153
43
1175
11619
66406

HD_Age

0-34
35-64
65-84
85+
Year
Age-Adjusted Rate per 100000
345
1158
1247
64879
416
112
11794
61938
35
1103
11529
58746
45
110
10827
56172
313
1048
10086
51609
38
1078
9937
49828
384
1019
9413
51918
42
1008
9174
50961
36
982
904
51209

CHD_Age

0-34
35-64
65-84
85+
Year
Age-Adjusted Rate per 100000
0613
874
7701
4670
0898
818
9012
44369
0889
799
8759
41061
0793
785
8018
38358
0865
757
7421
34644
097
773
7245
32617
088
727
6856
33503
117
709
6585
32727
102
657
6403
32504

Stroke_Age

0-34
35-64
65-84
85+
Year
Age-Adjusted Rate per 100000
068
174
2589
15841
0638
157
2522
1504
072
169
2397
1528
0737
157
2249
13741
0652
138
220
12629
0553
145
2063
11398
0734
127
196
11256
064
1368
1832
10718
047
134
1804
10646

HF_Age

35-64
65-84
85+
Year
Age-Adjusted Rate per 100000
3047
936
8287
2596
88
8285
2648
878
8057
3176
902
7722
2709
863
7586
2955
878
7388
2979
884
8354
274
828
7483
333
85
8102

total

CVD_RG

White Male
Black Male
White Female
Black Female
Year
Age-Adjusted Rate per 100000
4276
5424
3033
4161
4066
5524
2813
4091
3928
5468
2767
4114
3734
518
2638
3887
3448
5079
2432
3643
3366
4983
2375
3545
3276
4994
2313
3477
3236
4845
2223
327
3158
4694
2238
3327

Stroke_RG

White Male
Black Male
White Female
Black Female
Year
Age-Adjusted Rate per 100000
61
768
561
703
575
752
539
681
573
806
528
66
516
662
498
629
463
743
476
562
449
663
429
585
434
63
411
556
415
631
392
494
402
606
392
509

HD_RG

White Male
Black Male
White Female
Black Female
Year
Age-Adjusted Rate per 100000
3393
4298
227
3206
3232
4445
2124
3166
3118
4317
2197
3157
2986
4184
1957
3001
2777
3983
1783
2838
2704
4009
1776
2679
2644
3981
1739
2642
2619
3972
1679
2532
2566
3819
1687
2606

CHD_RG

White Male
Black Male
White Female
Black Female
Year
Age-Adjusted Rate per 100000
2625
329
1608
243
2478
3356
1508
2314
2404
3154
1419
2313
2221
3093
1328
209
2067
2956
119
1983
1989
2885
117
1853
1922
2903
1139
1825
1921
2771
1074
1645
1824
2592
1071
1722

HF_RG

White Male
Black Male
White Female
Black Female
Year
Age-Adjusted Rate per 100000
255
206
245
17
267
225
225
167
242
238
227
203
256
217
222
189
243
167
214
206
24
218
217
172
255
246
229
202
23
225
208
196
25
216
226
185

race_gender

Sheet3

Age-adjusted stroke mortality rates by race and gender Michigan 2000 to 2014

0

10

20

30

40

50

60

70

80

90

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014

Age

-Adj

uste

d R

ate

per 1

000

00

Year

White Male

Black Male

White Female

Black Female

Overall_Rates

CVD
CHD
HD
HF
Stroke
Year
Rate per 10000
3694
2118
2851
245
603
3524
2006
2719
237
577
3421
192
2631
233
571
3258
179
2517
233
527
3034
1656
2337
224
496
2972
1611
2308
224
464
2898
1564
226
24
444
2825
1516
2216
219
425
2791
1472
2192
233
419

CVD_Age

0-34
35-64
65-84
85+
Year
Age-Adjusted Rate per 100000
43
140
16141
86689
508
1348
15291
82889
45
1338
14891
79536
54
1324
14033
75185
41
1242
13209
69088
48
1283
1291
66011
48
1207
12246
6786
5
1206
1182
66153
43
1175
11619
66406

HD_Age

0-34
35-64
65-84
85+
Year
Age-Adjusted Rate per 100000
345
1158
1247
64879
416
112
11794
61938
35
1103
11529
58746
45
110
10827
56172
313
1048
10086
51609
38
1078
9937
49828
384
1019
9413
51918
42
1008
9174
50961
36
982
904
51209

CHD_Age

0-34
35-64
65-84
85+
Year
Age-Adjusted Rate per 100000
0613
874
7701
4670
0898
818
9012
44369
0889
799
8759
41061
0793
785
8018
38358
0865
757
7421
34644
097
773
7245
32617
088
727
6856
33503
117
709
6585
32727
102
657
6403
32504

Stroke_Age

0-34
35-64
65-84
85+
Year
Age-Adjusted Rate per 100000
068
174
2589
15841
0638
157
2522
1504
072
169
2397
1528
0737
157
2249
13741
0652
138
220
12629
0553
145
2063
11398
0734
127
196
11256
064
1368
1832
10718
047
134
1804
10646

HF_Age

35-64
65-84
85+
Year
Age-Adjusted Rate per 100000
3047
936
8287
2596
88
8285
2648
878
8057
3176
902
7722
2709
863
7586
2955
878
7388
2979
884
8354
274
828
7483
333
85
8102

total

CVD_RG

White Male
Black Male
White Female
Black Female
Year
Age-Adjusted Rate per 100000
4276
5424
3033
4161
4066
5524
2813
4091
3928
5468
2767
4114
3734
518
2638
3887
3448
5079
2432
3643
3366
4983
2375
3545
3276
4994
2313
3477
3236
4845
2223
327
3158
4694
2238
3327

Stroke_RG

White Male
Black Male
White Female
Black Female
Year
Age-Adjusted Rate per 100000
61
768
561
703
575
752
539
681
573
806
528
66
516
662
498
629
463
743
476
562
449
663
429
585
434
63
411
556
415
631
392
494
402
606
392
509
375
616
372
464
372
565
366
513
373
548
366
44
348
587
349
477
347
506
34
462
369
506
352
482

HD_RG

White Male
Black Male
White Female
Black Female
Year
Age-Adjusted Rate per 100000
3393
4298
227
3206
3232
4445
2124
3166
3118
4317
2197
3157
2986
4184
1957
3001
2777
3983
1783
2838
2704
4009
1776
2679
2644
3981
1739
2642
2619
3972
1679
2532
2566
3819
1687
2606

CHD_RG

White Male
Black Male
White Female
Black Female
Year
Age-Adjusted Rate per 100000
2625
329
1608
243
2478
3356
1508
2314
2404
3154
1419
2313
2221
3093
1328
209
2067
2956
119
1983
1989
2885
117
1853
1922
2903
1139
1825
1921
2771
1074
1645
1824
2592
1071
1722

HF_RG

White Male
Black Male
White Female
Black Female
Year
Age-Adjusted Rate per 100000
255
206
245
17
267
225
225
167
242
238
227
203
256
217
222
189
243
167
214
206
24
218
217
172
255
246
229
202
23
225
208
196
25
216
226
185

race_gender

Sheet3

Local Health Department data can be found at wwwmichigangovbrfsSource CDC BRFSS

RISK FACTORMI

2011

MI

2013

MI

2014

MI

2015US 2015

2015 NATIONAL RANKING

Current Smoking 233 214 212 207 175 11

Blood Pressure Ever Told High 342 346 NA 331 309 18

Cholesterol Ever Told High 418 406 NA 382 364 12

Overweight (BMIgt25) 342 347 349 351 355 32tied

Obese (BMIgt30) 313 315 307 312 298 16

No Leisure Time Physical Activity 236 244 255 255 262 27

Diabetes 100 104 104 107 100 18tied

Prevalence of CVD Risk Factors Michigan Adults 1990-2015Compared to 2015 National Prevalence

233214 212 207

175

10

15

20

25

30

MI 2011 MI 2013 MI 2014 MI 2015 US 2015

Current Smoking

342 346331

309

20

25

30

35

40

MI 2011 MI 2013 MI 2014 MI 2015 US 2015

Blood Pressure Ever told high

342 347 349 351 355

20

25

30

35

40

MI 2011 MI 2013 MI 2014 MI 2015 US 2015

Overweight (BMIgt25)

313 315 307 312298

20

25

30

35

40

MI 2011 MI 2013 MI 2014 MI 2015 US 2015

Obese (BMIgt30)

418406

382364

30

35

40

45

50

MI 2011 MI 2013 MI 2014 MI 2015 US 2015

Cholesterol Ever told high

10 104 104 10710

0

3

6

9

12

15

MI 2011 MI 2013 MI 2014 MI 2015 US 2015

Diabetes

236 244255 255 262

10

15

20

25

30

MI 2011 MI 2013 MI 2014 MI 2015 US 2015

No Leisure Time Physical Activity

11 1216 18

2732tied

05

101520253035404550

CurrentSmoking

CholesterolEver told high

Obese(BMIgt30)

BloodPressure Ever

told high

Diabetes No LeisureTime Physical

Activity

Overweight(BMIgt25)

2015 NATIONAL RANKING(1st is worst)

18tied

MOSAIC 2015-2020 Focus of Grant Developing Stroke Systems of

Care Community Awareness EMS In-hospital QI Transition of Care Post-Discharge

12

Pre-hospital Care

A V A I L A B L E D A T A

13

EMSMOSAIC Data Linkage

-The MOSAIC Team continues to link data from the Michigan EMS Information System (MiEMSIS) to MOSAIC Data- Reports have been created for and reviewed by the

Tri-County Area MCA and Detroit East MCA- This work will expand to other MCA regions that

serve hospitals participating in MOSAIC

GWTG Special Initiatives Tab

-A free tab that can be enabled in GWTG-The purpose of the tab is to collect data concerning patient hand-off from EMS

MOSAIC Participating Hospitals

Aspirus Keweenaw Hospital (Laurium)

Aspirus Grand View HospitalAspirus Iron River HospitalAspirus Ontonagon HospitalBixby Medical CenterBronson Methodist HospitalCovenant Health CareDetroit Receiving HospitalGenesys Regional Medical CenterHenry Ford Hospital Herrick Medical CenterHuron Valley-Sinai HospitalLakeland Regional Medical Center McLaren Bay Regional Medical CenterMcLaren Greater Medical Center

McLaren Macomb HospitalMcLaren Northern MI HospitalMcLaren Oakland Medical CenterMcLaren Port Huron HospitalMcLaren Regional Medical CenterMercy Health Saint Maryrsquos HospitalMetro Health HospitalMunson Medical Center

ProMedica Monroe Regional HospitalSparrow HospitalSt Joseph Mercy - Ann ArborSt Joseph Mercy ChelseaSt Joseph Mercy Livingston HospitalSt Mary MercySt Mary of Michigan HospitalU of M Hospital

Hospital Infrastructure19

Among all participating hospitals the average number of

Licensed beds was 374 (range 25 to 1059 beds)

Inpatient discharges was 17076 (range 1064 to 48916 patients)

Acute stroke discharges (primary diagnosis only) was 417 (range 34 to 982 patients)

Case Demographics MOSAIC Registry

VariablesN() or statistics(Total N=68906)

Age at admission (years)Median 710Range 180 - 1060Mean (SE) 697(01)

GenderMale 32886 (477)Female 36015 (523)

RaceAfrican American 9900 (197)AIAN 132 (03)Asian 320 (06)More than one race 44 (01)Unknown 3679 (73)White 36190 (720)Missing 70

EthnicityHispanic or Latino 804 (16)Others 49531 (984)

VariablesN() or statistics(Total N=68906)

Health insuranceMedicaid 2284 (45)MedicaidPrivate 211 (04)Medicare 16863 (336)Medicare Medicaid 2313 (46)

MedicareMedicaidPrivate125 (02)

MedicarePrivate 13640 (272)ND 268(05)No insurance 2123 (42)Private 12356 (246)

Arrival modeEMS 21052 (429)Private

transportationother19313 (393)

Transfer from another hospital

7733(157)

ND or unknown 1021 (21)Missing 1216

Who receives data reports on your stroke quality of care

21

7055

70

10085

65

40

Hos

pita

lC

EO

up

per

man

agem

ent

Hos

pita

lB

oard

Chi

efN

ursi

ngO

ffice

r(C

NO

)

Str

oke

Tea

m

Phy

sici

anS

trok

eC

ham

pion

Chi

ef o

fM

edic

ine

Oth

er

Data Use

1) In the most recent calendar year have you run additional analyses (beyond what was required for reporting) on your hospitalrsquos own stroke data

2)How frequently have you run and used the analyses generated

22

Yes (N=16) 80

No (N=4) 20Weekly (N=2) 125

Monthly (N=8) 500

Less than monthly but more

than 1-2 times(N=6) 375

Data Use

What is the main reason you do not run your own additional analyses (Select one best answer)

23

Not sure how to run analyses

25

Not sure what analyses are needed would be helpful 25

Other 50

Data Use

In the most recent calendar year what reports did you run

24

813 688

Pre-programmedautomated reports in thedata collection tool (eg GWTG)

Additional reports beyond pre-programmed reports from the tool

Data Use

How do you use these analyses reports

25

813 688375

Inform quality improvement (QI) efforts andor plan

ldquoaction itemsrdquo

Report to management administration on our

progress

Other

Data Use

If you run additional analysis what action items QI efforts did you plan as a result of these reports

26

o Discharge education intensive statin use

o Door to tPA time and dysphagia

o Review data between spoke amp hub hospitals regarding transfers IV-tPA administration Mechanical thrombectomy and SAH

o QI efforts were addressed in the department involving calling Stroke Alert on call for cases with FAST symptoms

o ED Medical Director works with team to fix fallouts and problematic areas We have seen improvement

o Process changes (ie fallout emails to RN manager) physician querieso Increased documentation of NIHSS ownership from individual units regarding stroke quality

improvement goalso Daily dysphagia screening determination of whowhat team responsible for documenting initial NIHSS

looking at patients beyond 2h LKW arrival

Hospital Arrival Mode Door-to Needle and Pre-Notification

Reports 2016

Percent of Cases Who Arrived via EMSMOSAIC 2009-2016

Table 1 Arrival Mode among Stroke Cases by Demographics MOSAIC 2016

Demographics N=3496 550 N=2938 450Stroke Type Ischemic 2558 542 2164 458 Hemorrhagic 560 728 209 272 TIA 378 478 413 522Age Group lt 50 Years 233 433 305 567 50-79 Years 1982 497 2008 503 ge 80 Years 1379 688 625 312Sex Female 1933 576 1422 424 Male 1661 523 1516 477Race Black 659 530 584 470 White 2824 557 2248 443 Other Missing 111 512 106 488

MOSAIC AggregateArrival Mode

EMS Private Mode

Table 2 Door-to-Needle Times by Arrival Mode among Stroke Cases MOSAIC 2016

Time Elements (in Minutes)Number of

Patients Mean (Minutes) Median

(Minutes)Range

(Minutes)Door-to-Image 4901 575 400 00-2700 Arrived via EMS 2767 463 270 00-2700 Arrived via Private Transportation 2134 720 570 00-2620

Door-to-Image (among t-PA treated) 492 155 130 00-970 Arrived via EMS 370 125 110 00-840 Arrived via Private Transportation 122 243 215 20-970Image-to Needle 492 500 450 70-2090 Arrived via EMS 370 503 460 70-2090 Arrived via Private Transportation 122 483 420 90-1770Door-to Needle 492 655 570 200-2180 Arrived via EMS 370 629 560 200-2180 Arrived via Private Transportation 122 726 650 290-2060Included ischemic or hemorrhagic cases with times that were less or equal to 270 minutes (45 hours)Transferred cases were excluded

MOSAIC Aggregate

Table 3 Pre-Notification among Stroke Cases Who Arrived Via EMS by Demographics MOSAIC 2016

Demographics N=2015 584 N=1437 416Stroke Type Ischemic 1523 622 924 378 Hemorrhagic 306 566 235 434 TIA 142 381 231 619Age Group lt 50 Years 133 607 86 393 50-79 Years 1105 585 784 415 ge 80 Years 777 578 567 422Sex Female 1075 578 786 422 Male 940 591 651 409Race Black 307 517 287 483 White 1657 602 1097 398 Other 51 490 53 510

All HospitalsPre-Notification

Yes No

MOSAIC Transitions of Care Project

Post-discharge data collection tool is being implemented into Outcome Science as a tab

Post-Discharge amp Transition of Care

Reporting on changes within 30 days of discharge from hospital via follow-up callschart review Interval events Physician follow-up visits Lifestyle changes Lab assessments Medication managementadherence Rehab amp Functional outcomes Falls

MOSAIC Website

wwwMichigangovstroke

Adrienne Nickles MPHnicklesamichigangov

Thank You

  • Michigan and MOSAIC Data Review
  • Overview
  • Age-adjusted Stroke Hospitalization Rates Michigan 2000-2015
  • Slide Number 4
  • Age-adjusted Stroke Mortality Rates Michigan 2000-2014
  • Slide Number 6
  • Slide Number 7
  • Slide Number 8
  • Slide Number 9
  • Slide Number 10
  • Slide Number 11
  • MOSAIC 2015-2020
  • Pre-hospital Care
  • EMSMOSAIC Data Linkage
  • Slide Number 15
  • GWTG Special Initiatives Tab
  • Slide Number 17
  • MOSAIC Participating Hospitals
  • Hospital Infrastructure
  • Case Demographics MOSAIC Registry
  • Who receives data reports on your stroke quality of care
  • 1) In the most recent calendar year have you run additional analyses (beyond what was required for reporting) on your hospitalrsquos own stroke data 2)How frequently have you run and used the analyses generated
  • What is the main reason you do not run your own additional analyses (Select one best answer)
  • In the most recent calendar year what reports did you run
  • How do you use these analyses reports
  • If you run additional analysis what action items QI efforts did you plan as a result of these reports
  • Hospital Arrival Mode Door-to Needle and Pre-Notification Reports 2016
  • Percent of Cases Who Arrived via EMSMOSAIC 2009-2016
  • Table 1 Arrival Mode among Stroke Cases by Demographics MOSAIC 2016
  • Table 2 Door-to-Needle Times by Arrival Mode among Stroke Cases MOSAIC 2016
  • Table 3 Pre-Notification among Stroke Cases Who Arrived Via EMS by Demographics MOSAIC 2016
  • MOSAIC Transitions of Care Project
  • Slide Number 33
  • MOSAIC Website
  • Adrienne Nickles MPHnicklesamichigangov
CVD
Year White Male Black Male White Female Black Female
2000 4276 5424 3033 4161
2001 4066 5524 2813 4091
2002 3928 5468 2767 4114
2003 3734 518 2638 3887
2004 3448 5079 2432 3643
2005 3366 4983 2375 3545
2006 3276 4994 2313 3477
2007 3236 4845 2223 327
2008 3158 4694 2238 3327
change 234 79 237 164
Heart Disease
Year White Male Black Male White Female Black Female
2000 3393 4298 227 3206
2001 3232 4445 2124 3166
2002 3118 4317 2197 3157
2003 2986 4184 1957 3001
2004 2777 3983 1783 2838
2005 2704 4009 1776 2679
2006 2644 3981 1739 2642
2007 2619 3972 1679 2532
2008 2566 3819 1687 2606
Stroke
Year White Male Black Male White Female Black Female
2000 61 768 561 703 176
2001 575 752 539 681 138
2002 573 806 528 66 15
2003 516 662 498 629 147
2004 463 743 476 562
2005 449 663 429 585
2006 434 63 411 556
2007 415 631 392 494
2008 402 606 392 509
2009 375 616 372 464
2010 372 565 366 513
2011 373 548 366 44
2012 348 587 349 477
2013 347 506 34 462
2014 369 506 352 482
Coronary Heart Disease
Year White Male Black Male White Female Black Female
2000 2625 329 1608 243
2001 2478 3356 1508 2314
2002 2404 3154 1419 2313
2003 2221 3093 1328 209
2004 2067 2956 119 1983
2005 1989 2885 117 1853
2006 1922 2903 1139 1825
2007 1921 2771 1074 1645
2008 1824 2592 1071 1722
Heart Failure
Year White Male Black Male White Female Black Female
2000 255 206 245 17
2001 267 225 225 167
2002 242 238 227 203
2003 256 217 222 189
2004 243 167 214 206
2005 24 218 217 172
2006 255 246 229 202
2007 23 225 208 196
2008 25 216 226 185
Not sure what this data is from previously HD Stroke
Year White Female Black Female White Female Black Female
2000 227 3206 561 703
2001 2124 3166 539 681
2002 2197 3157 528 66
2003 1957 3001 498 629
2004 1783 2838 476 562
2005 1776 2679 429 585
2006 1739 2642 411 556
2007
2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2009 2009 2009 2009
2010 2010 2010 2010
2011 2011 2011 2011
2012 2012 2012 2012
2013 2013 2013 2013
2014 2014 2014 2014
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
CVD
Year US Michigan 0-34 35-64 65-84 85+
2000 3397 3694 43 140 16141 86689
2001 3265 3524 508 1348 15291 82889
2002 3174 3421 45 1338 14891 79536
2003 3061 3258 54 1324 14033 75185
2004 2885 3034 41 1242 13209 69088
2005 2773 2972 48 1283 1291 66011
2006 2898 48 1207 12246 6786
2007 2825 5 1206 1182 66153
2008 2791 43 1175 11619 66406
Heart Disease
Year US Michigan 0-34 35-64 65-84 85+
2000 2576 2851 345 1158 1247 64879
2001 2478 2719 416 112 11794 61938
2002 2408 2631 35 1103 11529 58746
2003 2323 2517 45 110 10827 56172
2004 217 2337 313 1048 10086 51609
2005 2111 2308 38 1078 9937 49828
2006 226 384 1019 9413 51918
2007 2216 42 1008 9174 50961
2008 2192 36 982 904 51209
Stroke
Year US Michigan HP 2010 0-34 35-64 65-84 85+
2000 609 603 50 068 174 2589 15841
2001 579 577 50 0638 157 2522 1504
2002 562 571 50 072 169 2397 1528
2003 535 527 50 0737 157 2249 13741
2004 50 496 50 0652 138 220 12629
2005 466 464 50 0553 145 2063 11398
2006 444 50 0734 127 196 11256
2007 425 064 1368 1832 10718
2008 419 047 134 1804 10646
79 27 243 289
Coronary Heart Disease
Year US Michigan HP 2010 0-34 35-64 65-84 85+
2000 1868 2118 162 0613 874 7701 4670
2001 1778 2006 162 0898 818 9012 44369
2002 1709 192 162 0889 799 8759 41061
2003 1628 179 162 0793 785 8018 38358
2004 1502 1656 162 0865 757 7421 34644
2005 1444 1611 162 097 773 7245 32617
2006 1564 162 088 727 6856 33503
2007 1516 117 709 6585 32727
2008 1472 102 657 6403 32504
168 11 283
Heart Failure
Year US Michigan 35-64 65-84 85+
2000 203 245 3047 936 8287
2001 202 237 2596 88 8285
2002 194 233 2648 878 8057
2003 194 233 3176 902 7722
2004 189 224 2709 863 7586
2005 189 224 2955 878 7388
2006 24 2979 884 8354
2007 219 274 828 7483
2008 233 013 333 85 8102
Heart Disease Stroke
Michigan White Michigan Black US White US Black Michigan White Michigan Black US White US Black
1990 334 4315 317 3915 1990 638 733 629 917
1991 3289 4108 3088 3865 1991 626 781 607 894
1992 3126 3987 3011 3777 1992 609 694 598 86
1993 3234 429 3046 3843 1993 614 77 609 866
1994 3134 4156 295 3661 1994 634 875 609 869
1995 3048 4131 2912 3672 1995 638 925 615 879
1996 2997 380 2842 354 1996 617 804 61 852
1997 2851 3683 2764 345 1997 604 77 598 816
1998 2884 3586 2681 3406 1998 598 729 576 803
1999 2781 3692 2634 3367 1999 609 812 598 824
2000 2757 3663 2536 3265 2000 586 737 587 824
2001 261 3695 2435 3169 2001 56 718 558 788
2002 2522 3659 2367 3084 2002 553 729 542 763
2003 2409 350 2282 3002 2003 511 655 514 743
2004 222 3311 2133 2806 2004 477 633 48 699
2005 219 3227 2005 442 616
2006 2144 320 2006 426 589
2007 2007
2008 2008
CVD CHD HD HF Stroke
2000 3694 2118 2851 245 603
2001 3524 2006 2719 237 577
2002 3421 192 2631 233 571
2003 3258 179 2517 233 527
2004 3034 1656 2337 224 496
2005 2972 1611 2308 224 464
2006 2898 1564 226 24 444
2007 2825 1516 2216 219 425
2008 2791 1472 2192 233 419
2000 2000 2000
2001 2001 2001
2002 2002 2002
2003 2003 2003
2004 2004 2004
2005 2005 2005
2006 2006 2006
2007 2007 2007
2008 2008 2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2000 2000 2000 2000 2000
2001 2001 2001 2001 2001
2002 2002 2002 2002 2002
2003 2003 2003 2003 2003
2004 2004 2004 2004 2004
2005 2005 2005 2005 2005
2006 2006 2006 2006 2006
2007 2007 2007 2007 2007
2008 2008 2008 2008 2008
CVD
Year White Male Black Male White Female Black Female
2000 4276 5424 3033 4161
2001 4066 5524 2813 4091
2002 3928 5468 2767 4114
2003 3734 518 2638 3887
2004 3448 5079 2432 3643
2005 3366 4983 2375 3545
2006 3276 4994 2313 3477
2007 3236 4845 2223 327
2008 3158 4694 2238 3327
change 234 79 237 164
Heart Disease
Year White Male Black Male White Female Black Female
2000 3393 4298 227 3206
2001 3232 4445 2124 3166
2002 3118 4317 2197 3157
2003 2986 4184 1957 3001
2004 2777 3983 1783 2838
2005 2704 4009 1776 2679
2006 2644 3981 1739 2642
2007 2619 3972 1679 2532
2008 2566 3819 1687 2606
Stroke
Year White Male Black Male White Female Black Female
2000 61 768 561 703 176
2001 575 752 539 681 138
2002 573 806 528 66 15
2003 516 662 498 629 147
2004 463 743 476 562
2005 449 663 429 585
2006 434 63 411 556
2007 415 631 392 494
2008 402 606 392 509
Coronary Heart Disease
Year White Male Black Male White Female Black Female
2000 2625 329 1608 243
2001 2478 3356 1508 2314
2002 2404 3154 1419 2313
2003 2221 3093 1328 209
2004 2067 2956 119 1983
2005 1989 2885 117 1853
2006 1922 2903 1139 1825
2007 1921 2771 1074 1645
2008 1824 2592 1071 1722
Heart Failure
Year White Male Black Male White Female Black Female
2000 255 206 245 17
2001 267 225 225 167
2002 242 238 227 203
2003 256 217 222 189
2004 243 167 214 206
2005 24 218 217 172
2006 255 246 229 202
2007 23 225 208 196
2008 25 216 226 185
Not sure what this data is from previously HD Stroke
Year White Female Black Female White Female Black Female
2000 227 3206 561 703
2001 2124 3166 539 681
2002 2197 3157 528 66
2003 1957 3001 498 629
2004 1783 2838 476 562
2005 1776 2679 429 585
2006 1739 2642 411 556
2007
2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
CVD
Year US Michigan 0-34 35-64 65-84 85+
2000 3397 3694 43 140 16141 86689
2001 3265 3524 508 1348 15291 82889
2002 3174 3421 45 1338 14891 79536
2003 3061 3258 54 1324 14033 75185
2004 2885 3034 41 1242 13209 69088
2005 2773 2972 48 1283 1291 66011
2006 2898 48 1207 12246 6786
2007 2825 5 1206 1182 66153
2008 2791 43 1175 11619 66406
Heart Disease
Year US Michigan 0-34 35-64 65-84 85+
2000 2576 2851 345 1158 1247 64879
2001 2478 2719 416 112 11794 61938
2002 2408 2631 35 1103 11529 58746
2003 2323 2517 45 110 10827 56172
2004 217 2337 313 1048 10086 51609
2005 2111 2308 38 1078 9937 49828
2006 226 384 1019 9413 51918
2007 2216 42 1008 9174 50961
2008 2192 36 982 904 51209
Stroke
Year US Michigan HP 2010 0-34 35-64 65-84 85+
2000 609 603 50 068 174 2589 15841
2001 579 577 50 0638 157 2522 1504
2002 562 571 50 072 169 2397 1528
2003 535 527 50 0737 157 2249 13741
2004 50 496 50 0652 138 220 12629
2005 466 464 50 0553 145 2063 11398
2006 444 50 0734 127 196 11256
2007 425 064 1368 1832 10718
2008 419 047 134 1804 10646
79 27 243 289
Coronary Heart Disease
Year US Michigan HP 2010 0-34 35-64 65-84 85+
2000 1868 2118 162 0613 874 7701 4670
2001 1778 2006 162 0898 818 9012 44369
2002 1709 192 162 0889 799 8759 41061
2003 1628 179 162 0793 785 8018 38358
2004 1502 1656 162 0865 757 7421 34644
2005 1444 1611 162 097 773 7245 32617
2006 1564 162 088 727 6856 33503
2007 1516 117 709 6585 32727
2008 1472 102 657 6403 32504
168 11 283
Heart Failure
Year US Michigan 35-64 65-84 85+
2000 203 245 3047 936 8287
2001 202 237 2596 88 8285
2002 194 233 2648 878 8057
2003 194 233 3176 902 7722
2004 189 224 2709 863 7586
2005 189 224 2955 878 7388
2006 24 2979 884 8354
2007 219 274 828 7483
2008 233 013 333 85 8102
Heart Disease Stroke
Michigan White Michigan Black US White US Black Michigan White Michigan Black US White US Black
1990 334 4315 317 3915 1990 638 733 629 917
1991 3289 4108 3088 3865 1991 626 781 607 894
1992 3126 3987 3011 3777 1992 609 694 598 86
1993 3234 429 3046 3843 1993 614 77 609 866
1994 3134 4156 295 3661 1994 634 875 609 869
1995 3048 4131 2912 3672 1995 638 925 615 879
1996 2997 380 2842 354 1996 617 804 61 852
1997 2851 3683 2764 345 1997 604 77 598 816
1998 2884 3586 2681 3406 1998 598 729 576 803
1999 2781 3692 2634 3367 1999 609 812 598 824
2000 2757 3663 2536 3265 2000 586 737 587 824
2001 261 3695 2435 3169 2001 56 718 558 788
2002 2522 3659 2367 3084 2002 553 729 542 763
2003 2409 350 2282 3002 2003 511 655 514 743
2004 222 3311 2133 2806 2004 477 633 48 699
2005 219 3227 2005 442 616
2006 2144 320 2006 426 589
2007 2007
2008 2008
Stroke
CVD MI US
2000 3694 606 609
2001 3524 584 584
2002 3421 583 572
2003 3258 539 546
2004 3034 519 512
2005 2972 488 48
2006 2898 449 448
2007 2825 43 435
2008 2791 423 421
2009 262 396 396
2010 394 391
2011 387 379
2012 372 369
2013 363 369
2014 377 365
2000 2000 2000
2001 2001 2001
2002 2002 2002
2003 2003 2003
2004 2004 2004
2005 2005 2005
2006 2006 2006
2007 2007 2007
2008 2008 2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2000 2000
2001 2001
2002 2002
2003 2003
2004 2004
2005 2005
2006 2006
2007 2007
2008 2008
2009 2009
2010 2010
2011 2011
2012 2012
2013 2013
2014 2014
Page 9: Michigan and MOSAIC Data Review...Michigan and MOSAIC Data Review 2017 ANNUAL WORKSHOP 4/26/2017. Adrienne Nickles, MPH. Michigan’s Ongoing Stroke Registry to Accelerate the Improvement

CVD_Age

0-34
35-64
65-84
85+
Year
Age-Adjusted Rate per 100000
43
140
16141
86689
508
1348
15291
82889
45
1338
14891
79536
54
1324
14033
75185
41
1242
13209
69088
48
1283
1291
66011
48
1207
12246
6786
5
1206
1182
66153
43
1175
11619
66406

HD_Age

0-34
35-64
65-84
85+
Year
Age-Adjusted Rate per 100000
345
1158
1247
64879
416
112
11794
61938
35
1103
11529
58746
45
110
10827
56172
313
1048
10086
51609
38
1078
9937
49828
384
1019
9413
51918
42
1008
9174
50961
36
982
904
51209

CHD_Age

0-34
35-64
65-84
85+
Year
Age-Adjusted Rate per 100000
0613
874
7701
4670
0898
818
9012
44369
0889
799
8759
41061
0793
785
8018
38358
0865
757
7421
34644
097
773
7245
32617
088
727
6856
33503
117
709
6585
32727
102
657
6403
32504

Stroke_Age

0-34
35-64
65-84
85+
Year
Age-Adjusted Rate per 100000
068
174
2589
15841
0638
157
2522
1504
072
169
2397
1528
0737
157
2249
13741
0652
138
220
12629
0553
145
2063
11398
0734
127
196
11256
064
1368
1832
10718
047
134
1804
10646

HF_Age

35-64
65-84
85+
Year
Age-Adjusted Rate per 100000
3047
936
8287
2596
88
8285
2648
878
8057
3176
902
7722
2709
863
7586
2955
878
7388
2979
884
8354
274
828
7483
333
85
8102

total

CVD_RG

White Male
Black Male
White Female
Black Female
Year
Age-Adjusted Rate per 100000
4276
5424
3033
4161
4066
5524
2813
4091
3928
5468
2767
4114
3734
518
2638
3887
3448
5079
2432
3643
3366
4983
2375
3545
3276
4994
2313
3477
3236
4845
2223
327
3158
4694
2238
3327

Stroke_RG

White Male
Black Male
White Female
Black Female
Year
Age-Adjusted Rate per 100000
61
768
561
703
575
752
539
681
573
806
528
66
516
662
498
629
463
743
476
562
449
663
429
585
434
63
411
556
415
631
392
494
402
606
392
509

HD_RG

White Male
Black Male
White Female
Black Female
Year
Age-Adjusted Rate per 100000
3393
4298
227
3206
3232
4445
2124
3166
3118
4317
2197
3157
2986
4184
1957
3001
2777
3983
1783
2838
2704
4009
1776
2679
2644
3981
1739
2642
2619
3972
1679
2532
2566
3819
1687
2606

CHD_RG

White Male
Black Male
White Female
Black Female
Year
Age-Adjusted Rate per 100000
2625
329
1608
243
2478
3356
1508
2314
2404
3154
1419
2313
2221
3093
1328
209
2067
2956
119
1983
1989
2885
117
1853
1922
2903
1139
1825
1921
2771
1074
1645
1824
2592
1071
1722

HF_RG

White Male
Black Male
White Female
Black Female
Year
Age-Adjusted Rate per 100000
255
206
245
17
267
225
225
167
242
238
227
203
256
217
222
189
243
167
214
206
24
218
217
172
255
246
229
202
23
225
208
196
25
216
226
185

race_gender

Sheet3

Age-adjusted stroke mortality rates by race and gender Michigan 2000 to 2014

0

10

20

30

40

50

60

70

80

90

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014

Age

-Adj

uste

d R

ate

per 1

000

00

Year

White Male

Black Male

White Female

Black Female

Overall_Rates

CVD
CHD
HD
HF
Stroke
Year
Rate per 10000
3694
2118
2851
245
603
3524
2006
2719
237
577
3421
192
2631
233
571
3258
179
2517
233
527
3034
1656
2337
224
496
2972
1611
2308
224
464
2898
1564
226
24
444
2825
1516
2216
219
425
2791
1472
2192
233
419

CVD_Age

0-34
35-64
65-84
85+
Year
Age-Adjusted Rate per 100000
43
140
16141
86689
508
1348
15291
82889
45
1338
14891
79536
54
1324
14033
75185
41
1242
13209
69088
48
1283
1291
66011
48
1207
12246
6786
5
1206
1182
66153
43
1175
11619
66406

HD_Age

0-34
35-64
65-84
85+
Year
Age-Adjusted Rate per 100000
345
1158
1247
64879
416
112
11794
61938
35
1103
11529
58746
45
110
10827
56172
313
1048
10086
51609
38
1078
9937
49828
384
1019
9413
51918
42
1008
9174
50961
36
982
904
51209

CHD_Age

0-34
35-64
65-84
85+
Year
Age-Adjusted Rate per 100000
0613
874
7701
4670
0898
818
9012
44369
0889
799
8759
41061
0793
785
8018
38358
0865
757
7421
34644
097
773
7245
32617
088
727
6856
33503
117
709
6585
32727
102
657
6403
32504

Stroke_Age

0-34
35-64
65-84
85+
Year
Age-Adjusted Rate per 100000
068
174
2589
15841
0638
157
2522
1504
072
169
2397
1528
0737
157
2249
13741
0652
138
220
12629
0553
145
2063
11398
0734
127
196
11256
064
1368
1832
10718
047
134
1804
10646

HF_Age

35-64
65-84
85+
Year
Age-Adjusted Rate per 100000
3047
936
8287
2596
88
8285
2648
878
8057
3176
902
7722
2709
863
7586
2955
878
7388
2979
884
8354
274
828
7483
333
85
8102

total

CVD_RG

White Male
Black Male
White Female
Black Female
Year
Age-Adjusted Rate per 100000
4276
5424
3033
4161
4066
5524
2813
4091
3928
5468
2767
4114
3734
518
2638
3887
3448
5079
2432
3643
3366
4983
2375
3545
3276
4994
2313
3477
3236
4845
2223
327
3158
4694
2238
3327

Stroke_RG

White Male
Black Male
White Female
Black Female
Year
Age-Adjusted Rate per 100000
61
768
561
703
575
752
539
681
573
806
528
66
516
662
498
629
463
743
476
562
449
663
429
585
434
63
411
556
415
631
392
494
402
606
392
509
375
616
372
464
372
565
366
513
373
548
366
44
348
587
349
477
347
506
34
462
369
506
352
482

HD_RG

White Male
Black Male
White Female
Black Female
Year
Age-Adjusted Rate per 100000
3393
4298
227
3206
3232
4445
2124
3166
3118
4317
2197
3157
2986
4184
1957
3001
2777
3983
1783
2838
2704
4009
1776
2679
2644
3981
1739
2642
2619
3972
1679
2532
2566
3819
1687
2606

CHD_RG

White Male
Black Male
White Female
Black Female
Year
Age-Adjusted Rate per 100000
2625
329
1608
243
2478
3356
1508
2314
2404
3154
1419
2313
2221
3093
1328
209
2067
2956
119
1983
1989
2885
117
1853
1922
2903
1139
1825
1921
2771
1074
1645
1824
2592
1071
1722

HF_RG

White Male
Black Male
White Female
Black Female
Year
Age-Adjusted Rate per 100000
255
206
245
17
267
225
225
167
242
238
227
203
256
217
222
189
243
167
214
206
24
218
217
172
255
246
229
202
23
225
208
196
25
216
226
185

race_gender

Sheet3

Local Health Department data can be found at wwwmichigangovbrfsSource CDC BRFSS

RISK FACTORMI

2011

MI

2013

MI

2014

MI

2015US 2015

2015 NATIONAL RANKING

Current Smoking 233 214 212 207 175 11

Blood Pressure Ever Told High 342 346 NA 331 309 18

Cholesterol Ever Told High 418 406 NA 382 364 12

Overweight (BMIgt25) 342 347 349 351 355 32tied

Obese (BMIgt30) 313 315 307 312 298 16

No Leisure Time Physical Activity 236 244 255 255 262 27

Diabetes 100 104 104 107 100 18tied

Prevalence of CVD Risk Factors Michigan Adults 1990-2015Compared to 2015 National Prevalence

233214 212 207

175

10

15

20

25

30

MI 2011 MI 2013 MI 2014 MI 2015 US 2015

Current Smoking

342 346331

309

20

25

30

35

40

MI 2011 MI 2013 MI 2014 MI 2015 US 2015

Blood Pressure Ever told high

342 347 349 351 355

20

25

30

35

40

MI 2011 MI 2013 MI 2014 MI 2015 US 2015

Overweight (BMIgt25)

313 315 307 312298

20

25

30

35

40

MI 2011 MI 2013 MI 2014 MI 2015 US 2015

Obese (BMIgt30)

418406

382364

30

35

40

45

50

MI 2011 MI 2013 MI 2014 MI 2015 US 2015

Cholesterol Ever told high

10 104 104 10710

0

3

6

9

12

15

MI 2011 MI 2013 MI 2014 MI 2015 US 2015

Diabetes

236 244255 255 262

10

15

20

25

30

MI 2011 MI 2013 MI 2014 MI 2015 US 2015

No Leisure Time Physical Activity

11 1216 18

2732tied

05

101520253035404550

CurrentSmoking

CholesterolEver told high

Obese(BMIgt30)

BloodPressure Ever

told high

Diabetes No LeisureTime Physical

Activity

Overweight(BMIgt25)

2015 NATIONAL RANKING(1st is worst)

18tied

MOSAIC 2015-2020 Focus of Grant Developing Stroke Systems of

Care Community Awareness EMS In-hospital QI Transition of Care Post-Discharge

12

Pre-hospital Care

A V A I L A B L E D A T A

13

EMSMOSAIC Data Linkage

-The MOSAIC Team continues to link data from the Michigan EMS Information System (MiEMSIS) to MOSAIC Data- Reports have been created for and reviewed by the

Tri-County Area MCA and Detroit East MCA- This work will expand to other MCA regions that

serve hospitals participating in MOSAIC

GWTG Special Initiatives Tab

-A free tab that can be enabled in GWTG-The purpose of the tab is to collect data concerning patient hand-off from EMS

MOSAIC Participating Hospitals

Aspirus Keweenaw Hospital (Laurium)

Aspirus Grand View HospitalAspirus Iron River HospitalAspirus Ontonagon HospitalBixby Medical CenterBronson Methodist HospitalCovenant Health CareDetroit Receiving HospitalGenesys Regional Medical CenterHenry Ford Hospital Herrick Medical CenterHuron Valley-Sinai HospitalLakeland Regional Medical Center McLaren Bay Regional Medical CenterMcLaren Greater Medical Center

McLaren Macomb HospitalMcLaren Northern MI HospitalMcLaren Oakland Medical CenterMcLaren Port Huron HospitalMcLaren Regional Medical CenterMercy Health Saint Maryrsquos HospitalMetro Health HospitalMunson Medical Center

ProMedica Monroe Regional HospitalSparrow HospitalSt Joseph Mercy - Ann ArborSt Joseph Mercy ChelseaSt Joseph Mercy Livingston HospitalSt Mary MercySt Mary of Michigan HospitalU of M Hospital

Hospital Infrastructure19

Among all participating hospitals the average number of

Licensed beds was 374 (range 25 to 1059 beds)

Inpatient discharges was 17076 (range 1064 to 48916 patients)

Acute stroke discharges (primary diagnosis only) was 417 (range 34 to 982 patients)

Case Demographics MOSAIC Registry

VariablesN() or statistics(Total N=68906)

Age at admission (years)Median 710Range 180 - 1060Mean (SE) 697(01)

GenderMale 32886 (477)Female 36015 (523)

RaceAfrican American 9900 (197)AIAN 132 (03)Asian 320 (06)More than one race 44 (01)Unknown 3679 (73)White 36190 (720)Missing 70

EthnicityHispanic or Latino 804 (16)Others 49531 (984)

VariablesN() or statistics(Total N=68906)

Health insuranceMedicaid 2284 (45)MedicaidPrivate 211 (04)Medicare 16863 (336)Medicare Medicaid 2313 (46)

MedicareMedicaidPrivate125 (02)

MedicarePrivate 13640 (272)ND 268(05)No insurance 2123 (42)Private 12356 (246)

Arrival modeEMS 21052 (429)Private

transportationother19313 (393)

Transfer from another hospital

7733(157)

ND or unknown 1021 (21)Missing 1216

Who receives data reports on your stroke quality of care

21

7055

70

10085

65

40

Hos

pita

lC

EO

up

per

man

agem

ent

Hos

pita

lB

oard

Chi

efN

ursi

ngO

ffice

r(C

NO

)

Str

oke

Tea

m

Phy

sici

anS

trok

eC

ham

pion

Chi

ef o

fM

edic

ine

Oth

er

Data Use

1) In the most recent calendar year have you run additional analyses (beyond what was required for reporting) on your hospitalrsquos own stroke data

2)How frequently have you run and used the analyses generated

22

Yes (N=16) 80

No (N=4) 20Weekly (N=2) 125

Monthly (N=8) 500

Less than monthly but more

than 1-2 times(N=6) 375

Data Use

What is the main reason you do not run your own additional analyses (Select one best answer)

23

Not sure how to run analyses

25

Not sure what analyses are needed would be helpful 25

Other 50

Data Use

In the most recent calendar year what reports did you run

24

813 688

Pre-programmedautomated reports in thedata collection tool (eg GWTG)

Additional reports beyond pre-programmed reports from the tool

Data Use

How do you use these analyses reports

25

813 688375

Inform quality improvement (QI) efforts andor plan

ldquoaction itemsrdquo

Report to management administration on our

progress

Other

Data Use

If you run additional analysis what action items QI efforts did you plan as a result of these reports

26

o Discharge education intensive statin use

o Door to tPA time and dysphagia

o Review data between spoke amp hub hospitals regarding transfers IV-tPA administration Mechanical thrombectomy and SAH

o QI efforts were addressed in the department involving calling Stroke Alert on call for cases with FAST symptoms

o ED Medical Director works with team to fix fallouts and problematic areas We have seen improvement

o Process changes (ie fallout emails to RN manager) physician querieso Increased documentation of NIHSS ownership from individual units regarding stroke quality

improvement goalso Daily dysphagia screening determination of whowhat team responsible for documenting initial NIHSS

looking at patients beyond 2h LKW arrival

Hospital Arrival Mode Door-to Needle and Pre-Notification

Reports 2016

Percent of Cases Who Arrived via EMSMOSAIC 2009-2016

Table 1 Arrival Mode among Stroke Cases by Demographics MOSAIC 2016

Demographics N=3496 550 N=2938 450Stroke Type Ischemic 2558 542 2164 458 Hemorrhagic 560 728 209 272 TIA 378 478 413 522Age Group lt 50 Years 233 433 305 567 50-79 Years 1982 497 2008 503 ge 80 Years 1379 688 625 312Sex Female 1933 576 1422 424 Male 1661 523 1516 477Race Black 659 530 584 470 White 2824 557 2248 443 Other Missing 111 512 106 488

MOSAIC AggregateArrival Mode

EMS Private Mode

Table 2 Door-to-Needle Times by Arrival Mode among Stroke Cases MOSAIC 2016

Time Elements (in Minutes)Number of

Patients Mean (Minutes) Median

(Minutes)Range

(Minutes)Door-to-Image 4901 575 400 00-2700 Arrived via EMS 2767 463 270 00-2700 Arrived via Private Transportation 2134 720 570 00-2620

Door-to-Image (among t-PA treated) 492 155 130 00-970 Arrived via EMS 370 125 110 00-840 Arrived via Private Transportation 122 243 215 20-970Image-to Needle 492 500 450 70-2090 Arrived via EMS 370 503 460 70-2090 Arrived via Private Transportation 122 483 420 90-1770Door-to Needle 492 655 570 200-2180 Arrived via EMS 370 629 560 200-2180 Arrived via Private Transportation 122 726 650 290-2060Included ischemic or hemorrhagic cases with times that were less or equal to 270 minutes (45 hours)Transferred cases were excluded

MOSAIC Aggregate

Table 3 Pre-Notification among Stroke Cases Who Arrived Via EMS by Demographics MOSAIC 2016

Demographics N=2015 584 N=1437 416Stroke Type Ischemic 1523 622 924 378 Hemorrhagic 306 566 235 434 TIA 142 381 231 619Age Group lt 50 Years 133 607 86 393 50-79 Years 1105 585 784 415 ge 80 Years 777 578 567 422Sex Female 1075 578 786 422 Male 940 591 651 409Race Black 307 517 287 483 White 1657 602 1097 398 Other 51 490 53 510

All HospitalsPre-Notification

Yes No

MOSAIC Transitions of Care Project

Post-discharge data collection tool is being implemented into Outcome Science as a tab

Post-Discharge amp Transition of Care

Reporting on changes within 30 days of discharge from hospital via follow-up callschart review Interval events Physician follow-up visits Lifestyle changes Lab assessments Medication managementadherence Rehab amp Functional outcomes Falls

MOSAIC Website

wwwMichigangovstroke

Adrienne Nickles MPHnicklesamichigangov

Thank You

  • Michigan and MOSAIC Data Review
  • Overview
  • Age-adjusted Stroke Hospitalization Rates Michigan 2000-2015
  • Slide Number 4
  • Age-adjusted Stroke Mortality Rates Michigan 2000-2014
  • Slide Number 6
  • Slide Number 7
  • Slide Number 8
  • Slide Number 9
  • Slide Number 10
  • Slide Number 11
  • MOSAIC 2015-2020
  • Pre-hospital Care
  • EMSMOSAIC Data Linkage
  • Slide Number 15
  • GWTG Special Initiatives Tab
  • Slide Number 17
  • MOSAIC Participating Hospitals
  • Hospital Infrastructure
  • Case Demographics MOSAIC Registry
  • Who receives data reports on your stroke quality of care
  • 1) In the most recent calendar year have you run additional analyses (beyond what was required for reporting) on your hospitalrsquos own stroke data 2)How frequently have you run and used the analyses generated
  • What is the main reason you do not run your own additional analyses (Select one best answer)
  • In the most recent calendar year what reports did you run
  • How do you use these analyses reports
  • If you run additional analysis what action items QI efforts did you plan as a result of these reports
  • Hospital Arrival Mode Door-to Needle and Pre-Notification Reports 2016
  • Percent of Cases Who Arrived via EMSMOSAIC 2009-2016
  • Table 1 Arrival Mode among Stroke Cases by Demographics MOSAIC 2016
  • Table 2 Door-to-Needle Times by Arrival Mode among Stroke Cases MOSAIC 2016
  • Table 3 Pre-Notification among Stroke Cases Who Arrived Via EMS by Demographics MOSAIC 2016
  • MOSAIC Transitions of Care Project
  • Slide Number 33
  • MOSAIC Website
  • Adrienne Nickles MPHnicklesamichigangov
CVD
Year White Male Black Male White Female Black Female
2000 4276 5424 3033 4161
2001 4066 5524 2813 4091
2002 3928 5468 2767 4114
2003 3734 518 2638 3887
2004 3448 5079 2432 3643
2005 3366 4983 2375 3545
2006 3276 4994 2313 3477
2007 3236 4845 2223 327
2008 3158 4694 2238 3327
change 234 79 237 164
Heart Disease
Year White Male Black Male White Female Black Female
2000 3393 4298 227 3206
2001 3232 4445 2124 3166
2002 3118 4317 2197 3157
2003 2986 4184 1957 3001
2004 2777 3983 1783 2838
2005 2704 4009 1776 2679
2006 2644 3981 1739 2642
2007 2619 3972 1679 2532
2008 2566 3819 1687 2606
Stroke
Year White Male Black Male White Female Black Female
2000 61 768 561 703 176
2001 575 752 539 681 138
2002 573 806 528 66 15
2003 516 662 498 629 147
2004 463 743 476 562
2005 449 663 429 585
2006 434 63 411 556
2007 415 631 392 494
2008 402 606 392 509
2009 375 616 372 464
2010 372 565 366 513
2011 373 548 366 44
2012 348 587 349 477
2013 347 506 34 462
2014 369 506 352 482
Coronary Heart Disease
Year White Male Black Male White Female Black Female
2000 2625 329 1608 243
2001 2478 3356 1508 2314
2002 2404 3154 1419 2313
2003 2221 3093 1328 209
2004 2067 2956 119 1983
2005 1989 2885 117 1853
2006 1922 2903 1139 1825
2007 1921 2771 1074 1645
2008 1824 2592 1071 1722
Heart Failure
Year White Male Black Male White Female Black Female
2000 255 206 245 17
2001 267 225 225 167
2002 242 238 227 203
2003 256 217 222 189
2004 243 167 214 206
2005 24 218 217 172
2006 255 246 229 202
2007 23 225 208 196
2008 25 216 226 185
Not sure what this data is from previously HD Stroke
Year White Female Black Female White Female Black Female
2000 227 3206 561 703
2001 2124 3166 539 681
2002 2197 3157 528 66
2003 1957 3001 498 629
2004 1783 2838 476 562
2005 1776 2679 429 585
2006 1739 2642 411 556
2007
2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2009 2009 2009 2009
2010 2010 2010 2010
2011 2011 2011 2011
2012 2012 2012 2012
2013 2013 2013 2013
2014 2014 2014 2014
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
CVD
Year US Michigan 0-34 35-64 65-84 85+
2000 3397 3694 43 140 16141 86689
2001 3265 3524 508 1348 15291 82889
2002 3174 3421 45 1338 14891 79536
2003 3061 3258 54 1324 14033 75185
2004 2885 3034 41 1242 13209 69088
2005 2773 2972 48 1283 1291 66011
2006 2898 48 1207 12246 6786
2007 2825 5 1206 1182 66153
2008 2791 43 1175 11619 66406
Heart Disease
Year US Michigan 0-34 35-64 65-84 85+
2000 2576 2851 345 1158 1247 64879
2001 2478 2719 416 112 11794 61938
2002 2408 2631 35 1103 11529 58746
2003 2323 2517 45 110 10827 56172
2004 217 2337 313 1048 10086 51609
2005 2111 2308 38 1078 9937 49828
2006 226 384 1019 9413 51918
2007 2216 42 1008 9174 50961
2008 2192 36 982 904 51209
Stroke
Year US Michigan HP 2010 0-34 35-64 65-84 85+
2000 609 603 50 068 174 2589 15841
2001 579 577 50 0638 157 2522 1504
2002 562 571 50 072 169 2397 1528
2003 535 527 50 0737 157 2249 13741
2004 50 496 50 0652 138 220 12629
2005 466 464 50 0553 145 2063 11398
2006 444 50 0734 127 196 11256
2007 425 064 1368 1832 10718
2008 419 047 134 1804 10646
79 27 243 289
Coronary Heart Disease
Year US Michigan HP 2010 0-34 35-64 65-84 85+
2000 1868 2118 162 0613 874 7701 4670
2001 1778 2006 162 0898 818 9012 44369
2002 1709 192 162 0889 799 8759 41061
2003 1628 179 162 0793 785 8018 38358
2004 1502 1656 162 0865 757 7421 34644
2005 1444 1611 162 097 773 7245 32617
2006 1564 162 088 727 6856 33503
2007 1516 117 709 6585 32727
2008 1472 102 657 6403 32504
168 11 283
Heart Failure
Year US Michigan 35-64 65-84 85+
2000 203 245 3047 936 8287
2001 202 237 2596 88 8285
2002 194 233 2648 878 8057
2003 194 233 3176 902 7722
2004 189 224 2709 863 7586
2005 189 224 2955 878 7388
2006 24 2979 884 8354
2007 219 274 828 7483
2008 233 013 333 85 8102
Heart Disease Stroke
Michigan White Michigan Black US White US Black Michigan White Michigan Black US White US Black
1990 334 4315 317 3915 1990 638 733 629 917
1991 3289 4108 3088 3865 1991 626 781 607 894
1992 3126 3987 3011 3777 1992 609 694 598 86
1993 3234 429 3046 3843 1993 614 77 609 866
1994 3134 4156 295 3661 1994 634 875 609 869
1995 3048 4131 2912 3672 1995 638 925 615 879
1996 2997 380 2842 354 1996 617 804 61 852
1997 2851 3683 2764 345 1997 604 77 598 816
1998 2884 3586 2681 3406 1998 598 729 576 803
1999 2781 3692 2634 3367 1999 609 812 598 824
2000 2757 3663 2536 3265 2000 586 737 587 824
2001 261 3695 2435 3169 2001 56 718 558 788
2002 2522 3659 2367 3084 2002 553 729 542 763
2003 2409 350 2282 3002 2003 511 655 514 743
2004 222 3311 2133 2806 2004 477 633 48 699
2005 219 3227 2005 442 616
2006 2144 320 2006 426 589
2007 2007
2008 2008
CVD CHD HD HF Stroke
2000 3694 2118 2851 245 603
2001 3524 2006 2719 237 577
2002 3421 192 2631 233 571
2003 3258 179 2517 233 527
2004 3034 1656 2337 224 496
2005 2972 1611 2308 224 464
2006 2898 1564 226 24 444
2007 2825 1516 2216 219 425
2008 2791 1472 2192 233 419
2000 2000 2000
2001 2001 2001
2002 2002 2002
2003 2003 2003
2004 2004 2004
2005 2005 2005
2006 2006 2006
2007 2007 2007
2008 2008 2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2000 2000 2000 2000 2000
2001 2001 2001 2001 2001
2002 2002 2002 2002 2002
2003 2003 2003 2003 2003
2004 2004 2004 2004 2004
2005 2005 2005 2005 2005
2006 2006 2006 2006 2006
2007 2007 2007 2007 2007
2008 2008 2008 2008 2008
CVD
Year White Male Black Male White Female Black Female
2000 4276 5424 3033 4161
2001 4066 5524 2813 4091
2002 3928 5468 2767 4114
2003 3734 518 2638 3887
2004 3448 5079 2432 3643
2005 3366 4983 2375 3545
2006 3276 4994 2313 3477
2007 3236 4845 2223 327
2008 3158 4694 2238 3327
change 234 79 237 164
Heart Disease
Year White Male Black Male White Female Black Female
2000 3393 4298 227 3206
2001 3232 4445 2124 3166
2002 3118 4317 2197 3157
2003 2986 4184 1957 3001
2004 2777 3983 1783 2838
2005 2704 4009 1776 2679
2006 2644 3981 1739 2642
2007 2619 3972 1679 2532
2008 2566 3819 1687 2606
Stroke
Year White Male Black Male White Female Black Female
2000 61 768 561 703 176
2001 575 752 539 681 138
2002 573 806 528 66 15
2003 516 662 498 629 147
2004 463 743 476 562
2005 449 663 429 585
2006 434 63 411 556
2007 415 631 392 494
2008 402 606 392 509
Coronary Heart Disease
Year White Male Black Male White Female Black Female
2000 2625 329 1608 243
2001 2478 3356 1508 2314
2002 2404 3154 1419 2313
2003 2221 3093 1328 209
2004 2067 2956 119 1983
2005 1989 2885 117 1853
2006 1922 2903 1139 1825
2007 1921 2771 1074 1645
2008 1824 2592 1071 1722
Heart Failure
Year White Male Black Male White Female Black Female
2000 255 206 245 17
2001 267 225 225 167
2002 242 238 227 203
2003 256 217 222 189
2004 243 167 214 206
2005 24 218 217 172
2006 255 246 229 202
2007 23 225 208 196
2008 25 216 226 185
Not sure what this data is from previously HD Stroke
Year White Female Black Female White Female Black Female
2000 227 3206 561 703
2001 2124 3166 539 681
2002 2197 3157 528 66
2003 1957 3001 498 629
2004 1783 2838 476 562
2005 1776 2679 429 585
2006 1739 2642 411 556
2007
2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
CVD
Year US Michigan 0-34 35-64 65-84 85+
2000 3397 3694 43 140 16141 86689
2001 3265 3524 508 1348 15291 82889
2002 3174 3421 45 1338 14891 79536
2003 3061 3258 54 1324 14033 75185
2004 2885 3034 41 1242 13209 69088
2005 2773 2972 48 1283 1291 66011
2006 2898 48 1207 12246 6786
2007 2825 5 1206 1182 66153
2008 2791 43 1175 11619 66406
Heart Disease
Year US Michigan 0-34 35-64 65-84 85+
2000 2576 2851 345 1158 1247 64879
2001 2478 2719 416 112 11794 61938
2002 2408 2631 35 1103 11529 58746
2003 2323 2517 45 110 10827 56172
2004 217 2337 313 1048 10086 51609
2005 2111 2308 38 1078 9937 49828
2006 226 384 1019 9413 51918
2007 2216 42 1008 9174 50961
2008 2192 36 982 904 51209
Stroke
Year US Michigan HP 2010 0-34 35-64 65-84 85+
2000 609 603 50 068 174 2589 15841
2001 579 577 50 0638 157 2522 1504
2002 562 571 50 072 169 2397 1528
2003 535 527 50 0737 157 2249 13741
2004 50 496 50 0652 138 220 12629
2005 466 464 50 0553 145 2063 11398
2006 444 50 0734 127 196 11256
2007 425 064 1368 1832 10718
2008 419 047 134 1804 10646
79 27 243 289
Coronary Heart Disease
Year US Michigan HP 2010 0-34 35-64 65-84 85+
2000 1868 2118 162 0613 874 7701 4670
2001 1778 2006 162 0898 818 9012 44369
2002 1709 192 162 0889 799 8759 41061
2003 1628 179 162 0793 785 8018 38358
2004 1502 1656 162 0865 757 7421 34644
2005 1444 1611 162 097 773 7245 32617
2006 1564 162 088 727 6856 33503
2007 1516 117 709 6585 32727
2008 1472 102 657 6403 32504
168 11 283
Heart Failure
Year US Michigan 35-64 65-84 85+
2000 203 245 3047 936 8287
2001 202 237 2596 88 8285
2002 194 233 2648 878 8057
2003 194 233 3176 902 7722
2004 189 224 2709 863 7586
2005 189 224 2955 878 7388
2006 24 2979 884 8354
2007 219 274 828 7483
2008 233 013 333 85 8102
Heart Disease Stroke
Michigan White Michigan Black US White US Black Michigan White Michigan Black US White US Black
1990 334 4315 317 3915 1990 638 733 629 917
1991 3289 4108 3088 3865 1991 626 781 607 894
1992 3126 3987 3011 3777 1992 609 694 598 86
1993 3234 429 3046 3843 1993 614 77 609 866
1994 3134 4156 295 3661 1994 634 875 609 869
1995 3048 4131 2912 3672 1995 638 925 615 879
1996 2997 380 2842 354 1996 617 804 61 852
1997 2851 3683 2764 345 1997 604 77 598 816
1998 2884 3586 2681 3406 1998 598 729 576 803
1999 2781 3692 2634 3367 1999 609 812 598 824
2000 2757 3663 2536 3265 2000 586 737 587 824
2001 261 3695 2435 3169 2001 56 718 558 788
2002 2522 3659 2367 3084 2002 553 729 542 763
2003 2409 350 2282 3002 2003 511 655 514 743
2004 222 3311 2133 2806 2004 477 633 48 699
2005 219 3227 2005 442 616
2006 2144 320 2006 426 589
2007 2007
2008 2008
Stroke
CVD MI US
2000 3694 606 609
2001 3524 584 584
2002 3421 583 572
2003 3258 539 546
2004 3034 519 512
2005 2972 488 48
2006 2898 449 448
2007 2825 43 435
2008 2791 423 421
2009 262 396 396
2010 394 391
2011 387 379
2012 372 369
2013 363 369
2014 377 365
2000 2000 2000
2001 2001 2001
2002 2002 2002
2003 2003 2003
2004 2004 2004
2005 2005 2005
2006 2006 2006
2007 2007 2007
2008 2008 2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
Page 10: Michigan and MOSAIC Data Review...Michigan and MOSAIC Data Review 2017 ANNUAL WORKSHOP 4/26/2017. Adrienne Nickles, MPH. Michigan’s Ongoing Stroke Registry to Accelerate the Improvement

HD_Age

0-34
35-64
65-84
85+
Year
Age-Adjusted Rate per 100000
345
1158
1247
64879
416
112
11794
61938
35
1103
11529
58746
45
110
10827
56172
313
1048
10086
51609
38
1078
9937
49828
384
1019
9413
51918
42
1008
9174
50961
36
982
904
51209

CHD_Age

0-34
35-64
65-84
85+
Year
Age-Adjusted Rate per 100000
0613
874
7701
4670
0898
818
9012
44369
0889
799
8759
41061
0793
785
8018
38358
0865
757
7421
34644
097
773
7245
32617
088
727
6856
33503
117
709
6585
32727
102
657
6403
32504

Stroke_Age

0-34
35-64
65-84
85+
Year
Age-Adjusted Rate per 100000
068
174
2589
15841
0638
157
2522
1504
072
169
2397
1528
0737
157
2249
13741
0652
138
220
12629
0553
145
2063
11398
0734
127
196
11256
064
1368
1832
10718
047
134
1804
10646

HF_Age

35-64
65-84
85+
Year
Age-Adjusted Rate per 100000
3047
936
8287
2596
88
8285
2648
878
8057
3176
902
7722
2709
863
7586
2955
878
7388
2979
884
8354
274
828
7483
333
85
8102

total

CVD_RG

White Male
Black Male
White Female
Black Female
Year
Age-Adjusted Rate per 100000
4276
5424
3033
4161
4066
5524
2813
4091
3928
5468
2767
4114
3734
518
2638
3887
3448
5079
2432
3643
3366
4983
2375
3545
3276
4994
2313
3477
3236
4845
2223
327
3158
4694
2238
3327

Stroke_RG

White Male
Black Male
White Female
Black Female
Year
Age-Adjusted Rate per 100000
61
768
561
703
575
752
539
681
573
806
528
66
516
662
498
629
463
743
476
562
449
663
429
585
434
63
411
556
415
631
392
494
402
606
392
509

HD_RG

White Male
Black Male
White Female
Black Female
Year
Age-Adjusted Rate per 100000
3393
4298
227
3206
3232
4445
2124
3166
3118
4317
2197
3157
2986
4184
1957
3001
2777
3983
1783
2838
2704
4009
1776
2679
2644
3981
1739
2642
2619
3972
1679
2532
2566
3819
1687
2606

CHD_RG

White Male
Black Male
White Female
Black Female
Year
Age-Adjusted Rate per 100000
2625
329
1608
243
2478
3356
1508
2314
2404
3154
1419
2313
2221
3093
1328
209
2067
2956
119
1983
1989
2885
117
1853
1922
2903
1139
1825
1921
2771
1074
1645
1824
2592
1071
1722

HF_RG

White Male
Black Male
White Female
Black Female
Year
Age-Adjusted Rate per 100000
255
206
245
17
267
225
225
167
242
238
227
203
256
217
222
189
243
167
214
206
24
218
217
172
255
246
229
202
23
225
208
196
25
216
226
185

race_gender

Sheet3

Age-adjusted stroke mortality rates by race and gender Michigan 2000 to 2014

0

10

20

30

40

50

60

70

80

90

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014

Age

-Adj

uste

d R

ate

per 1

000

00

Year

White Male

Black Male

White Female

Black Female

Overall_Rates

CVD
CHD
HD
HF
Stroke
Year
Rate per 10000
3694
2118
2851
245
603
3524
2006
2719
237
577
3421
192
2631
233
571
3258
179
2517
233
527
3034
1656
2337
224
496
2972
1611
2308
224
464
2898
1564
226
24
444
2825
1516
2216
219
425
2791
1472
2192
233
419

CVD_Age

0-34
35-64
65-84
85+
Year
Age-Adjusted Rate per 100000
43
140
16141
86689
508
1348
15291
82889
45
1338
14891
79536
54
1324
14033
75185
41
1242
13209
69088
48
1283
1291
66011
48
1207
12246
6786
5
1206
1182
66153
43
1175
11619
66406

HD_Age

0-34
35-64
65-84
85+
Year
Age-Adjusted Rate per 100000
345
1158
1247
64879
416
112
11794
61938
35
1103
11529
58746
45
110
10827
56172
313
1048
10086
51609
38
1078
9937
49828
384
1019
9413
51918
42
1008
9174
50961
36
982
904
51209

CHD_Age

0-34
35-64
65-84
85+
Year
Age-Adjusted Rate per 100000
0613
874
7701
4670
0898
818
9012
44369
0889
799
8759
41061
0793
785
8018
38358
0865
757
7421
34644
097
773
7245
32617
088
727
6856
33503
117
709
6585
32727
102
657
6403
32504

Stroke_Age

0-34
35-64
65-84
85+
Year
Age-Adjusted Rate per 100000
068
174
2589
15841
0638
157
2522
1504
072
169
2397
1528
0737
157
2249
13741
0652
138
220
12629
0553
145
2063
11398
0734
127
196
11256
064
1368
1832
10718
047
134
1804
10646

HF_Age

35-64
65-84
85+
Year
Age-Adjusted Rate per 100000
3047
936
8287
2596
88
8285
2648
878
8057
3176
902
7722
2709
863
7586
2955
878
7388
2979
884
8354
274
828
7483
333
85
8102

total

CVD_RG

White Male
Black Male
White Female
Black Female
Year
Age-Adjusted Rate per 100000
4276
5424
3033
4161
4066
5524
2813
4091
3928
5468
2767
4114
3734
518
2638
3887
3448
5079
2432
3643
3366
4983
2375
3545
3276
4994
2313
3477
3236
4845
2223
327
3158
4694
2238
3327

Stroke_RG

White Male
Black Male
White Female
Black Female
Year
Age-Adjusted Rate per 100000
61
768
561
703
575
752
539
681
573
806
528
66
516
662
498
629
463
743
476
562
449
663
429
585
434
63
411
556
415
631
392
494
402
606
392
509
375
616
372
464
372
565
366
513
373
548
366
44
348
587
349
477
347
506
34
462
369
506
352
482

HD_RG

White Male
Black Male
White Female
Black Female
Year
Age-Adjusted Rate per 100000
3393
4298
227
3206
3232
4445
2124
3166
3118
4317
2197
3157
2986
4184
1957
3001
2777
3983
1783
2838
2704
4009
1776
2679
2644
3981
1739
2642
2619
3972
1679
2532
2566
3819
1687
2606

CHD_RG

White Male
Black Male
White Female
Black Female
Year
Age-Adjusted Rate per 100000
2625
329
1608
243
2478
3356
1508
2314
2404
3154
1419
2313
2221
3093
1328
209
2067
2956
119
1983
1989
2885
117
1853
1922
2903
1139
1825
1921
2771
1074
1645
1824
2592
1071
1722

HF_RG

White Male
Black Male
White Female
Black Female
Year
Age-Adjusted Rate per 100000
255
206
245
17
267
225
225
167
242
238
227
203
256
217
222
189
243
167
214
206
24
218
217
172
255
246
229
202
23
225
208
196
25
216
226
185

race_gender

Sheet3

Local Health Department data can be found at wwwmichigangovbrfsSource CDC BRFSS

RISK FACTORMI

2011

MI

2013

MI

2014

MI

2015US 2015

2015 NATIONAL RANKING

Current Smoking 233 214 212 207 175 11

Blood Pressure Ever Told High 342 346 NA 331 309 18

Cholesterol Ever Told High 418 406 NA 382 364 12

Overweight (BMIgt25) 342 347 349 351 355 32tied

Obese (BMIgt30) 313 315 307 312 298 16

No Leisure Time Physical Activity 236 244 255 255 262 27

Diabetes 100 104 104 107 100 18tied

Prevalence of CVD Risk Factors Michigan Adults 1990-2015Compared to 2015 National Prevalence

233214 212 207

175

10

15

20

25

30

MI 2011 MI 2013 MI 2014 MI 2015 US 2015

Current Smoking

342 346331

309

20

25

30

35

40

MI 2011 MI 2013 MI 2014 MI 2015 US 2015

Blood Pressure Ever told high

342 347 349 351 355

20

25

30

35

40

MI 2011 MI 2013 MI 2014 MI 2015 US 2015

Overweight (BMIgt25)

313 315 307 312298

20

25

30

35

40

MI 2011 MI 2013 MI 2014 MI 2015 US 2015

Obese (BMIgt30)

418406

382364

30

35

40

45

50

MI 2011 MI 2013 MI 2014 MI 2015 US 2015

Cholesterol Ever told high

10 104 104 10710

0

3

6

9

12

15

MI 2011 MI 2013 MI 2014 MI 2015 US 2015

Diabetes

236 244255 255 262

10

15

20

25

30

MI 2011 MI 2013 MI 2014 MI 2015 US 2015

No Leisure Time Physical Activity

11 1216 18

2732tied

05

101520253035404550

CurrentSmoking

CholesterolEver told high

Obese(BMIgt30)

BloodPressure Ever

told high

Diabetes No LeisureTime Physical

Activity

Overweight(BMIgt25)

2015 NATIONAL RANKING(1st is worst)

18tied

MOSAIC 2015-2020 Focus of Grant Developing Stroke Systems of

Care Community Awareness EMS In-hospital QI Transition of Care Post-Discharge

12

Pre-hospital Care

A V A I L A B L E D A T A

13

EMSMOSAIC Data Linkage

-The MOSAIC Team continues to link data from the Michigan EMS Information System (MiEMSIS) to MOSAIC Data- Reports have been created for and reviewed by the

Tri-County Area MCA and Detroit East MCA- This work will expand to other MCA regions that

serve hospitals participating in MOSAIC

GWTG Special Initiatives Tab

-A free tab that can be enabled in GWTG-The purpose of the tab is to collect data concerning patient hand-off from EMS

MOSAIC Participating Hospitals

Aspirus Keweenaw Hospital (Laurium)

Aspirus Grand View HospitalAspirus Iron River HospitalAspirus Ontonagon HospitalBixby Medical CenterBronson Methodist HospitalCovenant Health CareDetroit Receiving HospitalGenesys Regional Medical CenterHenry Ford Hospital Herrick Medical CenterHuron Valley-Sinai HospitalLakeland Regional Medical Center McLaren Bay Regional Medical CenterMcLaren Greater Medical Center

McLaren Macomb HospitalMcLaren Northern MI HospitalMcLaren Oakland Medical CenterMcLaren Port Huron HospitalMcLaren Regional Medical CenterMercy Health Saint Maryrsquos HospitalMetro Health HospitalMunson Medical Center

ProMedica Monroe Regional HospitalSparrow HospitalSt Joseph Mercy - Ann ArborSt Joseph Mercy ChelseaSt Joseph Mercy Livingston HospitalSt Mary MercySt Mary of Michigan HospitalU of M Hospital

Hospital Infrastructure19

Among all participating hospitals the average number of

Licensed beds was 374 (range 25 to 1059 beds)

Inpatient discharges was 17076 (range 1064 to 48916 patients)

Acute stroke discharges (primary diagnosis only) was 417 (range 34 to 982 patients)

Case Demographics MOSAIC Registry

VariablesN() or statistics(Total N=68906)

Age at admission (years)Median 710Range 180 - 1060Mean (SE) 697(01)

GenderMale 32886 (477)Female 36015 (523)

RaceAfrican American 9900 (197)AIAN 132 (03)Asian 320 (06)More than one race 44 (01)Unknown 3679 (73)White 36190 (720)Missing 70

EthnicityHispanic or Latino 804 (16)Others 49531 (984)

VariablesN() or statistics(Total N=68906)

Health insuranceMedicaid 2284 (45)MedicaidPrivate 211 (04)Medicare 16863 (336)Medicare Medicaid 2313 (46)

MedicareMedicaidPrivate125 (02)

MedicarePrivate 13640 (272)ND 268(05)No insurance 2123 (42)Private 12356 (246)

Arrival modeEMS 21052 (429)Private

transportationother19313 (393)

Transfer from another hospital

7733(157)

ND or unknown 1021 (21)Missing 1216

Who receives data reports on your stroke quality of care

21

7055

70

10085

65

40

Hos

pita

lC

EO

up

per

man

agem

ent

Hos

pita

lB

oard

Chi

efN

ursi

ngO

ffice

r(C

NO

)

Str

oke

Tea

m

Phy

sici

anS

trok

eC

ham

pion

Chi

ef o

fM

edic

ine

Oth

er

Data Use

1) In the most recent calendar year have you run additional analyses (beyond what was required for reporting) on your hospitalrsquos own stroke data

2)How frequently have you run and used the analyses generated

22

Yes (N=16) 80

No (N=4) 20Weekly (N=2) 125

Monthly (N=8) 500

Less than monthly but more

than 1-2 times(N=6) 375

Data Use

What is the main reason you do not run your own additional analyses (Select one best answer)

23

Not sure how to run analyses

25

Not sure what analyses are needed would be helpful 25

Other 50

Data Use

In the most recent calendar year what reports did you run

24

813 688

Pre-programmedautomated reports in thedata collection tool (eg GWTG)

Additional reports beyond pre-programmed reports from the tool

Data Use

How do you use these analyses reports

25

813 688375

Inform quality improvement (QI) efforts andor plan

ldquoaction itemsrdquo

Report to management administration on our

progress

Other

Data Use

If you run additional analysis what action items QI efforts did you plan as a result of these reports

26

o Discharge education intensive statin use

o Door to tPA time and dysphagia

o Review data between spoke amp hub hospitals regarding transfers IV-tPA administration Mechanical thrombectomy and SAH

o QI efforts were addressed in the department involving calling Stroke Alert on call for cases with FAST symptoms

o ED Medical Director works with team to fix fallouts and problematic areas We have seen improvement

o Process changes (ie fallout emails to RN manager) physician querieso Increased documentation of NIHSS ownership from individual units regarding stroke quality

improvement goalso Daily dysphagia screening determination of whowhat team responsible for documenting initial NIHSS

looking at patients beyond 2h LKW arrival

Hospital Arrival Mode Door-to Needle and Pre-Notification

Reports 2016

Percent of Cases Who Arrived via EMSMOSAIC 2009-2016

Table 1 Arrival Mode among Stroke Cases by Demographics MOSAIC 2016

Demographics N=3496 550 N=2938 450Stroke Type Ischemic 2558 542 2164 458 Hemorrhagic 560 728 209 272 TIA 378 478 413 522Age Group lt 50 Years 233 433 305 567 50-79 Years 1982 497 2008 503 ge 80 Years 1379 688 625 312Sex Female 1933 576 1422 424 Male 1661 523 1516 477Race Black 659 530 584 470 White 2824 557 2248 443 Other Missing 111 512 106 488

MOSAIC AggregateArrival Mode

EMS Private Mode

Table 2 Door-to-Needle Times by Arrival Mode among Stroke Cases MOSAIC 2016

Time Elements (in Minutes)Number of

Patients Mean (Minutes) Median

(Minutes)Range

(Minutes)Door-to-Image 4901 575 400 00-2700 Arrived via EMS 2767 463 270 00-2700 Arrived via Private Transportation 2134 720 570 00-2620

Door-to-Image (among t-PA treated) 492 155 130 00-970 Arrived via EMS 370 125 110 00-840 Arrived via Private Transportation 122 243 215 20-970Image-to Needle 492 500 450 70-2090 Arrived via EMS 370 503 460 70-2090 Arrived via Private Transportation 122 483 420 90-1770Door-to Needle 492 655 570 200-2180 Arrived via EMS 370 629 560 200-2180 Arrived via Private Transportation 122 726 650 290-2060Included ischemic or hemorrhagic cases with times that were less or equal to 270 minutes (45 hours)Transferred cases were excluded

MOSAIC Aggregate

Table 3 Pre-Notification among Stroke Cases Who Arrived Via EMS by Demographics MOSAIC 2016

Demographics N=2015 584 N=1437 416Stroke Type Ischemic 1523 622 924 378 Hemorrhagic 306 566 235 434 TIA 142 381 231 619Age Group lt 50 Years 133 607 86 393 50-79 Years 1105 585 784 415 ge 80 Years 777 578 567 422Sex Female 1075 578 786 422 Male 940 591 651 409Race Black 307 517 287 483 White 1657 602 1097 398 Other 51 490 53 510

All HospitalsPre-Notification

Yes No

MOSAIC Transitions of Care Project

Post-discharge data collection tool is being implemented into Outcome Science as a tab

Post-Discharge amp Transition of Care

Reporting on changes within 30 days of discharge from hospital via follow-up callschart review Interval events Physician follow-up visits Lifestyle changes Lab assessments Medication managementadherence Rehab amp Functional outcomes Falls

MOSAIC Website

wwwMichigangovstroke

Adrienne Nickles MPHnicklesamichigangov

Thank You

  • Michigan and MOSAIC Data Review
  • Overview
  • Age-adjusted Stroke Hospitalization Rates Michigan 2000-2015
  • Slide Number 4
  • Age-adjusted Stroke Mortality Rates Michigan 2000-2014
  • Slide Number 6
  • Slide Number 7
  • Slide Number 8
  • Slide Number 9
  • Slide Number 10
  • Slide Number 11
  • MOSAIC 2015-2020
  • Pre-hospital Care
  • EMSMOSAIC Data Linkage
  • Slide Number 15
  • GWTG Special Initiatives Tab
  • Slide Number 17
  • MOSAIC Participating Hospitals
  • Hospital Infrastructure
  • Case Demographics MOSAIC Registry
  • Who receives data reports on your stroke quality of care
  • 1) In the most recent calendar year have you run additional analyses (beyond what was required for reporting) on your hospitalrsquos own stroke data 2)How frequently have you run and used the analyses generated
  • What is the main reason you do not run your own additional analyses (Select one best answer)
  • In the most recent calendar year what reports did you run
  • How do you use these analyses reports
  • If you run additional analysis what action items QI efforts did you plan as a result of these reports
  • Hospital Arrival Mode Door-to Needle and Pre-Notification Reports 2016
  • Percent of Cases Who Arrived via EMSMOSAIC 2009-2016
  • Table 1 Arrival Mode among Stroke Cases by Demographics MOSAIC 2016
  • Table 2 Door-to-Needle Times by Arrival Mode among Stroke Cases MOSAIC 2016
  • Table 3 Pre-Notification among Stroke Cases Who Arrived Via EMS by Demographics MOSAIC 2016
  • MOSAIC Transitions of Care Project
  • Slide Number 33
  • MOSAIC Website
  • Adrienne Nickles MPHnicklesamichigangov
CVD
Year White Male Black Male White Female Black Female
2000 4276 5424 3033 4161
2001 4066 5524 2813 4091
2002 3928 5468 2767 4114
2003 3734 518 2638 3887
2004 3448 5079 2432 3643
2005 3366 4983 2375 3545
2006 3276 4994 2313 3477
2007 3236 4845 2223 327
2008 3158 4694 2238 3327
change 234 79 237 164
Heart Disease
Year White Male Black Male White Female Black Female
2000 3393 4298 227 3206
2001 3232 4445 2124 3166
2002 3118 4317 2197 3157
2003 2986 4184 1957 3001
2004 2777 3983 1783 2838
2005 2704 4009 1776 2679
2006 2644 3981 1739 2642
2007 2619 3972 1679 2532
2008 2566 3819 1687 2606
Stroke
Year White Male Black Male White Female Black Female
2000 61 768 561 703 176
2001 575 752 539 681 138
2002 573 806 528 66 15
2003 516 662 498 629 147
2004 463 743 476 562
2005 449 663 429 585
2006 434 63 411 556
2007 415 631 392 494
2008 402 606 392 509
2009 375 616 372 464
2010 372 565 366 513
2011 373 548 366 44
2012 348 587 349 477
2013 347 506 34 462
2014 369 506 352 482
Coronary Heart Disease
Year White Male Black Male White Female Black Female
2000 2625 329 1608 243
2001 2478 3356 1508 2314
2002 2404 3154 1419 2313
2003 2221 3093 1328 209
2004 2067 2956 119 1983
2005 1989 2885 117 1853
2006 1922 2903 1139 1825
2007 1921 2771 1074 1645
2008 1824 2592 1071 1722
Heart Failure
Year White Male Black Male White Female Black Female
2000 255 206 245 17
2001 267 225 225 167
2002 242 238 227 203
2003 256 217 222 189
2004 243 167 214 206
2005 24 218 217 172
2006 255 246 229 202
2007 23 225 208 196
2008 25 216 226 185
Not sure what this data is from previously HD Stroke
Year White Female Black Female White Female Black Female
2000 227 3206 561 703
2001 2124 3166 539 681
2002 2197 3157 528 66
2003 1957 3001 498 629
2004 1783 2838 476 562
2005 1776 2679 429 585
2006 1739 2642 411 556
2007
2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2009 2009 2009 2009
2010 2010 2010 2010
2011 2011 2011 2011
2012 2012 2012 2012
2013 2013 2013 2013
2014 2014 2014 2014
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
CVD
Year US Michigan 0-34 35-64 65-84 85+
2000 3397 3694 43 140 16141 86689
2001 3265 3524 508 1348 15291 82889
2002 3174 3421 45 1338 14891 79536
2003 3061 3258 54 1324 14033 75185
2004 2885 3034 41 1242 13209 69088
2005 2773 2972 48 1283 1291 66011
2006 2898 48 1207 12246 6786
2007 2825 5 1206 1182 66153
2008 2791 43 1175 11619 66406
Heart Disease
Year US Michigan 0-34 35-64 65-84 85+
2000 2576 2851 345 1158 1247 64879
2001 2478 2719 416 112 11794 61938
2002 2408 2631 35 1103 11529 58746
2003 2323 2517 45 110 10827 56172
2004 217 2337 313 1048 10086 51609
2005 2111 2308 38 1078 9937 49828
2006 226 384 1019 9413 51918
2007 2216 42 1008 9174 50961
2008 2192 36 982 904 51209
Stroke
Year US Michigan HP 2010 0-34 35-64 65-84 85+
2000 609 603 50 068 174 2589 15841
2001 579 577 50 0638 157 2522 1504
2002 562 571 50 072 169 2397 1528
2003 535 527 50 0737 157 2249 13741
2004 50 496 50 0652 138 220 12629
2005 466 464 50 0553 145 2063 11398
2006 444 50 0734 127 196 11256
2007 425 064 1368 1832 10718
2008 419 047 134 1804 10646
79 27 243 289
Coronary Heart Disease
Year US Michigan HP 2010 0-34 35-64 65-84 85+
2000 1868 2118 162 0613 874 7701 4670
2001 1778 2006 162 0898 818 9012 44369
2002 1709 192 162 0889 799 8759 41061
2003 1628 179 162 0793 785 8018 38358
2004 1502 1656 162 0865 757 7421 34644
2005 1444 1611 162 097 773 7245 32617
2006 1564 162 088 727 6856 33503
2007 1516 117 709 6585 32727
2008 1472 102 657 6403 32504
168 11 283
Heart Failure
Year US Michigan 35-64 65-84 85+
2000 203 245 3047 936 8287
2001 202 237 2596 88 8285
2002 194 233 2648 878 8057
2003 194 233 3176 902 7722
2004 189 224 2709 863 7586
2005 189 224 2955 878 7388
2006 24 2979 884 8354
2007 219 274 828 7483
2008 233 013 333 85 8102
Heart Disease Stroke
Michigan White Michigan Black US White US Black Michigan White Michigan Black US White US Black
1990 334 4315 317 3915 1990 638 733 629 917
1991 3289 4108 3088 3865 1991 626 781 607 894
1992 3126 3987 3011 3777 1992 609 694 598 86
1993 3234 429 3046 3843 1993 614 77 609 866
1994 3134 4156 295 3661 1994 634 875 609 869
1995 3048 4131 2912 3672 1995 638 925 615 879
1996 2997 380 2842 354 1996 617 804 61 852
1997 2851 3683 2764 345 1997 604 77 598 816
1998 2884 3586 2681 3406 1998 598 729 576 803
1999 2781 3692 2634 3367 1999 609 812 598 824
2000 2757 3663 2536 3265 2000 586 737 587 824
2001 261 3695 2435 3169 2001 56 718 558 788
2002 2522 3659 2367 3084 2002 553 729 542 763
2003 2409 350 2282 3002 2003 511 655 514 743
2004 222 3311 2133 2806 2004 477 633 48 699
2005 219 3227 2005 442 616
2006 2144 320 2006 426 589
2007 2007
2008 2008
CVD CHD HD HF Stroke
2000 3694 2118 2851 245 603
2001 3524 2006 2719 237 577
2002 3421 192 2631 233 571
2003 3258 179 2517 233 527
2004 3034 1656 2337 224 496
2005 2972 1611 2308 224 464
2006 2898 1564 226 24 444
2007 2825 1516 2216 219 425
2008 2791 1472 2192 233 419
2000 2000 2000
2001 2001 2001
2002 2002 2002
2003 2003 2003
2004 2004 2004
2005 2005 2005
2006 2006 2006
2007 2007 2007
2008 2008 2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2000 2000 2000 2000 2000
2001 2001 2001 2001 2001
2002 2002 2002 2002 2002
2003 2003 2003 2003 2003
2004 2004 2004 2004 2004
2005 2005 2005 2005 2005
2006 2006 2006 2006 2006
2007 2007 2007 2007 2007
2008 2008 2008 2008 2008
CVD
Year White Male Black Male White Female Black Female
2000 4276 5424 3033 4161
2001 4066 5524 2813 4091
2002 3928 5468 2767 4114
2003 3734 518 2638 3887
2004 3448 5079 2432 3643
2005 3366 4983 2375 3545
2006 3276 4994 2313 3477
2007 3236 4845 2223 327
2008 3158 4694 2238 3327
change 234 79 237 164
Heart Disease
Year White Male Black Male White Female Black Female
2000 3393 4298 227 3206
2001 3232 4445 2124 3166
2002 3118 4317 2197 3157
2003 2986 4184 1957 3001
2004 2777 3983 1783 2838
2005 2704 4009 1776 2679
2006 2644 3981 1739 2642
2007 2619 3972 1679 2532
2008 2566 3819 1687 2606
Stroke
Year White Male Black Male White Female Black Female
2000 61 768 561 703 176
2001 575 752 539 681 138
2002 573 806 528 66 15
2003 516 662 498 629 147
2004 463 743 476 562
2005 449 663 429 585
2006 434 63 411 556
2007 415 631 392 494
2008 402 606 392 509
Coronary Heart Disease
Year White Male Black Male White Female Black Female
2000 2625 329 1608 243
2001 2478 3356 1508 2314
2002 2404 3154 1419 2313
2003 2221 3093 1328 209
2004 2067 2956 119 1983
2005 1989 2885 117 1853
2006 1922 2903 1139 1825
2007 1921 2771 1074 1645
2008 1824 2592 1071 1722
Heart Failure
Year White Male Black Male White Female Black Female
2000 255 206 245 17
2001 267 225 225 167
2002 242 238 227 203
2003 256 217 222 189
2004 243 167 214 206
2005 24 218 217 172
2006 255 246 229 202
2007 23 225 208 196
2008 25 216 226 185
Not sure what this data is from previously HD Stroke
Year White Female Black Female White Female Black Female
2000 227 3206 561 703
2001 2124 3166 539 681
2002 2197 3157 528 66
2003 1957 3001 498 629
2004 1783 2838 476 562
2005 1776 2679 429 585
2006 1739 2642 411 556
2007
2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
CVD
Year US Michigan 0-34 35-64 65-84 85+
2000 3397 3694 43 140 16141 86689
2001 3265 3524 508 1348 15291 82889
2002 3174 3421 45 1338 14891 79536
2003 3061 3258 54 1324 14033 75185
2004 2885 3034 41 1242 13209 69088
2005 2773 2972 48 1283 1291 66011
2006 2898 48 1207 12246 6786
2007 2825 5 1206 1182 66153
2008 2791 43 1175 11619 66406
Heart Disease
Year US Michigan 0-34 35-64 65-84 85+
2000 2576 2851 345 1158 1247 64879
2001 2478 2719 416 112 11794 61938
2002 2408 2631 35 1103 11529 58746
2003 2323 2517 45 110 10827 56172
2004 217 2337 313 1048 10086 51609
2005 2111 2308 38 1078 9937 49828
2006 226 384 1019 9413 51918
2007 2216 42 1008 9174 50961
2008 2192 36 982 904 51209
Stroke
Year US Michigan HP 2010 0-34 35-64 65-84 85+
2000 609 603 50 068 174 2589 15841
2001 579 577 50 0638 157 2522 1504
2002 562 571 50 072 169 2397 1528
2003 535 527 50 0737 157 2249 13741
2004 50 496 50 0652 138 220 12629
2005 466 464 50 0553 145 2063 11398
2006 444 50 0734 127 196 11256
2007 425 064 1368 1832 10718
2008 419 047 134 1804 10646
79 27 243 289
Coronary Heart Disease
Year US Michigan HP 2010 0-34 35-64 65-84 85+
2000 1868 2118 162 0613 874 7701 4670
2001 1778 2006 162 0898 818 9012 44369
2002 1709 192 162 0889 799 8759 41061
2003 1628 179 162 0793 785 8018 38358
2004 1502 1656 162 0865 757 7421 34644
2005 1444 1611 162 097 773 7245 32617
2006 1564 162 088 727 6856 33503
2007 1516 117 709 6585 32727
2008 1472 102 657 6403 32504
168 11 283
Heart Failure
Year US Michigan 35-64 65-84 85+
2000 203 245 3047 936 8287
2001 202 237 2596 88 8285
2002 194 233 2648 878 8057
2003 194 233 3176 902 7722
2004 189 224 2709 863 7586
2005 189 224 2955 878 7388
2006 24 2979 884 8354
2007 219 274 828 7483
2008 233 013 333 85 8102
Heart Disease Stroke
Michigan White Michigan Black US White US Black Michigan White Michigan Black US White US Black
1990 334 4315 317 3915 1990 638 733 629 917
1991 3289 4108 3088 3865 1991 626 781 607 894
1992 3126 3987 3011 3777 1992 609 694 598 86
1993 3234 429 3046 3843 1993 614 77 609 866
1994 3134 4156 295 3661 1994 634 875 609 869
1995 3048 4131 2912 3672 1995 638 925 615 879
1996 2997 380 2842 354 1996 617 804 61 852
1997 2851 3683 2764 345 1997 604 77 598 816
1998 2884 3586 2681 3406 1998 598 729 576 803
1999 2781 3692 2634 3367 1999 609 812 598 824
2000 2757 3663 2536 3265 2000 586 737 587 824
2001 261 3695 2435 3169 2001 56 718 558 788
2002 2522 3659 2367 3084 2002 553 729 542 763
2003 2409 350 2282 3002 2003 511 655 514 743
2004 222 3311 2133 2806 2004 477 633 48 699
2005 219 3227 2005 442 616
2006 2144 320 2006 426 589
2007 2007
2008 2008
Stroke
CVD MI US
2000 3694 606 609
2001 3524 584 584
2002 3421 583 572
2003 3258 539 546
2004 3034 519 512
2005 2972 488 48
2006 2898 449 448
2007 2825 43 435
2008 2791 423 421
2009 262 396 396
2010 394 391
2011 387 379
2012 372 369
2013 363 369
2014 377 365
2000 2000 2000
2001 2001 2001
2002 2002 2002
2003 2003 2003
2004 2004 2004
2005 2005 2005
2006 2006 2006
2007 2007 2007
2008 2008 2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
Page 11: Michigan and MOSAIC Data Review...Michigan and MOSAIC Data Review 2017 ANNUAL WORKSHOP 4/26/2017. Adrienne Nickles, MPH. Michigan’s Ongoing Stroke Registry to Accelerate the Improvement

CHD_Age

0-34
35-64
65-84
85+
Year
Age-Adjusted Rate per 100000
0613
874
7701
4670
0898
818
9012
44369
0889
799
8759
41061
0793
785
8018
38358
0865
757
7421
34644
097
773
7245
32617
088
727
6856
33503
117
709
6585
32727
102
657
6403
32504

Stroke_Age

0-34
35-64
65-84
85+
Year
Age-Adjusted Rate per 100000
068
174
2589
15841
0638
157
2522
1504
072
169
2397
1528
0737
157
2249
13741
0652
138
220
12629
0553
145
2063
11398
0734
127
196
11256
064
1368
1832
10718
047
134
1804
10646

HF_Age

35-64
65-84
85+
Year
Age-Adjusted Rate per 100000
3047
936
8287
2596
88
8285
2648
878
8057
3176
902
7722
2709
863
7586
2955
878
7388
2979
884
8354
274
828
7483
333
85
8102

total

CVD_RG

White Male
Black Male
White Female
Black Female
Year
Age-Adjusted Rate per 100000
4276
5424
3033
4161
4066
5524
2813
4091
3928
5468
2767
4114
3734
518
2638
3887
3448
5079
2432
3643
3366
4983
2375
3545
3276
4994
2313
3477
3236
4845
2223
327
3158
4694
2238
3327

Stroke_RG

White Male
Black Male
White Female
Black Female
Year
Age-Adjusted Rate per 100000
61
768
561
703
575
752
539
681
573
806
528
66
516
662
498
629
463
743
476
562
449
663
429
585
434
63
411
556
415
631
392
494
402
606
392
509

HD_RG

White Male
Black Male
White Female
Black Female
Year
Age-Adjusted Rate per 100000
3393
4298
227
3206
3232
4445
2124
3166
3118
4317
2197
3157
2986
4184
1957
3001
2777
3983
1783
2838
2704
4009
1776
2679
2644
3981
1739
2642
2619
3972
1679
2532
2566
3819
1687
2606

CHD_RG

White Male
Black Male
White Female
Black Female
Year
Age-Adjusted Rate per 100000
2625
329
1608
243
2478
3356
1508
2314
2404
3154
1419
2313
2221
3093
1328
209
2067
2956
119
1983
1989
2885
117
1853
1922
2903
1139
1825
1921
2771
1074
1645
1824
2592
1071
1722

HF_RG

White Male
Black Male
White Female
Black Female
Year
Age-Adjusted Rate per 100000
255
206
245
17
267
225
225
167
242
238
227
203
256
217
222
189
243
167
214
206
24
218
217
172
255
246
229
202
23
225
208
196
25
216
226
185

race_gender

Sheet3

Age-adjusted stroke mortality rates by race and gender Michigan 2000 to 2014

0

10

20

30

40

50

60

70

80

90

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014

Age

-Adj

uste

d R

ate

per 1

000

00

Year

White Male

Black Male

White Female

Black Female

Overall_Rates

CVD
CHD
HD
HF
Stroke
Year
Rate per 10000
3694
2118
2851
245
603
3524
2006
2719
237
577
3421
192
2631
233
571
3258
179
2517
233
527
3034
1656
2337
224
496
2972
1611
2308
224
464
2898
1564
226
24
444
2825
1516
2216
219
425
2791
1472
2192
233
419

CVD_Age

0-34
35-64
65-84
85+
Year
Age-Adjusted Rate per 100000
43
140
16141
86689
508
1348
15291
82889
45
1338
14891
79536
54
1324
14033
75185
41
1242
13209
69088
48
1283
1291
66011
48
1207
12246
6786
5
1206
1182
66153
43
1175
11619
66406

HD_Age

0-34
35-64
65-84
85+
Year
Age-Adjusted Rate per 100000
345
1158
1247
64879
416
112
11794
61938
35
1103
11529
58746
45
110
10827
56172
313
1048
10086
51609
38
1078
9937
49828
384
1019
9413
51918
42
1008
9174
50961
36
982
904
51209

CHD_Age

0-34
35-64
65-84
85+
Year
Age-Adjusted Rate per 100000
0613
874
7701
4670
0898
818
9012
44369
0889
799
8759
41061
0793
785
8018
38358
0865
757
7421
34644
097
773
7245
32617
088
727
6856
33503
117
709
6585
32727
102
657
6403
32504

Stroke_Age

0-34
35-64
65-84
85+
Year
Age-Adjusted Rate per 100000
068
174
2589
15841
0638
157
2522
1504
072
169
2397
1528
0737
157
2249
13741
0652
138
220
12629
0553
145
2063
11398
0734
127
196
11256
064
1368
1832
10718
047
134
1804
10646

HF_Age

35-64
65-84
85+
Year
Age-Adjusted Rate per 100000
3047
936
8287
2596
88
8285
2648
878
8057
3176
902
7722
2709
863
7586
2955
878
7388
2979
884
8354
274
828
7483
333
85
8102

total

CVD_RG

White Male
Black Male
White Female
Black Female
Year
Age-Adjusted Rate per 100000
4276
5424
3033
4161
4066
5524
2813
4091
3928
5468
2767
4114
3734
518
2638
3887
3448
5079
2432
3643
3366
4983
2375
3545
3276
4994
2313
3477
3236
4845
2223
327
3158
4694
2238
3327

Stroke_RG

White Male
Black Male
White Female
Black Female
Year
Age-Adjusted Rate per 100000
61
768
561
703
575
752
539
681
573
806
528
66
516
662
498
629
463
743
476
562
449
663
429
585
434
63
411
556
415
631
392
494
402
606
392
509
375
616
372
464
372
565
366
513
373
548
366
44
348
587
349
477
347
506
34
462
369
506
352
482

HD_RG

White Male
Black Male
White Female
Black Female
Year
Age-Adjusted Rate per 100000
3393
4298
227
3206
3232
4445
2124
3166
3118
4317
2197
3157
2986
4184
1957
3001
2777
3983
1783
2838
2704
4009
1776
2679
2644
3981
1739
2642
2619
3972
1679
2532
2566
3819
1687
2606

CHD_RG

White Male
Black Male
White Female
Black Female
Year
Age-Adjusted Rate per 100000
2625
329
1608
243
2478
3356
1508
2314
2404
3154
1419
2313
2221
3093
1328
209
2067
2956
119
1983
1989
2885
117
1853
1922
2903
1139
1825
1921
2771
1074
1645
1824
2592
1071
1722

HF_RG

White Male
Black Male
White Female
Black Female
Year
Age-Adjusted Rate per 100000
255
206
245
17
267
225
225
167
242
238
227
203
256
217
222
189
243
167
214
206
24
218
217
172
255
246
229
202
23
225
208
196
25
216
226
185

race_gender

Sheet3

Local Health Department data can be found at wwwmichigangovbrfsSource CDC BRFSS

RISK FACTORMI

2011

MI

2013

MI

2014

MI

2015US 2015

2015 NATIONAL RANKING

Current Smoking 233 214 212 207 175 11

Blood Pressure Ever Told High 342 346 NA 331 309 18

Cholesterol Ever Told High 418 406 NA 382 364 12

Overweight (BMIgt25) 342 347 349 351 355 32tied

Obese (BMIgt30) 313 315 307 312 298 16

No Leisure Time Physical Activity 236 244 255 255 262 27

Diabetes 100 104 104 107 100 18tied

Prevalence of CVD Risk Factors Michigan Adults 1990-2015Compared to 2015 National Prevalence

233214 212 207

175

10

15

20

25

30

MI 2011 MI 2013 MI 2014 MI 2015 US 2015

Current Smoking

342 346331

309

20

25

30

35

40

MI 2011 MI 2013 MI 2014 MI 2015 US 2015

Blood Pressure Ever told high

342 347 349 351 355

20

25

30

35

40

MI 2011 MI 2013 MI 2014 MI 2015 US 2015

Overweight (BMIgt25)

313 315 307 312298

20

25

30

35

40

MI 2011 MI 2013 MI 2014 MI 2015 US 2015

Obese (BMIgt30)

418406

382364

30

35

40

45

50

MI 2011 MI 2013 MI 2014 MI 2015 US 2015

Cholesterol Ever told high

10 104 104 10710

0

3

6

9

12

15

MI 2011 MI 2013 MI 2014 MI 2015 US 2015

Diabetes

236 244255 255 262

10

15

20

25

30

MI 2011 MI 2013 MI 2014 MI 2015 US 2015

No Leisure Time Physical Activity

11 1216 18

2732tied

05

101520253035404550

CurrentSmoking

CholesterolEver told high

Obese(BMIgt30)

BloodPressure Ever

told high

Diabetes No LeisureTime Physical

Activity

Overweight(BMIgt25)

2015 NATIONAL RANKING(1st is worst)

18tied

MOSAIC 2015-2020 Focus of Grant Developing Stroke Systems of

Care Community Awareness EMS In-hospital QI Transition of Care Post-Discharge

12

Pre-hospital Care

A V A I L A B L E D A T A

13

EMSMOSAIC Data Linkage

-The MOSAIC Team continues to link data from the Michigan EMS Information System (MiEMSIS) to MOSAIC Data- Reports have been created for and reviewed by the

Tri-County Area MCA and Detroit East MCA- This work will expand to other MCA regions that

serve hospitals participating in MOSAIC

GWTG Special Initiatives Tab

-A free tab that can be enabled in GWTG-The purpose of the tab is to collect data concerning patient hand-off from EMS

MOSAIC Participating Hospitals

Aspirus Keweenaw Hospital (Laurium)

Aspirus Grand View HospitalAspirus Iron River HospitalAspirus Ontonagon HospitalBixby Medical CenterBronson Methodist HospitalCovenant Health CareDetroit Receiving HospitalGenesys Regional Medical CenterHenry Ford Hospital Herrick Medical CenterHuron Valley-Sinai HospitalLakeland Regional Medical Center McLaren Bay Regional Medical CenterMcLaren Greater Medical Center

McLaren Macomb HospitalMcLaren Northern MI HospitalMcLaren Oakland Medical CenterMcLaren Port Huron HospitalMcLaren Regional Medical CenterMercy Health Saint Maryrsquos HospitalMetro Health HospitalMunson Medical Center

ProMedica Monroe Regional HospitalSparrow HospitalSt Joseph Mercy - Ann ArborSt Joseph Mercy ChelseaSt Joseph Mercy Livingston HospitalSt Mary MercySt Mary of Michigan HospitalU of M Hospital

Hospital Infrastructure19

Among all participating hospitals the average number of

Licensed beds was 374 (range 25 to 1059 beds)

Inpatient discharges was 17076 (range 1064 to 48916 patients)

Acute stroke discharges (primary diagnosis only) was 417 (range 34 to 982 patients)

Case Demographics MOSAIC Registry

VariablesN() or statistics(Total N=68906)

Age at admission (years)Median 710Range 180 - 1060Mean (SE) 697(01)

GenderMale 32886 (477)Female 36015 (523)

RaceAfrican American 9900 (197)AIAN 132 (03)Asian 320 (06)More than one race 44 (01)Unknown 3679 (73)White 36190 (720)Missing 70

EthnicityHispanic or Latino 804 (16)Others 49531 (984)

VariablesN() or statistics(Total N=68906)

Health insuranceMedicaid 2284 (45)MedicaidPrivate 211 (04)Medicare 16863 (336)Medicare Medicaid 2313 (46)

MedicareMedicaidPrivate125 (02)

MedicarePrivate 13640 (272)ND 268(05)No insurance 2123 (42)Private 12356 (246)

Arrival modeEMS 21052 (429)Private

transportationother19313 (393)

Transfer from another hospital

7733(157)

ND or unknown 1021 (21)Missing 1216

Who receives data reports on your stroke quality of care

21

7055

70

10085

65

40

Hos

pita

lC

EO

up

per

man

agem

ent

Hos

pita

lB

oard

Chi

efN

ursi

ngO

ffice

r(C

NO

)

Str

oke

Tea

m

Phy

sici

anS

trok

eC

ham

pion

Chi

ef o

fM

edic

ine

Oth

er

Data Use

1) In the most recent calendar year have you run additional analyses (beyond what was required for reporting) on your hospitalrsquos own stroke data

2)How frequently have you run and used the analyses generated

22

Yes (N=16) 80

No (N=4) 20Weekly (N=2) 125

Monthly (N=8) 500

Less than monthly but more

than 1-2 times(N=6) 375

Data Use

What is the main reason you do not run your own additional analyses (Select one best answer)

23

Not sure how to run analyses

25

Not sure what analyses are needed would be helpful 25

Other 50

Data Use

In the most recent calendar year what reports did you run

24

813 688

Pre-programmedautomated reports in thedata collection tool (eg GWTG)

Additional reports beyond pre-programmed reports from the tool

Data Use

How do you use these analyses reports

25

813 688375

Inform quality improvement (QI) efforts andor plan

ldquoaction itemsrdquo

Report to management administration on our

progress

Other

Data Use

If you run additional analysis what action items QI efforts did you plan as a result of these reports

26

o Discharge education intensive statin use

o Door to tPA time and dysphagia

o Review data between spoke amp hub hospitals regarding transfers IV-tPA administration Mechanical thrombectomy and SAH

o QI efforts were addressed in the department involving calling Stroke Alert on call for cases with FAST symptoms

o ED Medical Director works with team to fix fallouts and problematic areas We have seen improvement

o Process changes (ie fallout emails to RN manager) physician querieso Increased documentation of NIHSS ownership from individual units regarding stroke quality

improvement goalso Daily dysphagia screening determination of whowhat team responsible for documenting initial NIHSS

looking at patients beyond 2h LKW arrival

Hospital Arrival Mode Door-to Needle and Pre-Notification

Reports 2016

Percent of Cases Who Arrived via EMSMOSAIC 2009-2016

Table 1 Arrival Mode among Stroke Cases by Demographics MOSAIC 2016

Demographics N=3496 550 N=2938 450Stroke Type Ischemic 2558 542 2164 458 Hemorrhagic 560 728 209 272 TIA 378 478 413 522Age Group lt 50 Years 233 433 305 567 50-79 Years 1982 497 2008 503 ge 80 Years 1379 688 625 312Sex Female 1933 576 1422 424 Male 1661 523 1516 477Race Black 659 530 584 470 White 2824 557 2248 443 Other Missing 111 512 106 488

MOSAIC AggregateArrival Mode

EMS Private Mode

Table 2 Door-to-Needle Times by Arrival Mode among Stroke Cases MOSAIC 2016

Time Elements (in Minutes)Number of

Patients Mean (Minutes) Median

(Minutes)Range

(Minutes)Door-to-Image 4901 575 400 00-2700 Arrived via EMS 2767 463 270 00-2700 Arrived via Private Transportation 2134 720 570 00-2620

Door-to-Image (among t-PA treated) 492 155 130 00-970 Arrived via EMS 370 125 110 00-840 Arrived via Private Transportation 122 243 215 20-970Image-to Needle 492 500 450 70-2090 Arrived via EMS 370 503 460 70-2090 Arrived via Private Transportation 122 483 420 90-1770Door-to Needle 492 655 570 200-2180 Arrived via EMS 370 629 560 200-2180 Arrived via Private Transportation 122 726 650 290-2060Included ischemic or hemorrhagic cases with times that were less or equal to 270 minutes (45 hours)Transferred cases were excluded

MOSAIC Aggregate

Table 3 Pre-Notification among Stroke Cases Who Arrived Via EMS by Demographics MOSAIC 2016

Demographics N=2015 584 N=1437 416Stroke Type Ischemic 1523 622 924 378 Hemorrhagic 306 566 235 434 TIA 142 381 231 619Age Group lt 50 Years 133 607 86 393 50-79 Years 1105 585 784 415 ge 80 Years 777 578 567 422Sex Female 1075 578 786 422 Male 940 591 651 409Race Black 307 517 287 483 White 1657 602 1097 398 Other 51 490 53 510

All HospitalsPre-Notification

Yes No

MOSAIC Transitions of Care Project

Post-discharge data collection tool is being implemented into Outcome Science as a tab

Post-Discharge amp Transition of Care

Reporting on changes within 30 days of discharge from hospital via follow-up callschart review Interval events Physician follow-up visits Lifestyle changes Lab assessments Medication managementadherence Rehab amp Functional outcomes Falls

MOSAIC Website

wwwMichigangovstroke

Adrienne Nickles MPHnicklesamichigangov

Thank You

  • Michigan and MOSAIC Data Review
  • Overview
  • Age-adjusted Stroke Hospitalization Rates Michigan 2000-2015
  • Slide Number 4
  • Age-adjusted Stroke Mortality Rates Michigan 2000-2014
  • Slide Number 6
  • Slide Number 7
  • Slide Number 8
  • Slide Number 9
  • Slide Number 10
  • Slide Number 11
  • MOSAIC 2015-2020
  • Pre-hospital Care
  • EMSMOSAIC Data Linkage
  • Slide Number 15
  • GWTG Special Initiatives Tab
  • Slide Number 17
  • MOSAIC Participating Hospitals
  • Hospital Infrastructure
  • Case Demographics MOSAIC Registry
  • Who receives data reports on your stroke quality of care
  • 1) In the most recent calendar year have you run additional analyses (beyond what was required for reporting) on your hospitalrsquos own stroke data 2)How frequently have you run and used the analyses generated
  • What is the main reason you do not run your own additional analyses (Select one best answer)
  • In the most recent calendar year what reports did you run
  • How do you use these analyses reports
  • If you run additional analysis what action items QI efforts did you plan as a result of these reports
  • Hospital Arrival Mode Door-to Needle and Pre-Notification Reports 2016
  • Percent of Cases Who Arrived via EMSMOSAIC 2009-2016
  • Table 1 Arrival Mode among Stroke Cases by Demographics MOSAIC 2016
  • Table 2 Door-to-Needle Times by Arrival Mode among Stroke Cases MOSAIC 2016
  • Table 3 Pre-Notification among Stroke Cases Who Arrived Via EMS by Demographics MOSAIC 2016
  • MOSAIC Transitions of Care Project
  • Slide Number 33
  • MOSAIC Website
  • Adrienne Nickles MPHnicklesamichigangov
CVD
Year White Male Black Male White Female Black Female
2000 4276 5424 3033 4161
2001 4066 5524 2813 4091
2002 3928 5468 2767 4114
2003 3734 518 2638 3887
2004 3448 5079 2432 3643
2005 3366 4983 2375 3545
2006 3276 4994 2313 3477
2007 3236 4845 2223 327
2008 3158 4694 2238 3327
change 234 79 237 164
Heart Disease
Year White Male Black Male White Female Black Female
2000 3393 4298 227 3206
2001 3232 4445 2124 3166
2002 3118 4317 2197 3157
2003 2986 4184 1957 3001
2004 2777 3983 1783 2838
2005 2704 4009 1776 2679
2006 2644 3981 1739 2642
2007 2619 3972 1679 2532
2008 2566 3819 1687 2606
Stroke
Year White Male Black Male White Female Black Female
2000 61 768 561 703 176
2001 575 752 539 681 138
2002 573 806 528 66 15
2003 516 662 498 629 147
2004 463 743 476 562
2005 449 663 429 585
2006 434 63 411 556
2007 415 631 392 494
2008 402 606 392 509
2009 375 616 372 464
2010 372 565 366 513
2011 373 548 366 44
2012 348 587 349 477
2013 347 506 34 462
2014 369 506 352 482
Coronary Heart Disease
Year White Male Black Male White Female Black Female
2000 2625 329 1608 243
2001 2478 3356 1508 2314
2002 2404 3154 1419 2313
2003 2221 3093 1328 209
2004 2067 2956 119 1983
2005 1989 2885 117 1853
2006 1922 2903 1139 1825
2007 1921 2771 1074 1645
2008 1824 2592 1071 1722
Heart Failure
Year White Male Black Male White Female Black Female
2000 255 206 245 17
2001 267 225 225 167
2002 242 238 227 203
2003 256 217 222 189
2004 243 167 214 206
2005 24 218 217 172
2006 255 246 229 202
2007 23 225 208 196
2008 25 216 226 185
Not sure what this data is from previously HD Stroke
Year White Female Black Female White Female Black Female
2000 227 3206 561 703
2001 2124 3166 539 681
2002 2197 3157 528 66
2003 1957 3001 498 629
2004 1783 2838 476 562
2005 1776 2679 429 585
2006 1739 2642 411 556
2007
2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2009 2009 2009 2009
2010 2010 2010 2010
2011 2011 2011 2011
2012 2012 2012 2012
2013 2013 2013 2013
2014 2014 2014 2014
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
CVD
Year US Michigan 0-34 35-64 65-84 85+
2000 3397 3694 43 140 16141 86689
2001 3265 3524 508 1348 15291 82889
2002 3174 3421 45 1338 14891 79536
2003 3061 3258 54 1324 14033 75185
2004 2885 3034 41 1242 13209 69088
2005 2773 2972 48 1283 1291 66011
2006 2898 48 1207 12246 6786
2007 2825 5 1206 1182 66153
2008 2791 43 1175 11619 66406
Heart Disease
Year US Michigan 0-34 35-64 65-84 85+
2000 2576 2851 345 1158 1247 64879
2001 2478 2719 416 112 11794 61938
2002 2408 2631 35 1103 11529 58746
2003 2323 2517 45 110 10827 56172
2004 217 2337 313 1048 10086 51609
2005 2111 2308 38 1078 9937 49828
2006 226 384 1019 9413 51918
2007 2216 42 1008 9174 50961
2008 2192 36 982 904 51209
Stroke
Year US Michigan HP 2010 0-34 35-64 65-84 85+
2000 609 603 50 068 174 2589 15841
2001 579 577 50 0638 157 2522 1504
2002 562 571 50 072 169 2397 1528
2003 535 527 50 0737 157 2249 13741
2004 50 496 50 0652 138 220 12629
2005 466 464 50 0553 145 2063 11398
2006 444 50 0734 127 196 11256
2007 425 064 1368 1832 10718
2008 419 047 134 1804 10646
79 27 243 289
Coronary Heart Disease
Year US Michigan HP 2010 0-34 35-64 65-84 85+
2000 1868 2118 162 0613 874 7701 4670
2001 1778 2006 162 0898 818 9012 44369
2002 1709 192 162 0889 799 8759 41061
2003 1628 179 162 0793 785 8018 38358
2004 1502 1656 162 0865 757 7421 34644
2005 1444 1611 162 097 773 7245 32617
2006 1564 162 088 727 6856 33503
2007 1516 117 709 6585 32727
2008 1472 102 657 6403 32504
168 11 283
Heart Failure
Year US Michigan 35-64 65-84 85+
2000 203 245 3047 936 8287
2001 202 237 2596 88 8285
2002 194 233 2648 878 8057
2003 194 233 3176 902 7722
2004 189 224 2709 863 7586
2005 189 224 2955 878 7388
2006 24 2979 884 8354
2007 219 274 828 7483
2008 233 013 333 85 8102
Heart Disease Stroke
Michigan White Michigan Black US White US Black Michigan White Michigan Black US White US Black
1990 334 4315 317 3915 1990 638 733 629 917
1991 3289 4108 3088 3865 1991 626 781 607 894
1992 3126 3987 3011 3777 1992 609 694 598 86
1993 3234 429 3046 3843 1993 614 77 609 866
1994 3134 4156 295 3661 1994 634 875 609 869
1995 3048 4131 2912 3672 1995 638 925 615 879
1996 2997 380 2842 354 1996 617 804 61 852
1997 2851 3683 2764 345 1997 604 77 598 816
1998 2884 3586 2681 3406 1998 598 729 576 803
1999 2781 3692 2634 3367 1999 609 812 598 824
2000 2757 3663 2536 3265 2000 586 737 587 824
2001 261 3695 2435 3169 2001 56 718 558 788
2002 2522 3659 2367 3084 2002 553 729 542 763
2003 2409 350 2282 3002 2003 511 655 514 743
2004 222 3311 2133 2806 2004 477 633 48 699
2005 219 3227 2005 442 616
2006 2144 320 2006 426 589
2007 2007
2008 2008
CVD CHD HD HF Stroke
2000 3694 2118 2851 245 603
2001 3524 2006 2719 237 577
2002 3421 192 2631 233 571
2003 3258 179 2517 233 527
2004 3034 1656 2337 224 496
2005 2972 1611 2308 224 464
2006 2898 1564 226 24 444
2007 2825 1516 2216 219 425
2008 2791 1472 2192 233 419
2000 2000 2000
2001 2001 2001
2002 2002 2002
2003 2003 2003
2004 2004 2004
2005 2005 2005
2006 2006 2006
2007 2007 2007
2008 2008 2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2000 2000 2000 2000 2000
2001 2001 2001 2001 2001
2002 2002 2002 2002 2002
2003 2003 2003 2003 2003
2004 2004 2004 2004 2004
2005 2005 2005 2005 2005
2006 2006 2006 2006 2006
2007 2007 2007 2007 2007
2008 2008 2008 2008 2008
CVD
Year White Male Black Male White Female Black Female
2000 4276 5424 3033 4161
2001 4066 5524 2813 4091
2002 3928 5468 2767 4114
2003 3734 518 2638 3887
2004 3448 5079 2432 3643
2005 3366 4983 2375 3545
2006 3276 4994 2313 3477
2007 3236 4845 2223 327
2008 3158 4694 2238 3327
change 234 79 237 164
Heart Disease
Year White Male Black Male White Female Black Female
2000 3393 4298 227 3206
2001 3232 4445 2124 3166
2002 3118 4317 2197 3157
2003 2986 4184 1957 3001
2004 2777 3983 1783 2838
2005 2704 4009 1776 2679
2006 2644 3981 1739 2642
2007 2619 3972 1679 2532
2008 2566 3819 1687 2606
Stroke
Year White Male Black Male White Female Black Female
2000 61 768 561 703 176
2001 575 752 539 681 138
2002 573 806 528 66 15
2003 516 662 498 629 147
2004 463 743 476 562
2005 449 663 429 585
2006 434 63 411 556
2007 415 631 392 494
2008 402 606 392 509
Coronary Heart Disease
Year White Male Black Male White Female Black Female
2000 2625 329 1608 243
2001 2478 3356 1508 2314
2002 2404 3154 1419 2313
2003 2221 3093 1328 209
2004 2067 2956 119 1983
2005 1989 2885 117 1853
2006 1922 2903 1139 1825
2007 1921 2771 1074 1645
2008 1824 2592 1071 1722
Heart Failure
Year White Male Black Male White Female Black Female
2000 255 206 245 17
2001 267 225 225 167
2002 242 238 227 203
2003 256 217 222 189
2004 243 167 214 206
2005 24 218 217 172
2006 255 246 229 202
2007 23 225 208 196
2008 25 216 226 185
Not sure what this data is from previously HD Stroke
Year White Female Black Female White Female Black Female
2000 227 3206 561 703
2001 2124 3166 539 681
2002 2197 3157 528 66
2003 1957 3001 498 629
2004 1783 2838 476 562
2005 1776 2679 429 585
2006 1739 2642 411 556
2007
2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
CVD
Year US Michigan 0-34 35-64 65-84 85+
2000 3397 3694 43 140 16141 86689
2001 3265 3524 508 1348 15291 82889
2002 3174 3421 45 1338 14891 79536
2003 3061 3258 54 1324 14033 75185
2004 2885 3034 41 1242 13209 69088
2005 2773 2972 48 1283 1291 66011
2006 2898 48 1207 12246 6786
2007 2825 5 1206 1182 66153
2008 2791 43 1175 11619 66406
Heart Disease
Year US Michigan 0-34 35-64 65-84 85+
2000 2576 2851 345 1158 1247 64879
2001 2478 2719 416 112 11794 61938
2002 2408 2631 35 1103 11529 58746
2003 2323 2517 45 110 10827 56172
2004 217 2337 313 1048 10086 51609
2005 2111 2308 38 1078 9937 49828
2006 226 384 1019 9413 51918
2007 2216 42 1008 9174 50961
2008 2192 36 982 904 51209
Stroke
Year US Michigan HP 2010 0-34 35-64 65-84 85+
2000 609 603 50 068 174 2589 15841
2001 579 577 50 0638 157 2522 1504
2002 562 571 50 072 169 2397 1528
2003 535 527 50 0737 157 2249 13741
2004 50 496 50 0652 138 220 12629
2005 466 464 50 0553 145 2063 11398
2006 444 50 0734 127 196 11256
2007 425 064 1368 1832 10718
2008 419 047 134 1804 10646
79 27 243 289
Coronary Heart Disease
Year US Michigan HP 2010 0-34 35-64 65-84 85+
2000 1868 2118 162 0613 874 7701 4670
2001 1778 2006 162 0898 818 9012 44369
2002 1709 192 162 0889 799 8759 41061
2003 1628 179 162 0793 785 8018 38358
2004 1502 1656 162 0865 757 7421 34644
2005 1444 1611 162 097 773 7245 32617
2006 1564 162 088 727 6856 33503
2007 1516 117 709 6585 32727
2008 1472 102 657 6403 32504
168 11 283
Heart Failure
Year US Michigan 35-64 65-84 85+
2000 203 245 3047 936 8287
2001 202 237 2596 88 8285
2002 194 233 2648 878 8057
2003 194 233 3176 902 7722
2004 189 224 2709 863 7586
2005 189 224 2955 878 7388
2006 24 2979 884 8354
2007 219 274 828 7483
2008 233 013 333 85 8102
Heart Disease Stroke
Michigan White Michigan Black US White US Black Michigan White Michigan Black US White US Black
1990 334 4315 317 3915 1990 638 733 629 917
1991 3289 4108 3088 3865 1991 626 781 607 894
1992 3126 3987 3011 3777 1992 609 694 598 86
1993 3234 429 3046 3843 1993 614 77 609 866
1994 3134 4156 295 3661 1994 634 875 609 869
1995 3048 4131 2912 3672 1995 638 925 615 879
1996 2997 380 2842 354 1996 617 804 61 852
1997 2851 3683 2764 345 1997 604 77 598 816
1998 2884 3586 2681 3406 1998 598 729 576 803
1999 2781 3692 2634 3367 1999 609 812 598 824
2000 2757 3663 2536 3265 2000 586 737 587 824
2001 261 3695 2435 3169 2001 56 718 558 788
2002 2522 3659 2367 3084 2002 553 729 542 763
2003 2409 350 2282 3002 2003 511 655 514 743
2004 222 3311 2133 2806 2004 477 633 48 699
2005 219 3227 2005 442 616
2006 2144 320 2006 426 589
2007 2007
2008 2008
Stroke
CVD MI US
2000 3694 606 609
2001 3524 584 584
2002 3421 583 572
2003 3258 539 546
2004 3034 519 512
2005 2972 488 48
2006 2898 449 448
2007 2825 43 435
2008 2791 423 421
2009 262 396 396
2010 394 391
2011 387 379
2012 372 369
2013 363 369
2014 377 365
2000 2000 2000
2001 2001 2001
2002 2002 2002
2003 2003 2003
2004 2004 2004
2005 2005 2005
2006 2006 2006
2007 2007 2007
2008 2008 2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
Page 12: Michigan and MOSAIC Data Review...Michigan and MOSAIC Data Review 2017 ANNUAL WORKSHOP 4/26/2017. Adrienne Nickles, MPH. Michigan’s Ongoing Stroke Registry to Accelerate the Improvement

Stroke_Age

0-34
35-64
65-84
85+
Year
Age-Adjusted Rate per 100000
068
174
2589
15841
0638
157
2522
1504
072
169
2397
1528
0737
157
2249
13741
0652
138
220
12629
0553
145
2063
11398
0734
127
196
11256
064
1368
1832
10718
047
134
1804
10646

HF_Age

35-64
65-84
85+
Year
Age-Adjusted Rate per 100000
3047
936
8287
2596
88
8285
2648
878
8057
3176
902
7722
2709
863
7586
2955
878
7388
2979
884
8354
274
828
7483
333
85
8102

total

CVD_RG

White Male
Black Male
White Female
Black Female
Year
Age-Adjusted Rate per 100000
4276
5424
3033
4161
4066
5524
2813
4091
3928
5468
2767
4114
3734
518
2638
3887
3448
5079
2432
3643
3366
4983
2375
3545
3276
4994
2313
3477
3236
4845
2223
327
3158
4694
2238
3327

Stroke_RG

White Male
Black Male
White Female
Black Female
Year
Age-Adjusted Rate per 100000
61
768
561
703
575
752
539
681
573
806
528
66
516
662
498
629
463
743
476
562
449
663
429
585
434
63
411
556
415
631
392
494
402
606
392
509

HD_RG

White Male
Black Male
White Female
Black Female
Year
Age-Adjusted Rate per 100000
3393
4298
227
3206
3232
4445
2124
3166
3118
4317
2197
3157
2986
4184
1957
3001
2777
3983
1783
2838
2704
4009
1776
2679
2644
3981
1739
2642
2619
3972
1679
2532
2566
3819
1687
2606

CHD_RG

White Male
Black Male
White Female
Black Female
Year
Age-Adjusted Rate per 100000
2625
329
1608
243
2478
3356
1508
2314
2404
3154
1419
2313
2221
3093
1328
209
2067
2956
119
1983
1989
2885
117
1853
1922
2903
1139
1825
1921
2771
1074
1645
1824
2592
1071
1722

HF_RG

White Male
Black Male
White Female
Black Female
Year
Age-Adjusted Rate per 100000
255
206
245
17
267
225
225
167
242
238
227
203
256
217
222
189
243
167
214
206
24
218
217
172
255
246
229
202
23
225
208
196
25
216
226
185

race_gender

Sheet3

Age-adjusted stroke mortality rates by race and gender Michigan 2000 to 2014

0

10

20

30

40

50

60

70

80

90

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014

Age

-Adj

uste

d R

ate

per 1

000

00

Year

White Male

Black Male

White Female

Black Female

Overall_Rates

CVD
CHD
HD
HF
Stroke
Year
Rate per 10000
3694
2118
2851
245
603
3524
2006
2719
237
577
3421
192
2631
233
571
3258
179
2517
233
527
3034
1656
2337
224
496
2972
1611
2308
224
464
2898
1564
226
24
444
2825
1516
2216
219
425
2791
1472
2192
233
419

CVD_Age

0-34
35-64
65-84
85+
Year
Age-Adjusted Rate per 100000
43
140
16141
86689
508
1348
15291
82889
45
1338
14891
79536
54
1324
14033
75185
41
1242
13209
69088
48
1283
1291
66011
48
1207
12246
6786
5
1206
1182
66153
43
1175
11619
66406

HD_Age

0-34
35-64
65-84
85+
Year
Age-Adjusted Rate per 100000
345
1158
1247
64879
416
112
11794
61938
35
1103
11529
58746
45
110
10827
56172
313
1048
10086
51609
38
1078
9937
49828
384
1019
9413
51918
42
1008
9174
50961
36
982
904
51209

CHD_Age

0-34
35-64
65-84
85+
Year
Age-Adjusted Rate per 100000
0613
874
7701
4670
0898
818
9012
44369
0889
799
8759
41061
0793
785
8018
38358
0865
757
7421
34644
097
773
7245
32617
088
727
6856
33503
117
709
6585
32727
102
657
6403
32504

Stroke_Age

0-34
35-64
65-84
85+
Year
Age-Adjusted Rate per 100000
068
174
2589
15841
0638
157
2522
1504
072
169
2397
1528
0737
157
2249
13741
0652
138
220
12629
0553
145
2063
11398
0734
127
196
11256
064
1368
1832
10718
047
134
1804
10646

HF_Age

35-64
65-84
85+
Year
Age-Adjusted Rate per 100000
3047
936
8287
2596
88
8285
2648
878
8057
3176
902
7722
2709
863
7586
2955
878
7388
2979
884
8354
274
828
7483
333
85
8102

total

CVD_RG

White Male
Black Male
White Female
Black Female
Year
Age-Adjusted Rate per 100000
4276
5424
3033
4161
4066
5524
2813
4091
3928
5468
2767
4114
3734
518
2638
3887
3448
5079
2432
3643
3366
4983
2375
3545
3276
4994
2313
3477
3236
4845
2223
327
3158
4694
2238
3327

Stroke_RG

White Male
Black Male
White Female
Black Female
Year
Age-Adjusted Rate per 100000
61
768
561
703
575
752
539
681
573
806
528
66
516
662
498
629
463
743
476
562
449
663
429
585
434
63
411
556
415
631
392
494
402
606
392
509
375
616
372
464
372
565
366
513
373
548
366
44
348
587
349
477
347
506
34
462
369
506
352
482

HD_RG

White Male
Black Male
White Female
Black Female
Year
Age-Adjusted Rate per 100000
3393
4298
227
3206
3232
4445
2124
3166
3118
4317
2197
3157
2986
4184
1957
3001
2777
3983
1783
2838
2704
4009
1776
2679
2644
3981
1739
2642
2619
3972
1679
2532
2566
3819
1687
2606

CHD_RG

White Male
Black Male
White Female
Black Female
Year
Age-Adjusted Rate per 100000
2625
329
1608
243
2478
3356
1508
2314
2404
3154
1419
2313
2221
3093
1328
209
2067
2956
119
1983
1989
2885
117
1853
1922
2903
1139
1825
1921
2771
1074
1645
1824
2592
1071
1722

HF_RG

White Male
Black Male
White Female
Black Female
Year
Age-Adjusted Rate per 100000
255
206
245
17
267
225
225
167
242
238
227
203
256
217
222
189
243
167
214
206
24
218
217
172
255
246
229
202
23
225
208
196
25
216
226
185

race_gender

Sheet3

Local Health Department data can be found at wwwmichigangovbrfsSource CDC BRFSS

RISK FACTORMI

2011

MI

2013

MI

2014

MI

2015US 2015

2015 NATIONAL RANKING

Current Smoking 233 214 212 207 175 11

Blood Pressure Ever Told High 342 346 NA 331 309 18

Cholesterol Ever Told High 418 406 NA 382 364 12

Overweight (BMIgt25) 342 347 349 351 355 32tied

Obese (BMIgt30) 313 315 307 312 298 16

No Leisure Time Physical Activity 236 244 255 255 262 27

Diabetes 100 104 104 107 100 18tied

Prevalence of CVD Risk Factors Michigan Adults 1990-2015Compared to 2015 National Prevalence

233214 212 207

175

10

15

20

25

30

MI 2011 MI 2013 MI 2014 MI 2015 US 2015

Current Smoking

342 346331

309

20

25

30

35

40

MI 2011 MI 2013 MI 2014 MI 2015 US 2015

Blood Pressure Ever told high

342 347 349 351 355

20

25

30

35

40

MI 2011 MI 2013 MI 2014 MI 2015 US 2015

Overweight (BMIgt25)

313 315 307 312298

20

25

30

35

40

MI 2011 MI 2013 MI 2014 MI 2015 US 2015

Obese (BMIgt30)

418406

382364

30

35

40

45

50

MI 2011 MI 2013 MI 2014 MI 2015 US 2015

Cholesterol Ever told high

10 104 104 10710

0

3

6

9

12

15

MI 2011 MI 2013 MI 2014 MI 2015 US 2015

Diabetes

236 244255 255 262

10

15

20

25

30

MI 2011 MI 2013 MI 2014 MI 2015 US 2015

No Leisure Time Physical Activity

11 1216 18

2732tied

05

101520253035404550

CurrentSmoking

CholesterolEver told high

Obese(BMIgt30)

BloodPressure Ever

told high

Diabetes No LeisureTime Physical

Activity

Overweight(BMIgt25)

2015 NATIONAL RANKING(1st is worst)

18tied

MOSAIC 2015-2020 Focus of Grant Developing Stroke Systems of

Care Community Awareness EMS In-hospital QI Transition of Care Post-Discharge

12

Pre-hospital Care

A V A I L A B L E D A T A

13

EMSMOSAIC Data Linkage

-The MOSAIC Team continues to link data from the Michigan EMS Information System (MiEMSIS) to MOSAIC Data- Reports have been created for and reviewed by the

Tri-County Area MCA and Detroit East MCA- This work will expand to other MCA regions that

serve hospitals participating in MOSAIC

GWTG Special Initiatives Tab

-A free tab that can be enabled in GWTG-The purpose of the tab is to collect data concerning patient hand-off from EMS

MOSAIC Participating Hospitals

Aspirus Keweenaw Hospital (Laurium)

Aspirus Grand View HospitalAspirus Iron River HospitalAspirus Ontonagon HospitalBixby Medical CenterBronson Methodist HospitalCovenant Health CareDetroit Receiving HospitalGenesys Regional Medical CenterHenry Ford Hospital Herrick Medical CenterHuron Valley-Sinai HospitalLakeland Regional Medical Center McLaren Bay Regional Medical CenterMcLaren Greater Medical Center

McLaren Macomb HospitalMcLaren Northern MI HospitalMcLaren Oakland Medical CenterMcLaren Port Huron HospitalMcLaren Regional Medical CenterMercy Health Saint Maryrsquos HospitalMetro Health HospitalMunson Medical Center

ProMedica Monroe Regional HospitalSparrow HospitalSt Joseph Mercy - Ann ArborSt Joseph Mercy ChelseaSt Joseph Mercy Livingston HospitalSt Mary MercySt Mary of Michigan HospitalU of M Hospital

Hospital Infrastructure19

Among all participating hospitals the average number of

Licensed beds was 374 (range 25 to 1059 beds)

Inpatient discharges was 17076 (range 1064 to 48916 patients)

Acute stroke discharges (primary diagnosis only) was 417 (range 34 to 982 patients)

Case Demographics MOSAIC Registry

VariablesN() or statistics(Total N=68906)

Age at admission (years)Median 710Range 180 - 1060Mean (SE) 697(01)

GenderMale 32886 (477)Female 36015 (523)

RaceAfrican American 9900 (197)AIAN 132 (03)Asian 320 (06)More than one race 44 (01)Unknown 3679 (73)White 36190 (720)Missing 70

EthnicityHispanic or Latino 804 (16)Others 49531 (984)

VariablesN() or statistics(Total N=68906)

Health insuranceMedicaid 2284 (45)MedicaidPrivate 211 (04)Medicare 16863 (336)Medicare Medicaid 2313 (46)

MedicareMedicaidPrivate125 (02)

MedicarePrivate 13640 (272)ND 268(05)No insurance 2123 (42)Private 12356 (246)

Arrival modeEMS 21052 (429)Private

transportationother19313 (393)

Transfer from another hospital

7733(157)

ND or unknown 1021 (21)Missing 1216

Who receives data reports on your stroke quality of care

21

7055

70

10085

65

40

Hos

pita

lC

EO

up

per

man

agem

ent

Hos

pita

lB

oard

Chi

efN

ursi

ngO

ffice

r(C

NO

)

Str

oke

Tea

m

Phy

sici

anS

trok

eC

ham

pion

Chi

ef o

fM

edic

ine

Oth

er

Data Use

1) In the most recent calendar year have you run additional analyses (beyond what was required for reporting) on your hospitalrsquos own stroke data

2)How frequently have you run and used the analyses generated

22

Yes (N=16) 80

No (N=4) 20Weekly (N=2) 125

Monthly (N=8) 500

Less than monthly but more

than 1-2 times(N=6) 375

Data Use

What is the main reason you do not run your own additional analyses (Select one best answer)

23

Not sure how to run analyses

25

Not sure what analyses are needed would be helpful 25

Other 50

Data Use

In the most recent calendar year what reports did you run

24

813 688

Pre-programmedautomated reports in thedata collection tool (eg GWTG)

Additional reports beyond pre-programmed reports from the tool

Data Use

How do you use these analyses reports

25

813 688375

Inform quality improvement (QI) efforts andor plan

ldquoaction itemsrdquo

Report to management administration on our

progress

Other

Data Use

If you run additional analysis what action items QI efforts did you plan as a result of these reports

26

o Discharge education intensive statin use

o Door to tPA time and dysphagia

o Review data between spoke amp hub hospitals regarding transfers IV-tPA administration Mechanical thrombectomy and SAH

o QI efforts were addressed in the department involving calling Stroke Alert on call for cases with FAST symptoms

o ED Medical Director works with team to fix fallouts and problematic areas We have seen improvement

o Process changes (ie fallout emails to RN manager) physician querieso Increased documentation of NIHSS ownership from individual units regarding stroke quality

improvement goalso Daily dysphagia screening determination of whowhat team responsible for documenting initial NIHSS

looking at patients beyond 2h LKW arrival

Hospital Arrival Mode Door-to Needle and Pre-Notification

Reports 2016

Percent of Cases Who Arrived via EMSMOSAIC 2009-2016

Table 1 Arrival Mode among Stroke Cases by Demographics MOSAIC 2016

Demographics N=3496 550 N=2938 450Stroke Type Ischemic 2558 542 2164 458 Hemorrhagic 560 728 209 272 TIA 378 478 413 522Age Group lt 50 Years 233 433 305 567 50-79 Years 1982 497 2008 503 ge 80 Years 1379 688 625 312Sex Female 1933 576 1422 424 Male 1661 523 1516 477Race Black 659 530 584 470 White 2824 557 2248 443 Other Missing 111 512 106 488

MOSAIC AggregateArrival Mode

EMS Private Mode

Table 2 Door-to-Needle Times by Arrival Mode among Stroke Cases MOSAIC 2016

Time Elements (in Minutes)Number of

Patients Mean (Minutes) Median

(Minutes)Range

(Minutes)Door-to-Image 4901 575 400 00-2700 Arrived via EMS 2767 463 270 00-2700 Arrived via Private Transportation 2134 720 570 00-2620

Door-to-Image (among t-PA treated) 492 155 130 00-970 Arrived via EMS 370 125 110 00-840 Arrived via Private Transportation 122 243 215 20-970Image-to Needle 492 500 450 70-2090 Arrived via EMS 370 503 460 70-2090 Arrived via Private Transportation 122 483 420 90-1770Door-to Needle 492 655 570 200-2180 Arrived via EMS 370 629 560 200-2180 Arrived via Private Transportation 122 726 650 290-2060Included ischemic or hemorrhagic cases with times that were less or equal to 270 minutes (45 hours)Transferred cases were excluded

MOSAIC Aggregate

Table 3 Pre-Notification among Stroke Cases Who Arrived Via EMS by Demographics MOSAIC 2016

Demographics N=2015 584 N=1437 416Stroke Type Ischemic 1523 622 924 378 Hemorrhagic 306 566 235 434 TIA 142 381 231 619Age Group lt 50 Years 133 607 86 393 50-79 Years 1105 585 784 415 ge 80 Years 777 578 567 422Sex Female 1075 578 786 422 Male 940 591 651 409Race Black 307 517 287 483 White 1657 602 1097 398 Other 51 490 53 510

All HospitalsPre-Notification

Yes No

MOSAIC Transitions of Care Project

Post-discharge data collection tool is being implemented into Outcome Science as a tab

Post-Discharge amp Transition of Care

Reporting on changes within 30 days of discharge from hospital via follow-up callschart review Interval events Physician follow-up visits Lifestyle changes Lab assessments Medication managementadherence Rehab amp Functional outcomes Falls

MOSAIC Website

wwwMichigangovstroke

Adrienne Nickles MPHnicklesamichigangov

Thank You

  • Michigan and MOSAIC Data Review
  • Overview
  • Age-adjusted Stroke Hospitalization Rates Michigan 2000-2015
  • Slide Number 4
  • Age-adjusted Stroke Mortality Rates Michigan 2000-2014
  • Slide Number 6
  • Slide Number 7
  • Slide Number 8
  • Slide Number 9
  • Slide Number 10
  • Slide Number 11
  • MOSAIC 2015-2020
  • Pre-hospital Care
  • EMSMOSAIC Data Linkage
  • Slide Number 15
  • GWTG Special Initiatives Tab
  • Slide Number 17
  • MOSAIC Participating Hospitals
  • Hospital Infrastructure
  • Case Demographics MOSAIC Registry
  • Who receives data reports on your stroke quality of care
  • 1) In the most recent calendar year have you run additional analyses (beyond what was required for reporting) on your hospitalrsquos own stroke data 2)How frequently have you run and used the analyses generated
  • What is the main reason you do not run your own additional analyses (Select one best answer)
  • In the most recent calendar year what reports did you run
  • How do you use these analyses reports
  • If you run additional analysis what action items QI efforts did you plan as a result of these reports
  • Hospital Arrival Mode Door-to Needle and Pre-Notification Reports 2016
  • Percent of Cases Who Arrived via EMSMOSAIC 2009-2016
  • Table 1 Arrival Mode among Stroke Cases by Demographics MOSAIC 2016
  • Table 2 Door-to-Needle Times by Arrival Mode among Stroke Cases MOSAIC 2016
  • Table 3 Pre-Notification among Stroke Cases Who Arrived Via EMS by Demographics MOSAIC 2016
  • MOSAIC Transitions of Care Project
  • Slide Number 33
  • MOSAIC Website
  • Adrienne Nickles MPHnicklesamichigangov
CVD
Year White Male Black Male White Female Black Female
2000 4276 5424 3033 4161
2001 4066 5524 2813 4091
2002 3928 5468 2767 4114
2003 3734 518 2638 3887
2004 3448 5079 2432 3643
2005 3366 4983 2375 3545
2006 3276 4994 2313 3477
2007 3236 4845 2223 327
2008 3158 4694 2238 3327
change 234 79 237 164
Heart Disease
Year White Male Black Male White Female Black Female
2000 3393 4298 227 3206
2001 3232 4445 2124 3166
2002 3118 4317 2197 3157
2003 2986 4184 1957 3001
2004 2777 3983 1783 2838
2005 2704 4009 1776 2679
2006 2644 3981 1739 2642
2007 2619 3972 1679 2532
2008 2566 3819 1687 2606
Stroke
Year White Male Black Male White Female Black Female
2000 61 768 561 703 176
2001 575 752 539 681 138
2002 573 806 528 66 15
2003 516 662 498 629 147
2004 463 743 476 562
2005 449 663 429 585
2006 434 63 411 556
2007 415 631 392 494
2008 402 606 392 509
2009 375 616 372 464
2010 372 565 366 513
2011 373 548 366 44
2012 348 587 349 477
2013 347 506 34 462
2014 369 506 352 482
Coronary Heart Disease
Year White Male Black Male White Female Black Female
2000 2625 329 1608 243
2001 2478 3356 1508 2314
2002 2404 3154 1419 2313
2003 2221 3093 1328 209
2004 2067 2956 119 1983
2005 1989 2885 117 1853
2006 1922 2903 1139 1825
2007 1921 2771 1074 1645
2008 1824 2592 1071 1722
Heart Failure
Year White Male Black Male White Female Black Female
2000 255 206 245 17
2001 267 225 225 167
2002 242 238 227 203
2003 256 217 222 189
2004 243 167 214 206
2005 24 218 217 172
2006 255 246 229 202
2007 23 225 208 196
2008 25 216 226 185
Not sure what this data is from previously HD Stroke
Year White Female Black Female White Female Black Female
2000 227 3206 561 703
2001 2124 3166 539 681
2002 2197 3157 528 66
2003 1957 3001 498 629
2004 1783 2838 476 562
2005 1776 2679 429 585
2006 1739 2642 411 556
2007
2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2009 2009 2009 2009
2010 2010 2010 2010
2011 2011 2011 2011
2012 2012 2012 2012
2013 2013 2013 2013
2014 2014 2014 2014
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
CVD
Year US Michigan 0-34 35-64 65-84 85+
2000 3397 3694 43 140 16141 86689
2001 3265 3524 508 1348 15291 82889
2002 3174 3421 45 1338 14891 79536
2003 3061 3258 54 1324 14033 75185
2004 2885 3034 41 1242 13209 69088
2005 2773 2972 48 1283 1291 66011
2006 2898 48 1207 12246 6786
2007 2825 5 1206 1182 66153
2008 2791 43 1175 11619 66406
Heart Disease
Year US Michigan 0-34 35-64 65-84 85+
2000 2576 2851 345 1158 1247 64879
2001 2478 2719 416 112 11794 61938
2002 2408 2631 35 1103 11529 58746
2003 2323 2517 45 110 10827 56172
2004 217 2337 313 1048 10086 51609
2005 2111 2308 38 1078 9937 49828
2006 226 384 1019 9413 51918
2007 2216 42 1008 9174 50961
2008 2192 36 982 904 51209
Stroke
Year US Michigan HP 2010 0-34 35-64 65-84 85+
2000 609 603 50 068 174 2589 15841
2001 579 577 50 0638 157 2522 1504
2002 562 571 50 072 169 2397 1528
2003 535 527 50 0737 157 2249 13741
2004 50 496 50 0652 138 220 12629
2005 466 464 50 0553 145 2063 11398
2006 444 50 0734 127 196 11256
2007 425 064 1368 1832 10718
2008 419 047 134 1804 10646
79 27 243 289
Coronary Heart Disease
Year US Michigan HP 2010 0-34 35-64 65-84 85+
2000 1868 2118 162 0613 874 7701 4670
2001 1778 2006 162 0898 818 9012 44369
2002 1709 192 162 0889 799 8759 41061
2003 1628 179 162 0793 785 8018 38358
2004 1502 1656 162 0865 757 7421 34644
2005 1444 1611 162 097 773 7245 32617
2006 1564 162 088 727 6856 33503
2007 1516 117 709 6585 32727
2008 1472 102 657 6403 32504
168 11 283
Heart Failure
Year US Michigan 35-64 65-84 85+
2000 203 245 3047 936 8287
2001 202 237 2596 88 8285
2002 194 233 2648 878 8057
2003 194 233 3176 902 7722
2004 189 224 2709 863 7586
2005 189 224 2955 878 7388
2006 24 2979 884 8354
2007 219 274 828 7483
2008 233 013 333 85 8102
Heart Disease Stroke
Michigan White Michigan Black US White US Black Michigan White Michigan Black US White US Black
1990 334 4315 317 3915 1990 638 733 629 917
1991 3289 4108 3088 3865 1991 626 781 607 894
1992 3126 3987 3011 3777 1992 609 694 598 86
1993 3234 429 3046 3843 1993 614 77 609 866
1994 3134 4156 295 3661 1994 634 875 609 869
1995 3048 4131 2912 3672 1995 638 925 615 879
1996 2997 380 2842 354 1996 617 804 61 852
1997 2851 3683 2764 345 1997 604 77 598 816
1998 2884 3586 2681 3406 1998 598 729 576 803
1999 2781 3692 2634 3367 1999 609 812 598 824
2000 2757 3663 2536 3265 2000 586 737 587 824
2001 261 3695 2435 3169 2001 56 718 558 788
2002 2522 3659 2367 3084 2002 553 729 542 763
2003 2409 350 2282 3002 2003 511 655 514 743
2004 222 3311 2133 2806 2004 477 633 48 699
2005 219 3227 2005 442 616
2006 2144 320 2006 426 589
2007 2007
2008 2008
CVD CHD HD HF Stroke
2000 3694 2118 2851 245 603
2001 3524 2006 2719 237 577
2002 3421 192 2631 233 571
2003 3258 179 2517 233 527
2004 3034 1656 2337 224 496
2005 2972 1611 2308 224 464
2006 2898 1564 226 24 444
2007 2825 1516 2216 219 425
2008 2791 1472 2192 233 419
2000 2000 2000
2001 2001 2001
2002 2002 2002
2003 2003 2003
2004 2004 2004
2005 2005 2005
2006 2006 2006
2007 2007 2007
2008 2008 2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2000 2000 2000 2000 2000
2001 2001 2001 2001 2001
2002 2002 2002 2002 2002
2003 2003 2003 2003 2003
2004 2004 2004 2004 2004
2005 2005 2005 2005 2005
2006 2006 2006 2006 2006
2007 2007 2007 2007 2007
2008 2008 2008 2008 2008
CVD
Year White Male Black Male White Female Black Female
2000 4276 5424 3033 4161
2001 4066 5524 2813 4091
2002 3928 5468 2767 4114
2003 3734 518 2638 3887
2004 3448 5079 2432 3643
2005 3366 4983 2375 3545
2006 3276 4994 2313 3477
2007 3236 4845 2223 327
2008 3158 4694 2238 3327
change 234 79 237 164
Heart Disease
Year White Male Black Male White Female Black Female
2000 3393 4298 227 3206
2001 3232 4445 2124 3166
2002 3118 4317 2197 3157
2003 2986 4184 1957 3001
2004 2777 3983 1783 2838
2005 2704 4009 1776 2679
2006 2644 3981 1739 2642
2007 2619 3972 1679 2532
2008 2566 3819 1687 2606
Stroke
Year White Male Black Male White Female Black Female
2000 61 768 561 703 176
2001 575 752 539 681 138
2002 573 806 528 66 15
2003 516 662 498 629 147
2004 463 743 476 562
2005 449 663 429 585
2006 434 63 411 556
2007 415 631 392 494
2008 402 606 392 509
Coronary Heart Disease
Year White Male Black Male White Female Black Female
2000 2625 329 1608 243
2001 2478 3356 1508 2314
2002 2404 3154 1419 2313
2003 2221 3093 1328 209
2004 2067 2956 119 1983
2005 1989 2885 117 1853
2006 1922 2903 1139 1825
2007 1921 2771 1074 1645
2008 1824 2592 1071 1722
Heart Failure
Year White Male Black Male White Female Black Female
2000 255 206 245 17
2001 267 225 225 167
2002 242 238 227 203
2003 256 217 222 189
2004 243 167 214 206
2005 24 218 217 172
2006 255 246 229 202
2007 23 225 208 196
2008 25 216 226 185
Not sure what this data is from previously HD Stroke
Year White Female Black Female White Female Black Female
2000 227 3206 561 703
2001 2124 3166 539 681
2002 2197 3157 528 66
2003 1957 3001 498 629
2004 1783 2838 476 562
2005 1776 2679 429 585
2006 1739 2642 411 556
2007
2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
CVD
Year US Michigan 0-34 35-64 65-84 85+
2000 3397 3694 43 140 16141 86689
2001 3265 3524 508 1348 15291 82889
2002 3174 3421 45 1338 14891 79536
2003 3061 3258 54 1324 14033 75185
2004 2885 3034 41 1242 13209 69088
2005 2773 2972 48 1283 1291 66011
2006 2898 48 1207 12246 6786
2007 2825 5 1206 1182 66153
2008 2791 43 1175 11619 66406
Heart Disease
Year US Michigan 0-34 35-64 65-84 85+
2000 2576 2851 345 1158 1247 64879
2001 2478 2719 416 112 11794 61938
2002 2408 2631 35 1103 11529 58746
2003 2323 2517 45 110 10827 56172
2004 217 2337 313 1048 10086 51609
2005 2111 2308 38 1078 9937 49828
2006 226 384 1019 9413 51918
2007 2216 42 1008 9174 50961
2008 2192 36 982 904 51209
Stroke
Year US Michigan HP 2010 0-34 35-64 65-84 85+
2000 609 603 50 068 174 2589 15841
2001 579 577 50 0638 157 2522 1504
2002 562 571 50 072 169 2397 1528
2003 535 527 50 0737 157 2249 13741
2004 50 496 50 0652 138 220 12629
2005 466 464 50 0553 145 2063 11398
2006 444 50 0734 127 196 11256
2007 425 064 1368 1832 10718
2008 419 047 134 1804 10646
79 27 243 289
Coronary Heart Disease
Year US Michigan HP 2010 0-34 35-64 65-84 85+
2000 1868 2118 162 0613 874 7701 4670
2001 1778 2006 162 0898 818 9012 44369
2002 1709 192 162 0889 799 8759 41061
2003 1628 179 162 0793 785 8018 38358
2004 1502 1656 162 0865 757 7421 34644
2005 1444 1611 162 097 773 7245 32617
2006 1564 162 088 727 6856 33503
2007 1516 117 709 6585 32727
2008 1472 102 657 6403 32504
168 11 283
Heart Failure
Year US Michigan 35-64 65-84 85+
2000 203 245 3047 936 8287
2001 202 237 2596 88 8285
2002 194 233 2648 878 8057
2003 194 233 3176 902 7722
2004 189 224 2709 863 7586
2005 189 224 2955 878 7388
2006 24 2979 884 8354
2007 219 274 828 7483
2008 233 013 333 85 8102
Heart Disease Stroke
Michigan White Michigan Black US White US Black Michigan White Michigan Black US White US Black
1990 334 4315 317 3915 1990 638 733 629 917
1991 3289 4108 3088 3865 1991 626 781 607 894
1992 3126 3987 3011 3777 1992 609 694 598 86
1993 3234 429 3046 3843 1993 614 77 609 866
1994 3134 4156 295 3661 1994 634 875 609 869
1995 3048 4131 2912 3672 1995 638 925 615 879
1996 2997 380 2842 354 1996 617 804 61 852
1997 2851 3683 2764 345 1997 604 77 598 816
1998 2884 3586 2681 3406 1998 598 729 576 803
1999 2781 3692 2634 3367 1999 609 812 598 824
2000 2757 3663 2536 3265 2000 586 737 587 824
2001 261 3695 2435 3169 2001 56 718 558 788
2002 2522 3659 2367 3084 2002 553 729 542 763
2003 2409 350 2282 3002 2003 511 655 514 743
2004 222 3311 2133 2806 2004 477 633 48 699
2005 219 3227 2005 442 616
2006 2144 320 2006 426 589
2007 2007
2008 2008
Stroke
CVD MI US
2000 3694 606 609
2001 3524 584 584
2002 3421 583 572
2003 3258 539 546
2004 3034 519 512
2005 2972 488 48
2006 2898 449 448
2007 2825 43 435
2008 2791 423 421
2009 262 396 396
2010 394 391
2011 387 379
2012 372 369
2013 363 369
2014 377 365
2000 2000 2000
2001 2001 2001
2002 2002 2002
2003 2003 2003
2004 2004 2004
2005 2005 2005
2006 2006 2006
2007 2007 2007
2008 2008 2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
Page 13: Michigan and MOSAIC Data Review...Michigan and MOSAIC Data Review 2017 ANNUAL WORKSHOP 4/26/2017. Adrienne Nickles, MPH. Michigan’s Ongoing Stroke Registry to Accelerate the Improvement

HF_Age

35-64
65-84
85+
Year
Age-Adjusted Rate per 100000
3047
936
8287
2596
88
8285
2648
878
8057
3176
902
7722
2709
863
7586
2955
878
7388
2979
884
8354
274
828
7483
333
85
8102

total

CVD_RG

White Male
Black Male
White Female
Black Female
Year
Age-Adjusted Rate per 100000
4276
5424
3033
4161
4066
5524
2813
4091
3928
5468
2767
4114
3734
518
2638
3887
3448
5079
2432
3643
3366
4983
2375
3545
3276
4994
2313
3477
3236
4845
2223
327
3158
4694
2238
3327

Stroke_RG

White Male
Black Male
White Female
Black Female
Year
Age-Adjusted Rate per 100000
61
768
561
703
575
752
539
681
573
806
528
66
516
662
498
629
463
743
476
562
449
663
429
585
434
63
411
556
415
631
392
494
402
606
392
509

HD_RG

White Male
Black Male
White Female
Black Female
Year
Age-Adjusted Rate per 100000
3393
4298
227
3206
3232
4445
2124
3166
3118
4317
2197
3157
2986
4184
1957
3001
2777
3983
1783
2838
2704
4009
1776
2679
2644
3981
1739
2642
2619
3972
1679
2532
2566
3819
1687
2606

CHD_RG

White Male
Black Male
White Female
Black Female
Year
Age-Adjusted Rate per 100000
2625
329
1608
243
2478
3356
1508
2314
2404
3154
1419
2313
2221
3093
1328
209
2067
2956
119
1983
1989
2885
117
1853
1922
2903
1139
1825
1921
2771
1074
1645
1824
2592
1071
1722

HF_RG

White Male
Black Male
White Female
Black Female
Year
Age-Adjusted Rate per 100000
255
206
245
17
267
225
225
167
242
238
227
203
256
217
222
189
243
167
214
206
24
218
217
172
255
246
229
202
23
225
208
196
25
216
226
185

race_gender

Sheet3

Age-adjusted stroke mortality rates by race and gender Michigan 2000 to 2014

0

10

20

30

40

50

60

70

80

90

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014

Age

-Adj

uste

d R

ate

per 1

000

00

Year

White Male

Black Male

White Female

Black Female

Overall_Rates

CVD
CHD
HD
HF
Stroke
Year
Rate per 10000
3694
2118
2851
245
603
3524
2006
2719
237
577
3421
192
2631
233
571
3258
179
2517
233
527
3034
1656
2337
224
496
2972
1611
2308
224
464
2898
1564
226
24
444
2825
1516
2216
219
425
2791
1472
2192
233
419

CVD_Age

0-34
35-64
65-84
85+
Year
Age-Adjusted Rate per 100000
43
140
16141
86689
508
1348
15291
82889
45
1338
14891
79536
54
1324
14033
75185
41
1242
13209
69088
48
1283
1291
66011
48
1207
12246
6786
5
1206
1182
66153
43
1175
11619
66406

HD_Age

0-34
35-64
65-84
85+
Year
Age-Adjusted Rate per 100000
345
1158
1247
64879
416
112
11794
61938
35
1103
11529
58746
45
110
10827
56172
313
1048
10086
51609
38
1078
9937
49828
384
1019
9413
51918
42
1008
9174
50961
36
982
904
51209

CHD_Age

0-34
35-64
65-84
85+
Year
Age-Adjusted Rate per 100000
0613
874
7701
4670
0898
818
9012
44369
0889
799
8759
41061
0793
785
8018
38358
0865
757
7421
34644
097
773
7245
32617
088
727
6856
33503
117
709
6585
32727
102
657
6403
32504

Stroke_Age

0-34
35-64
65-84
85+
Year
Age-Adjusted Rate per 100000
068
174
2589
15841
0638
157
2522
1504
072
169
2397
1528
0737
157
2249
13741
0652
138
220
12629
0553
145
2063
11398
0734
127
196
11256
064
1368
1832
10718
047
134
1804
10646

HF_Age

35-64
65-84
85+
Year
Age-Adjusted Rate per 100000
3047
936
8287
2596
88
8285
2648
878
8057
3176
902
7722
2709
863
7586
2955
878
7388
2979
884
8354
274
828
7483
333
85
8102

total

CVD_RG

White Male
Black Male
White Female
Black Female
Year
Age-Adjusted Rate per 100000
4276
5424
3033
4161
4066
5524
2813
4091
3928
5468
2767
4114
3734
518
2638
3887
3448
5079
2432
3643
3366
4983
2375
3545
3276
4994
2313
3477
3236
4845
2223
327
3158
4694
2238
3327

Stroke_RG

White Male
Black Male
White Female
Black Female
Year
Age-Adjusted Rate per 100000
61
768
561
703
575
752
539
681
573
806
528
66
516
662
498
629
463
743
476
562
449
663
429
585
434
63
411
556
415
631
392
494
402
606
392
509
375
616
372
464
372
565
366
513
373
548
366
44
348
587
349
477
347
506
34
462
369
506
352
482

HD_RG

White Male
Black Male
White Female
Black Female
Year
Age-Adjusted Rate per 100000
3393
4298
227
3206
3232
4445
2124
3166
3118
4317
2197
3157
2986
4184
1957
3001
2777
3983
1783
2838
2704
4009
1776
2679
2644
3981
1739
2642
2619
3972
1679
2532
2566
3819
1687
2606

CHD_RG

White Male
Black Male
White Female
Black Female
Year
Age-Adjusted Rate per 100000
2625
329
1608
243
2478
3356
1508
2314
2404
3154
1419
2313
2221
3093
1328
209
2067
2956
119
1983
1989
2885
117
1853
1922
2903
1139
1825
1921
2771
1074
1645
1824
2592
1071
1722

HF_RG

White Male
Black Male
White Female
Black Female
Year
Age-Adjusted Rate per 100000
255
206
245
17
267
225
225
167
242
238
227
203
256
217
222
189
243
167
214
206
24
218
217
172
255
246
229
202
23
225
208
196
25
216
226
185

race_gender

Sheet3

Local Health Department data can be found at wwwmichigangovbrfsSource CDC BRFSS

RISK FACTORMI

2011

MI

2013

MI

2014

MI

2015US 2015

2015 NATIONAL RANKING

Current Smoking 233 214 212 207 175 11

Blood Pressure Ever Told High 342 346 NA 331 309 18

Cholesterol Ever Told High 418 406 NA 382 364 12

Overweight (BMIgt25) 342 347 349 351 355 32tied

Obese (BMIgt30) 313 315 307 312 298 16

No Leisure Time Physical Activity 236 244 255 255 262 27

Diabetes 100 104 104 107 100 18tied

Prevalence of CVD Risk Factors Michigan Adults 1990-2015Compared to 2015 National Prevalence

233214 212 207

175

10

15

20

25

30

MI 2011 MI 2013 MI 2014 MI 2015 US 2015

Current Smoking

342 346331

309

20

25

30

35

40

MI 2011 MI 2013 MI 2014 MI 2015 US 2015

Blood Pressure Ever told high

342 347 349 351 355

20

25

30

35

40

MI 2011 MI 2013 MI 2014 MI 2015 US 2015

Overweight (BMIgt25)

313 315 307 312298

20

25

30

35

40

MI 2011 MI 2013 MI 2014 MI 2015 US 2015

Obese (BMIgt30)

418406

382364

30

35

40

45

50

MI 2011 MI 2013 MI 2014 MI 2015 US 2015

Cholesterol Ever told high

10 104 104 10710

0

3

6

9

12

15

MI 2011 MI 2013 MI 2014 MI 2015 US 2015

Diabetes

236 244255 255 262

10

15

20

25

30

MI 2011 MI 2013 MI 2014 MI 2015 US 2015

No Leisure Time Physical Activity

11 1216 18

2732tied

05

101520253035404550

CurrentSmoking

CholesterolEver told high

Obese(BMIgt30)

BloodPressure Ever

told high

Diabetes No LeisureTime Physical

Activity

Overweight(BMIgt25)

2015 NATIONAL RANKING(1st is worst)

18tied

MOSAIC 2015-2020 Focus of Grant Developing Stroke Systems of

Care Community Awareness EMS In-hospital QI Transition of Care Post-Discharge

12

Pre-hospital Care

A V A I L A B L E D A T A

13

EMSMOSAIC Data Linkage

-The MOSAIC Team continues to link data from the Michigan EMS Information System (MiEMSIS) to MOSAIC Data- Reports have been created for and reviewed by the

Tri-County Area MCA and Detroit East MCA- This work will expand to other MCA regions that

serve hospitals participating in MOSAIC

GWTG Special Initiatives Tab

-A free tab that can be enabled in GWTG-The purpose of the tab is to collect data concerning patient hand-off from EMS

MOSAIC Participating Hospitals

Aspirus Keweenaw Hospital (Laurium)

Aspirus Grand View HospitalAspirus Iron River HospitalAspirus Ontonagon HospitalBixby Medical CenterBronson Methodist HospitalCovenant Health CareDetroit Receiving HospitalGenesys Regional Medical CenterHenry Ford Hospital Herrick Medical CenterHuron Valley-Sinai HospitalLakeland Regional Medical Center McLaren Bay Regional Medical CenterMcLaren Greater Medical Center

McLaren Macomb HospitalMcLaren Northern MI HospitalMcLaren Oakland Medical CenterMcLaren Port Huron HospitalMcLaren Regional Medical CenterMercy Health Saint Maryrsquos HospitalMetro Health HospitalMunson Medical Center

ProMedica Monroe Regional HospitalSparrow HospitalSt Joseph Mercy - Ann ArborSt Joseph Mercy ChelseaSt Joseph Mercy Livingston HospitalSt Mary MercySt Mary of Michigan HospitalU of M Hospital

Hospital Infrastructure19

Among all participating hospitals the average number of

Licensed beds was 374 (range 25 to 1059 beds)

Inpatient discharges was 17076 (range 1064 to 48916 patients)

Acute stroke discharges (primary diagnosis only) was 417 (range 34 to 982 patients)

Case Demographics MOSAIC Registry

VariablesN() or statistics(Total N=68906)

Age at admission (years)Median 710Range 180 - 1060Mean (SE) 697(01)

GenderMale 32886 (477)Female 36015 (523)

RaceAfrican American 9900 (197)AIAN 132 (03)Asian 320 (06)More than one race 44 (01)Unknown 3679 (73)White 36190 (720)Missing 70

EthnicityHispanic or Latino 804 (16)Others 49531 (984)

VariablesN() or statistics(Total N=68906)

Health insuranceMedicaid 2284 (45)MedicaidPrivate 211 (04)Medicare 16863 (336)Medicare Medicaid 2313 (46)

MedicareMedicaidPrivate125 (02)

MedicarePrivate 13640 (272)ND 268(05)No insurance 2123 (42)Private 12356 (246)

Arrival modeEMS 21052 (429)Private

transportationother19313 (393)

Transfer from another hospital

7733(157)

ND or unknown 1021 (21)Missing 1216

Who receives data reports on your stroke quality of care

21

7055

70

10085

65

40

Hos

pita

lC

EO

up

per

man

agem

ent

Hos

pita

lB

oard

Chi

efN

ursi

ngO

ffice

r(C

NO

)

Str

oke

Tea

m

Phy

sici

anS

trok

eC

ham

pion

Chi

ef o

fM

edic

ine

Oth

er

Data Use

1) In the most recent calendar year have you run additional analyses (beyond what was required for reporting) on your hospitalrsquos own stroke data

2)How frequently have you run and used the analyses generated

22

Yes (N=16) 80

No (N=4) 20Weekly (N=2) 125

Monthly (N=8) 500

Less than monthly but more

than 1-2 times(N=6) 375

Data Use

What is the main reason you do not run your own additional analyses (Select one best answer)

23

Not sure how to run analyses

25

Not sure what analyses are needed would be helpful 25

Other 50

Data Use

In the most recent calendar year what reports did you run

24

813 688

Pre-programmedautomated reports in thedata collection tool (eg GWTG)

Additional reports beyond pre-programmed reports from the tool

Data Use

How do you use these analyses reports

25

813 688375

Inform quality improvement (QI) efforts andor plan

ldquoaction itemsrdquo

Report to management administration on our

progress

Other

Data Use

If you run additional analysis what action items QI efforts did you plan as a result of these reports

26

o Discharge education intensive statin use

o Door to tPA time and dysphagia

o Review data between spoke amp hub hospitals regarding transfers IV-tPA administration Mechanical thrombectomy and SAH

o QI efforts were addressed in the department involving calling Stroke Alert on call for cases with FAST symptoms

o ED Medical Director works with team to fix fallouts and problematic areas We have seen improvement

o Process changes (ie fallout emails to RN manager) physician querieso Increased documentation of NIHSS ownership from individual units regarding stroke quality

improvement goalso Daily dysphagia screening determination of whowhat team responsible for documenting initial NIHSS

looking at patients beyond 2h LKW arrival

Hospital Arrival Mode Door-to Needle and Pre-Notification

Reports 2016

Percent of Cases Who Arrived via EMSMOSAIC 2009-2016

Table 1 Arrival Mode among Stroke Cases by Demographics MOSAIC 2016

Demographics N=3496 550 N=2938 450Stroke Type Ischemic 2558 542 2164 458 Hemorrhagic 560 728 209 272 TIA 378 478 413 522Age Group lt 50 Years 233 433 305 567 50-79 Years 1982 497 2008 503 ge 80 Years 1379 688 625 312Sex Female 1933 576 1422 424 Male 1661 523 1516 477Race Black 659 530 584 470 White 2824 557 2248 443 Other Missing 111 512 106 488

MOSAIC AggregateArrival Mode

EMS Private Mode

Table 2 Door-to-Needle Times by Arrival Mode among Stroke Cases MOSAIC 2016

Time Elements (in Minutes)Number of

Patients Mean (Minutes) Median

(Minutes)Range

(Minutes)Door-to-Image 4901 575 400 00-2700 Arrived via EMS 2767 463 270 00-2700 Arrived via Private Transportation 2134 720 570 00-2620

Door-to-Image (among t-PA treated) 492 155 130 00-970 Arrived via EMS 370 125 110 00-840 Arrived via Private Transportation 122 243 215 20-970Image-to Needle 492 500 450 70-2090 Arrived via EMS 370 503 460 70-2090 Arrived via Private Transportation 122 483 420 90-1770Door-to Needle 492 655 570 200-2180 Arrived via EMS 370 629 560 200-2180 Arrived via Private Transportation 122 726 650 290-2060Included ischemic or hemorrhagic cases with times that were less or equal to 270 minutes (45 hours)Transferred cases were excluded

MOSAIC Aggregate

Table 3 Pre-Notification among Stroke Cases Who Arrived Via EMS by Demographics MOSAIC 2016

Demographics N=2015 584 N=1437 416Stroke Type Ischemic 1523 622 924 378 Hemorrhagic 306 566 235 434 TIA 142 381 231 619Age Group lt 50 Years 133 607 86 393 50-79 Years 1105 585 784 415 ge 80 Years 777 578 567 422Sex Female 1075 578 786 422 Male 940 591 651 409Race Black 307 517 287 483 White 1657 602 1097 398 Other 51 490 53 510

All HospitalsPre-Notification

Yes No

MOSAIC Transitions of Care Project

Post-discharge data collection tool is being implemented into Outcome Science as a tab

Post-Discharge amp Transition of Care

Reporting on changes within 30 days of discharge from hospital via follow-up callschart review Interval events Physician follow-up visits Lifestyle changes Lab assessments Medication managementadherence Rehab amp Functional outcomes Falls

MOSAIC Website

wwwMichigangovstroke

Adrienne Nickles MPHnicklesamichigangov

Thank You

  • Michigan and MOSAIC Data Review
  • Overview
  • Age-adjusted Stroke Hospitalization Rates Michigan 2000-2015
  • Slide Number 4
  • Age-adjusted Stroke Mortality Rates Michigan 2000-2014
  • Slide Number 6
  • Slide Number 7
  • Slide Number 8
  • Slide Number 9
  • Slide Number 10
  • Slide Number 11
  • MOSAIC 2015-2020
  • Pre-hospital Care
  • EMSMOSAIC Data Linkage
  • Slide Number 15
  • GWTG Special Initiatives Tab
  • Slide Number 17
  • MOSAIC Participating Hospitals
  • Hospital Infrastructure
  • Case Demographics MOSAIC Registry
  • Who receives data reports on your stroke quality of care
  • 1) In the most recent calendar year have you run additional analyses (beyond what was required for reporting) on your hospitalrsquos own stroke data 2)How frequently have you run and used the analyses generated
  • What is the main reason you do not run your own additional analyses (Select one best answer)
  • In the most recent calendar year what reports did you run
  • How do you use these analyses reports
  • If you run additional analysis what action items QI efforts did you plan as a result of these reports
  • Hospital Arrival Mode Door-to Needle and Pre-Notification Reports 2016
  • Percent of Cases Who Arrived via EMSMOSAIC 2009-2016
  • Table 1 Arrival Mode among Stroke Cases by Demographics MOSAIC 2016
  • Table 2 Door-to-Needle Times by Arrival Mode among Stroke Cases MOSAIC 2016
  • Table 3 Pre-Notification among Stroke Cases Who Arrived Via EMS by Demographics MOSAIC 2016
  • MOSAIC Transitions of Care Project
  • Slide Number 33
  • MOSAIC Website
  • Adrienne Nickles MPHnicklesamichigangov
CVD
Year White Male Black Male White Female Black Female
2000 4276 5424 3033 4161
2001 4066 5524 2813 4091
2002 3928 5468 2767 4114
2003 3734 518 2638 3887
2004 3448 5079 2432 3643
2005 3366 4983 2375 3545
2006 3276 4994 2313 3477
2007 3236 4845 2223 327
2008 3158 4694 2238 3327
change 234 79 237 164
Heart Disease
Year White Male Black Male White Female Black Female
2000 3393 4298 227 3206
2001 3232 4445 2124 3166
2002 3118 4317 2197 3157
2003 2986 4184 1957 3001
2004 2777 3983 1783 2838
2005 2704 4009 1776 2679
2006 2644 3981 1739 2642
2007 2619 3972 1679 2532
2008 2566 3819 1687 2606
Stroke
Year White Male Black Male White Female Black Female
2000 61 768 561 703 176
2001 575 752 539 681 138
2002 573 806 528 66 15
2003 516 662 498 629 147
2004 463 743 476 562
2005 449 663 429 585
2006 434 63 411 556
2007 415 631 392 494
2008 402 606 392 509
2009 375 616 372 464
2010 372 565 366 513
2011 373 548 366 44
2012 348 587 349 477
2013 347 506 34 462
2014 369 506 352 482
Coronary Heart Disease
Year White Male Black Male White Female Black Female
2000 2625 329 1608 243
2001 2478 3356 1508 2314
2002 2404 3154 1419 2313
2003 2221 3093 1328 209
2004 2067 2956 119 1983
2005 1989 2885 117 1853
2006 1922 2903 1139 1825
2007 1921 2771 1074 1645
2008 1824 2592 1071 1722
Heart Failure
Year White Male Black Male White Female Black Female
2000 255 206 245 17
2001 267 225 225 167
2002 242 238 227 203
2003 256 217 222 189
2004 243 167 214 206
2005 24 218 217 172
2006 255 246 229 202
2007 23 225 208 196
2008 25 216 226 185
Not sure what this data is from previously HD Stroke
Year White Female Black Female White Female Black Female
2000 227 3206 561 703
2001 2124 3166 539 681
2002 2197 3157 528 66
2003 1957 3001 498 629
2004 1783 2838 476 562
2005 1776 2679 429 585
2006 1739 2642 411 556
2007
2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2009 2009 2009 2009
2010 2010 2010 2010
2011 2011 2011 2011
2012 2012 2012 2012
2013 2013 2013 2013
2014 2014 2014 2014
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
CVD
Year US Michigan 0-34 35-64 65-84 85+
2000 3397 3694 43 140 16141 86689
2001 3265 3524 508 1348 15291 82889
2002 3174 3421 45 1338 14891 79536
2003 3061 3258 54 1324 14033 75185
2004 2885 3034 41 1242 13209 69088
2005 2773 2972 48 1283 1291 66011
2006 2898 48 1207 12246 6786
2007 2825 5 1206 1182 66153
2008 2791 43 1175 11619 66406
Heart Disease
Year US Michigan 0-34 35-64 65-84 85+
2000 2576 2851 345 1158 1247 64879
2001 2478 2719 416 112 11794 61938
2002 2408 2631 35 1103 11529 58746
2003 2323 2517 45 110 10827 56172
2004 217 2337 313 1048 10086 51609
2005 2111 2308 38 1078 9937 49828
2006 226 384 1019 9413 51918
2007 2216 42 1008 9174 50961
2008 2192 36 982 904 51209
Stroke
Year US Michigan HP 2010 0-34 35-64 65-84 85+
2000 609 603 50 068 174 2589 15841
2001 579 577 50 0638 157 2522 1504
2002 562 571 50 072 169 2397 1528
2003 535 527 50 0737 157 2249 13741
2004 50 496 50 0652 138 220 12629
2005 466 464 50 0553 145 2063 11398
2006 444 50 0734 127 196 11256
2007 425 064 1368 1832 10718
2008 419 047 134 1804 10646
79 27 243 289
Coronary Heart Disease
Year US Michigan HP 2010 0-34 35-64 65-84 85+
2000 1868 2118 162 0613 874 7701 4670
2001 1778 2006 162 0898 818 9012 44369
2002 1709 192 162 0889 799 8759 41061
2003 1628 179 162 0793 785 8018 38358
2004 1502 1656 162 0865 757 7421 34644
2005 1444 1611 162 097 773 7245 32617
2006 1564 162 088 727 6856 33503
2007 1516 117 709 6585 32727
2008 1472 102 657 6403 32504
168 11 283
Heart Failure
Year US Michigan 35-64 65-84 85+
2000 203 245 3047 936 8287
2001 202 237 2596 88 8285
2002 194 233 2648 878 8057
2003 194 233 3176 902 7722
2004 189 224 2709 863 7586
2005 189 224 2955 878 7388
2006 24 2979 884 8354
2007 219 274 828 7483
2008 233 013 333 85 8102
Heart Disease Stroke
Michigan White Michigan Black US White US Black Michigan White Michigan Black US White US Black
1990 334 4315 317 3915 1990 638 733 629 917
1991 3289 4108 3088 3865 1991 626 781 607 894
1992 3126 3987 3011 3777 1992 609 694 598 86
1993 3234 429 3046 3843 1993 614 77 609 866
1994 3134 4156 295 3661 1994 634 875 609 869
1995 3048 4131 2912 3672 1995 638 925 615 879
1996 2997 380 2842 354 1996 617 804 61 852
1997 2851 3683 2764 345 1997 604 77 598 816
1998 2884 3586 2681 3406 1998 598 729 576 803
1999 2781 3692 2634 3367 1999 609 812 598 824
2000 2757 3663 2536 3265 2000 586 737 587 824
2001 261 3695 2435 3169 2001 56 718 558 788
2002 2522 3659 2367 3084 2002 553 729 542 763
2003 2409 350 2282 3002 2003 511 655 514 743
2004 222 3311 2133 2806 2004 477 633 48 699
2005 219 3227 2005 442 616
2006 2144 320 2006 426 589
2007 2007
2008 2008
CVD CHD HD HF Stroke
2000 3694 2118 2851 245 603
2001 3524 2006 2719 237 577
2002 3421 192 2631 233 571
2003 3258 179 2517 233 527
2004 3034 1656 2337 224 496
2005 2972 1611 2308 224 464
2006 2898 1564 226 24 444
2007 2825 1516 2216 219 425
2008 2791 1472 2192 233 419
2000 2000 2000
2001 2001 2001
2002 2002 2002
2003 2003 2003
2004 2004 2004
2005 2005 2005
2006 2006 2006
2007 2007 2007
2008 2008 2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2000 2000 2000 2000 2000
2001 2001 2001 2001 2001
2002 2002 2002 2002 2002
2003 2003 2003 2003 2003
2004 2004 2004 2004 2004
2005 2005 2005 2005 2005
2006 2006 2006 2006 2006
2007 2007 2007 2007 2007
2008 2008 2008 2008 2008
CVD
Year White Male Black Male White Female Black Female
2000 4276 5424 3033 4161
2001 4066 5524 2813 4091
2002 3928 5468 2767 4114
2003 3734 518 2638 3887
2004 3448 5079 2432 3643
2005 3366 4983 2375 3545
2006 3276 4994 2313 3477
2007 3236 4845 2223 327
2008 3158 4694 2238 3327
change 234 79 237 164
Heart Disease
Year White Male Black Male White Female Black Female
2000 3393 4298 227 3206
2001 3232 4445 2124 3166
2002 3118 4317 2197 3157
2003 2986 4184 1957 3001
2004 2777 3983 1783 2838
2005 2704 4009 1776 2679
2006 2644 3981 1739 2642
2007 2619 3972 1679 2532
2008 2566 3819 1687 2606
Stroke
Year White Male Black Male White Female Black Female
2000 61 768 561 703 176
2001 575 752 539 681 138
2002 573 806 528 66 15
2003 516 662 498 629 147
2004 463 743 476 562
2005 449 663 429 585
2006 434 63 411 556
2007 415 631 392 494
2008 402 606 392 509
Coronary Heart Disease
Year White Male Black Male White Female Black Female
2000 2625 329 1608 243
2001 2478 3356 1508 2314
2002 2404 3154 1419 2313
2003 2221 3093 1328 209
2004 2067 2956 119 1983
2005 1989 2885 117 1853
2006 1922 2903 1139 1825
2007 1921 2771 1074 1645
2008 1824 2592 1071 1722
Heart Failure
Year White Male Black Male White Female Black Female
2000 255 206 245 17
2001 267 225 225 167
2002 242 238 227 203
2003 256 217 222 189
2004 243 167 214 206
2005 24 218 217 172
2006 255 246 229 202
2007 23 225 208 196
2008 25 216 226 185
Not sure what this data is from previously HD Stroke
Year White Female Black Female White Female Black Female
2000 227 3206 561 703
2001 2124 3166 539 681
2002 2197 3157 528 66
2003 1957 3001 498 629
2004 1783 2838 476 562
2005 1776 2679 429 585
2006 1739 2642 411 556
2007
2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
CVD
Year US Michigan 0-34 35-64 65-84 85+
2000 3397 3694 43 140 16141 86689
2001 3265 3524 508 1348 15291 82889
2002 3174 3421 45 1338 14891 79536
2003 3061 3258 54 1324 14033 75185
2004 2885 3034 41 1242 13209 69088
2005 2773 2972 48 1283 1291 66011
2006 2898 48 1207 12246 6786
2007 2825 5 1206 1182 66153
2008 2791 43 1175 11619 66406
Heart Disease
Year US Michigan 0-34 35-64 65-84 85+
2000 2576 2851 345 1158 1247 64879
2001 2478 2719 416 112 11794 61938
2002 2408 2631 35 1103 11529 58746
2003 2323 2517 45 110 10827 56172
2004 217 2337 313 1048 10086 51609
2005 2111 2308 38 1078 9937 49828
2006 226 384 1019 9413 51918
2007 2216 42 1008 9174 50961
2008 2192 36 982 904 51209
Stroke
Year US Michigan HP 2010 0-34 35-64 65-84 85+
2000 609 603 50 068 174 2589 15841
2001 579 577 50 0638 157 2522 1504
2002 562 571 50 072 169 2397 1528
2003 535 527 50 0737 157 2249 13741
2004 50 496 50 0652 138 220 12629
2005 466 464 50 0553 145 2063 11398
2006 444 50 0734 127 196 11256
2007 425 064 1368 1832 10718
2008 419 047 134 1804 10646
79 27 243 289
Coronary Heart Disease
Year US Michigan HP 2010 0-34 35-64 65-84 85+
2000 1868 2118 162 0613 874 7701 4670
2001 1778 2006 162 0898 818 9012 44369
2002 1709 192 162 0889 799 8759 41061
2003 1628 179 162 0793 785 8018 38358
2004 1502 1656 162 0865 757 7421 34644
2005 1444 1611 162 097 773 7245 32617
2006 1564 162 088 727 6856 33503
2007 1516 117 709 6585 32727
2008 1472 102 657 6403 32504
168 11 283
Heart Failure
Year US Michigan 35-64 65-84 85+
2000 203 245 3047 936 8287
2001 202 237 2596 88 8285
2002 194 233 2648 878 8057
2003 194 233 3176 902 7722
2004 189 224 2709 863 7586
2005 189 224 2955 878 7388
2006 24 2979 884 8354
2007 219 274 828 7483
2008 233 013 333 85 8102
Heart Disease Stroke
Michigan White Michigan Black US White US Black Michigan White Michigan Black US White US Black
1990 334 4315 317 3915 1990 638 733 629 917
1991 3289 4108 3088 3865 1991 626 781 607 894
1992 3126 3987 3011 3777 1992 609 694 598 86
1993 3234 429 3046 3843 1993 614 77 609 866
1994 3134 4156 295 3661 1994 634 875 609 869
1995 3048 4131 2912 3672 1995 638 925 615 879
1996 2997 380 2842 354 1996 617 804 61 852
1997 2851 3683 2764 345 1997 604 77 598 816
1998 2884 3586 2681 3406 1998 598 729 576 803
1999 2781 3692 2634 3367 1999 609 812 598 824
2000 2757 3663 2536 3265 2000 586 737 587 824
2001 261 3695 2435 3169 2001 56 718 558 788
2002 2522 3659 2367 3084 2002 553 729 542 763
2003 2409 350 2282 3002 2003 511 655 514 743
2004 222 3311 2133 2806 2004 477 633 48 699
2005 219 3227 2005 442 616
2006 2144 320 2006 426 589
2007 2007
2008 2008
Stroke
CVD MI US
2000 3694 606 609
2001 3524 584 584
2002 3421 583 572
2003 3258 539 546
2004 3034 519 512
2005 2972 488 48
2006 2898 449 448
2007 2825 43 435
2008 2791 423 421
2009 262 396 396
2010 394 391
2011 387 379
2012 372 369
2013 363 369
2014 377 365
2000 2000 2000
2001 2001 2001
2002 2002 2002
2003 2003 2003
2004 2004 2004
2005 2005 2005
2006 2006 2006
2007 2007 2007
2008 2008 2008
Page 14: Michigan and MOSAIC Data Review...Michigan and MOSAIC Data Review 2017 ANNUAL WORKSHOP 4/26/2017. Adrienne Nickles, MPH. Michigan’s Ongoing Stroke Registry to Accelerate the Improvement

total

CVD_RG

White Male
Black Male
White Female
Black Female
Year
Age-Adjusted Rate per 100000
4276
5424
3033
4161
4066
5524
2813
4091
3928
5468
2767
4114
3734
518
2638
3887
3448
5079
2432
3643
3366
4983
2375
3545
3276
4994
2313
3477
3236
4845
2223
327
3158
4694
2238
3327

Stroke_RG

White Male
Black Male
White Female
Black Female
Year
Age-Adjusted Rate per 100000
61
768
561
703
575
752
539
681
573
806
528
66
516
662
498
629
463
743
476
562
449
663
429
585
434
63
411
556
415
631
392
494
402
606
392
509

HD_RG

White Male
Black Male
White Female
Black Female
Year
Age-Adjusted Rate per 100000
3393
4298
227
3206
3232
4445
2124
3166
3118
4317
2197
3157
2986
4184
1957
3001
2777
3983
1783
2838
2704
4009
1776
2679
2644
3981
1739
2642
2619
3972
1679
2532
2566
3819
1687
2606

CHD_RG

White Male
Black Male
White Female
Black Female
Year
Age-Adjusted Rate per 100000
2625
329
1608
243
2478
3356
1508
2314
2404
3154
1419
2313
2221
3093
1328
209
2067
2956
119
1983
1989
2885
117
1853
1922
2903
1139
1825
1921
2771
1074
1645
1824
2592
1071
1722

HF_RG

White Male
Black Male
White Female
Black Female
Year
Age-Adjusted Rate per 100000
255
206
245
17
267
225
225
167
242
238
227
203
256
217
222
189
243
167
214
206
24
218
217
172
255
246
229
202
23
225
208
196
25
216
226
185

race_gender

Sheet3

Age-adjusted stroke mortality rates by race and gender Michigan 2000 to 2014

0

10

20

30

40

50

60

70

80

90

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014

Age

-Adj

uste

d R

ate

per 1

000

00

Year

White Male

Black Male

White Female

Black Female

Overall_Rates

CVD
CHD
HD
HF
Stroke
Year
Rate per 10000
3694
2118
2851
245
603
3524
2006
2719
237
577
3421
192
2631
233
571
3258
179
2517
233
527
3034
1656
2337
224
496
2972
1611
2308
224
464
2898
1564
226
24
444
2825
1516
2216
219
425
2791
1472
2192
233
419

CVD_Age

0-34
35-64
65-84
85+
Year
Age-Adjusted Rate per 100000
43
140
16141
86689
508
1348
15291
82889
45
1338
14891
79536
54
1324
14033
75185
41
1242
13209
69088
48
1283
1291
66011
48
1207
12246
6786
5
1206
1182
66153
43
1175
11619
66406

HD_Age

0-34
35-64
65-84
85+
Year
Age-Adjusted Rate per 100000
345
1158
1247
64879
416
112
11794
61938
35
1103
11529
58746
45
110
10827
56172
313
1048
10086
51609
38
1078
9937
49828
384
1019
9413
51918
42
1008
9174
50961
36
982
904
51209

CHD_Age

0-34
35-64
65-84
85+
Year
Age-Adjusted Rate per 100000
0613
874
7701
4670
0898
818
9012
44369
0889
799
8759
41061
0793
785
8018
38358
0865
757
7421
34644
097
773
7245
32617
088
727
6856
33503
117
709
6585
32727
102
657
6403
32504

Stroke_Age

0-34
35-64
65-84
85+
Year
Age-Adjusted Rate per 100000
068
174
2589
15841
0638
157
2522
1504
072
169
2397
1528
0737
157
2249
13741
0652
138
220
12629
0553
145
2063
11398
0734
127
196
11256
064
1368
1832
10718
047
134
1804
10646

HF_Age

35-64
65-84
85+
Year
Age-Adjusted Rate per 100000
3047
936
8287
2596
88
8285
2648
878
8057
3176
902
7722
2709
863
7586
2955
878
7388
2979
884
8354
274
828
7483
333
85
8102

total

CVD_RG

White Male
Black Male
White Female
Black Female
Year
Age-Adjusted Rate per 100000
4276
5424
3033
4161
4066
5524
2813
4091
3928
5468
2767
4114
3734
518
2638
3887
3448
5079
2432
3643
3366
4983
2375
3545
3276
4994
2313
3477
3236
4845
2223
327
3158
4694
2238
3327

Stroke_RG

White Male
Black Male
White Female
Black Female
Year
Age-Adjusted Rate per 100000
61
768
561
703
575
752
539
681
573
806
528
66
516
662
498
629
463
743
476
562
449
663
429
585
434
63
411
556
415
631
392
494
402
606
392
509
375
616
372
464
372
565
366
513
373
548
366
44
348
587
349
477
347
506
34
462
369
506
352
482

HD_RG

White Male
Black Male
White Female
Black Female
Year
Age-Adjusted Rate per 100000
3393
4298
227
3206
3232
4445
2124
3166
3118
4317
2197
3157
2986
4184
1957
3001
2777
3983
1783
2838
2704
4009
1776
2679
2644
3981
1739
2642
2619
3972
1679
2532
2566
3819
1687
2606

CHD_RG

White Male
Black Male
White Female
Black Female
Year
Age-Adjusted Rate per 100000
2625
329
1608
243
2478
3356
1508
2314
2404
3154
1419
2313
2221
3093
1328
209
2067
2956
119
1983
1989
2885
117
1853
1922
2903
1139
1825
1921
2771
1074
1645
1824
2592
1071
1722

HF_RG

White Male
Black Male
White Female
Black Female
Year
Age-Adjusted Rate per 100000
255
206
245
17
267
225
225
167
242
238
227
203
256
217
222
189
243
167
214
206
24
218
217
172
255
246
229
202
23
225
208
196
25
216
226
185

race_gender

Sheet3

Local Health Department data can be found at wwwmichigangovbrfsSource CDC BRFSS

RISK FACTORMI

2011

MI

2013

MI

2014

MI

2015US 2015

2015 NATIONAL RANKING

Current Smoking 233 214 212 207 175 11

Blood Pressure Ever Told High 342 346 NA 331 309 18

Cholesterol Ever Told High 418 406 NA 382 364 12

Overweight (BMIgt25) 342 347 349 351 355 32tied

Obese (BMIgt30) 313 315 307 312 298 16

No Leisure Time Physical Activity 236 244 255 255 262 27

Diabetes 100 104 104 107 100 18tied

Prevalence of CVD Risk Factors Michigan Adults 1990-2015Compared to 2015 National Prevalence

233214 212 207

175

10

15

20

25

30

MI 2011 MI 2013 MI 2014 MI 2015 US 2015

Current Smoking

342 346331

309

20

25

30

35

40

MI 2011 MI 2013 MI 2014 MI 2015 US 2015

Blood Pressure Ever told high

342 347 349 351 355

20

25

30

35

40

MI 2011 MI 2013 MI 2014 MI 2015 US 2015

Overweight (BMIgt25)

313 315 307 312298

20

25

30

35

40

MI 2011 MI 2013 MI 2014 MI 2015 US 2015

Obese (BMIgt30)

418406

382364

30

35

40

45

50

MI 2011 MI 2013 MI 2014 MI 2015 US 2015

Cholesterol Ever told high

10 104 104 10710

0

3

6

9

12

15

MI 2011 MI 2013 MI 2014 MI 2015 US 2015

Diabetes

236 244255 255 262

10

15

20

25

30

MI 2011 MI 2013 MI 2014 MI 2015 US 2015

No Leisure Time Physical Activity

11 1216 18

2732tied

05

101520253035404550

CurrentSmoking

CholesterolEver told high

Obese(BMIgt30)

BloodPressure Ever

told high

Diabetes No LeisureTime Physical

Activity

Overweight(BMIgt25)

2015 NATIONAL RANKING(1st is worst)

18tied

MOSAIC 2015-2020 Focus of Grant Developing Stroke Systems of

Care Community Awareness EMS In-hospital QI Transition of Care Post-Discharge

12

Pre-hospital Care

A V A I L A B L E D A T A

13

EMSMOSAIC Data Linkage

-The MOSAIC Team continues to link data from the Michigan EMS Information System (MiEMSIS) to MOSAIC Data- Reports have been created for and reviewed by the

Tri-County Area MCA and Detroit East MCA- This work will expand to other MCA regions that

serve hospitals participating in MOSAIC

GWTG Special Initiatives Tab

-A free tab that can be enabled in GWTG-The purpose of the tab is to collect data concerning patient hand-off from EMS

MOSAIC Participating Hospitals

Aspirus Keweenaw Hospital (Laurium)

Aspirus Grand View HospitalAspirus Iron River HospitalAspirus Ontonagon HospitalBixby Medical CenterBronson Methodist HospitalCovenant Health CareDetroit Receiving HospitalGenesys Regional Medical CenterHenry Ford Hospital Herrick Medical CenterHuron Valley-Sinai HospitalLakeland Regional Medical Center McLaren Bay Regional Medical CenterMcLaren Greater Medical Center

McLaren Macomb HospitalMcLaren Northern MI HospitalMcLaren Oakland Medical CenterMcLaren Port Huron HospitalMcLaren Regional Medical CenterMercy Health Saint Maryrsquos HospitalMetro Health HospitalMunson Medical Center

ProMedica Monroe Regional HospitalSparrow HospitalSt Joseph Mercy - Ann ArborSt Joseph Mercy ChelseaSt Joseph Mercy Livingston HospitalSt Mary MercySt Mary of Michigan HospitalU of M Hospital

Hospital Infrastructure19

Among all participating hospitals the average number of

Licensed beds was 374 (range 25 to 1059 beds)

Inpatient discharges was 17076 (range 1064 to 48916 patients)

Acute stroke discharges (primary diagnosis only) was 417 (range 34 to 982 patients)

Case Demographics MOSAIC Registry

VariablesN() or statistics(Total N=68906)

Age at admission (years)Median 710Range 180 - 1060Mean (SE) 697(01)

GenderMale 32886 (477)Female 36015 (523)

RaceAfrican American 9900 (197)AIAN 132 (03)Asian 320 (06)More than one race 44 (01)Unknown 3679 (73)White 36190 (720)Missing 70

EthnicityHispanic or Latino 804 (16)Others 49531 (984)

VariablesN() or statistics(Total N=68906)

Health insuranceMedicaid 2284 (45)MedicaidPrivate 211 (04)Medicare 16863 (336)Medicare Medicaid 2313 (46)

MedicareMedicaidPrivate125 (02)

MedicarePrivate 13640 (272)ND 268(05)No insurance 2123 (42)Private 12356 (246)

Arrival modeEMS 21052 (429)Private

transportationother19313 (393)

Transfer from another hospital

7733(157)

ND or unknown 1021 (21)Missing 1216

Who receives data reports on your stroke quality of care

21

7055

70

10085

65

40

Hos

pita

lC

EO

up

per

man

agem

ent

Hos

pita

lB

oard

Chi

efN

ursi

ngO

ffice

r(C

NO

)

Str

oke

Tea

m

Phy

sici

anS

trok

eC

ham

pion

Chi

ef o

fM

edic

ine

Oth

er

Data Use

1) In the most recent calendar year have you run additional analyses (beyond what was required for reporting) on your hospitalrsquos own stroke data

2)How frequently have you run and used the analyses generated

22

Yes (N=16) 80

No (N=4) 20Weekly (N=2) 125

Monthly (N=8) 500

Less than monthly but more

than 1-2 times(N=6) 375

Data Use

What is the main reason you do not run your own additional analyses (Select one best answer)

23

Not sure how to run analyses

25

Not sure what analyses are needed would be helpful 25

Other 50

Data Use

In the most recent calendar year what reports did you run

24

813 688

Pre-programmedautomated reports in thedata collection tool (eg GWTG)

Additional reports beyond pre-programmed reports from the tool

Data Use

How do you use these analyses reports

25

813 688375

Inform quality improvement (QI) efforts andor plan

ldquoaction itemsrdquo

Report to management administration on our

progress

Other

Data Use

If you run additional analysis what action items QI efforts did you plan as a result of these reports

26

o Discharge education intensive statin use

o Door to tPA time and dysphagia

o Review data between spoke amp hub hospitals regarding transfers IV-tPA administration Mechanical thrombectomy and SAH

o QI efforts were addressed in the department involving calling Stroke Alert on call for cases with FAST symptoms

o ED Medical Director works with team to fix fallouts and problematic areas We have seen improvement

o Process changes (ie fallout emails to RN manager) physician querieso Increased documentation of NIHSS ownership from individual units regarding stroke quality

improvement goalso Daily dysphagia screening determination of whowhat team responsible for documenting initial NIHSS

looking at patients beyond 2h LKW arrival

Hospital Arrival Mode Door-to Needle and Pre-Notification

Reports 2016

Percent of Cases Who Arrived via EMSMOSAIC 2009-2016

Table 1 Arrival Mode among Stroke Cases by Demographics MOSAIC 2016

Demographics N=3496 550 N=2938 450Stroke Type Ischemic 2558 542 2164 458 Hemorrhagic 560 728 209 272 TIA 378 478 413 522Age Group lt 50 Years 233 433 305 567 50-79 Years 1982 497 2008 503 ge 80 Years 1379 688 625 312Sex Female 1933 576 1422 424 Male 1661 523 1516 477Race Black 659 530 584 470 White 2824 557 2248 443 Other Missing 111 512 106 488

MOSAIC AggregateArrival Mode

EMS Private Mode

Table 2 Door-to-Needle Times by Arrival Mode among Stroke Cases MOSAIC 2016

Time Elements (in Minutes)Number of

Patients Mean (Minutes) Median

(Minutes)Range

(Minutes)Door-to-Image 4901 575 400 00-2700 Arrived via EMS 2767 463 270 00-2700 Arrived via Private Transportation 2134 720 570 00-2620

Door-to-Image (among t-PA treated) 492 155 130 00-970 Arrived via EMS 370 125 110 00-840 Arrived via Private Transportation 122 243 215 20-970Image-to Needle 492 500 450 70-2090 Arrived via EMS 370 503 460 70-2090 Arrived via Private Transportation 122 483 420 90-1770Door-to Needle 492 655 570 200-2180 Arrived via EMS 370 629 560 200-2180 Arrived via Private Transportation 122 726 650 290-2060Included ischemic or hemorrhagic cases with times that were less or equal to 270 minutes (45 hours)Transferred cases were excluded

MOSAIC Aggregate

Table 3 Pre-Notification among Stroke Cases Who Arrived Via EMS by Demographics MOSAIC 2016

Demographics N=2015 584 N=1437 416Stroke Type Ischemic 1523 622 924 378 Hemorrhagic 306 566 235 434 TIA 142 381 231 619Age Group lt 50 Years 133 607 86 393 50-79 Years 1105 585 784 415 ge 80 Years 777 578 567 422Sex Female 1075 578 786 422 Male 940 591 651 409Race Black 307 517 287 483 White 1657 602 1097 398 Other 51 490 53 510

All HospitalsPre-Notification

Yes No

MOSAIC Transitions of Care Project

Post-discharge data collection tool is being implemented into Outcome Science as a tab

Post-Discharge amp Transition of Care

Reporting on changes within 30 days of discharge from hospital via follow-up callschart review Interval events Physician follow-up visits Lifestyle changes Lab assessments Medication managementadherence Rehab amp Functional outcomes Falls

MOSAIC Website

wwwMichigangovstroke

Adrienne Nickles MPHnicklesamichigangov

Thank You

  • Michigan and MOSAIC Data Review
  • Overview
  • Age-adjusted Stroke Hospitalization Rates Michigan 2000-2015
  • Slide Number 4
  • Age-adjusted Stroke Mortality Rates Michigan 2000-2014
  • Slide Number 6
  • Slide Number 7
  • Slide Number 8
  • Slide Number 9
  • Slide Number 10
  • Slide Number 11
  • MOSAIC 2015-2020
  • Pre-hospital Care
  • EMSMOSAIC Data Linkage
  • Slide Number 15
  • GWTG Special Initiatives Tab
  • Slide Number 17
  • MOSAIC Participating Hospitals
  • Hospital Infrastructure
  • Case Demographics MOSAIC Registry
  • Who receives data reports on your stroke quality of care
  • 1) In the most recent calendar year have you run additional analyses (beyond what was required for reporting) on your hospitalrsquos own stroke data 2)How frequently have you run and used the analyses generated
  • What is the main reason you do not run your own additional analyses (Select one best answer)
  • In the most recent calendar year what reports did you run
  • How do you use these analyses reports
  • If you run additional analysis what action items QI efforts did you plan as a result of these reports
  • Hospital Arrival Mode Door-to Needle and Pre-Notification Reports 2016
  • Percent of Cases Who Arrived via EMSMOSAIC 2009-2016
  • Table 1 Arrival Mode among Stroke Cases by Demographics MOSAIC 2016
  • Table 2 Door-to-Needle Times by Arrival Mode among Stroke Cases MOSAIC 2016
  • Table 3 Pre-Notification among Stroke Cases Who Arrived Via EMS by Demographics MOSAIC 2016
  • MOSAIC Transitions of Care Project
  • Slide Number 33
  • MOSAIC Website
  • Adrienne Nickles MPHnicklesamichigangov
CVD
Year White Male Black Male White Female Black Female
2000 4276 5424 3033 4161
2001 4066 5524 2813 4091
2002 3928 5468 2767 4114
2003 3734 518 2638 3887
2004 3448 5079 2432 3643
2005 3366 4983 2375 3545
2006 3276 4994 2313 3477
2007 3236 4845 2223 327
2008 3158 4694 2238 3327
change 234 79 237 164
Heart Disease
Year White Male Black Male White Female Black Female
2000 3393 4298 227 3206
2001 3232 4445 2124 3166
2002 3118 4317 2197 3157
2003 2986 4184 1957 3001
2004 2777 3983 1783 2838
2005 2704 4009 1776 2679
2006 2644 3981 1739 2642
2007 2619 3972 1679 2532
2008 2566 3819 1687 2606
Stroke
Year White Male Black Male White Female Black Female
2000 61 768 561 703 176
2001 575 752 539 681 138
2002 573 806 528 66 15
2003 516 662 498 629 147
2004 463 743 476 562
2005 449 663 429 585
2006 434 63 411 556
2007 415 631 392 494
2008 402 606 392 509
2009 375 616 372 464
2010 372 565 366 513
2011 373 548 366 44
2012 348 587 349 477
2013 347 506 34 462
2014 369 506 352 482
Coronary Heart Disease
Year White Male Black Male White Female Black Female
2000 2625 329 1608 243
2001 2478 3356 1508 2314
2002 2404 3154 1419 2313
2003 2221 3093 1328 209
2004 2067 2956 119 1983
2005 1989 2885 117 1853
2006 1922 2903 1139 1825
2007 1921 2771 1074 1645
2008 1824 2592 1071 1722
Heart Failure
Year White Male Black Male White Female Black Female
2000 255 206 245 17
2001 267 225 225 167
2002 242 238 227 203
2003 256 217 222 189
2004 243 167 214 206
2005 24 218 217 172
2006 255 246 229 202
2007 23 225 208 196
2008 25 216 226 185
Not sure what this data is from previously HD Stroke
Year White Female Black Female White Female Black Female
2000 227 3206 561 703
2001 2124 3166 539 681
2002 2197 3157 528 66
2003 1957 3001 498 629
2004 1783 2838 476 562
2005 1776 2679 429 585
2006 1739 2642 411 556
2007
2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2009 2009 2009 2009
2010 2010 2010 2010
2011 2011 2011 2011
2012 2012 2012 2012
2013 2013 2013 2013
2014 2014 2014 2014
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
CVD
Year US Michigan 0-34 35-64 65-84 85+
2000 3397 3694 43 140 16141 86689
2001 3265 3524 508 1348 15291 82889
2002 3174 3421 45 1338 14891 79536
2003 3061 3258 54 1324 14033 75185
2004 2885 3034 41 1242 13209 69088
2005 2773 2972 48 1283 1291 66011
2006 2898 48 1207 12246 6786
2007 2825 5 1206 1182 66153
2008 2791 43 1175 11619 66406
Heart Disease
Year US Michigan 0-34 35-64 65-84 85+
2000 2576 2851 345 1158 1247 64879
2001 2478 2719 416 112 11794 61938
2002 2408 2631 35 1103 11529 58746
2003 2323 2517 45 110 10827 56172
2004 217 2337 313 1048 10086 51609
2005 2111 2308 38 1078 9937 49828
2006 226 384 1019 9413 51918
2007 2216 42 1008 9174 50961
2008 2192 36 982 904 51209
Stroke
Year US Michigan HP 2010 0-34 35-64 65-84 85+
2000 609 603 50 068 174 2589 15841
2001 579 577 50 0638 157 2522 1504
2002 562 571 50 072 169 2397 1528
2003 535 527 50 0737 157 2249 13741
2004 50 496 50 0652 138 220 12629
2005 466 464 50 0553 145 2063 11398
2006 444 50 0734 127 196 11256
2007 425 064 1368 1832 10718
2008 419 047 134 1804 10646
79 27 243 289
Coronary Heart Disease
Year US Michigan HP 2010 0-34 35-64 65-84 85+
2000 1868 2118 162 0613 874 7701 4670
2001 1778 2006 162 0898 818 9012 44369
2002 1709 192 162 0889 799 8759 41061
2003 1628 179 162 0793 785 8018 38358
2004 1502 1656 162 0865 757 7421 34644
2005 1444 1611 162 097 773 7245 32617
2006 1564 162 088 727 6856 33503
2007 1516 117 709 6585 32727
2008 1472 102 657 6403 32504
168 11 283
Heart Failure
Year US Michigan 35-64 65-84 85+
2000 203 245 3047 936 8287
2001 202 237 2596 88 8285
2002 194 233 2648 878 8057
2003 194 233 3176 902 7722
2004 189 224 2709 863 7586
2005 189 224 2955 878 7388
2006 24 2979 884 8354
2007 219 274 828 7483
2008 233 013 333 85 8102
Heart Disease Stroke
Michigan White Michigan Black US White US Black Michigan White Michigan Black US White US Black
1990 334 4315 317 3915 1990 638 733 629 917
1991 3289 4108 3088 3865 1991 626 781 607 894
1992 3126 3987 3011 3777 1992 609 694 598 86
1993 3234 429 3046 3843 1993 614 77 609 866
1994 3134 4156 295 3661 1994 634 875 609 869
1995 3048 4131 2912 3672 1995 638 925 615 879
1996 2997 380 2842 354 1996 617 804 61 852
1997 2851 3683 2764 345 1997 604 77 598 816
1998 2884 3586 2681 3406 1998 598 729 576 803
1999 2781 3692 2634 3367 1999 609 812 598 824
2000 2757 3663 2536 3265 2000 586 737 587 824
2001 261 3695 2435 3169 2001 56 718 558 788
2002 2522 3659 2367 3084 2002 553 729 542 763
2003 2409 350 2282 3002 2003 511 655 514 743
2004 222 3311 2133 2806 2004 477 633 48 699
2005 219 3227 2005 442 616
2006 2144 320 2006 426 589
2007 2007
2008 2008
CVD CHD HD HF Stroke
2000 3694 2118 2851 245 603
2001 3524 2006 2719 237 577
2002 3421 192 2631 233 571
2003 3258 179 2517 233 527
2004 3034 1656 2337 224 496
2005 2972 1611 2308 224 464
2006 2898 1564 226 24 444
2007 2825 1516 2216 219 425
2008 2791 1472 2192 233 419
2000 2000 2000
2001 2001 2001
2002 2002 2002
2003 2003 2003
2004 2004 2004
2005 2005 2005
2006 2006 2006
2007 2007 2007
2008 2008 2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2000 2000 2000 2000 2000
2001 2001 2001 2001 2001
2002 2002 2002 2002 2002
2003 2003 2003 2003 2003
2004 2004 2004 2004 2004
2005 2005 2005 2005 2005
2006 2006 2006 2006 2006
2007 2007 2007 2007 2007
2008 2008 2008 2008 2008
CVD
Year White Male Black Male White Female Black Female
2000 4276 5424 3033 4161
2001 4066 5524 2813 4091
2002 3928 5468 2767 4114
2003 3734 518 2638 3887
2004 3448 5079 2432 3643
2005 3366 4983 2375 3545
2006 3276 4994 2313 3477
2007 3236 4845 2223 327
2008 3158 4694 2238 3327
change 234 79 237 164
Heart Disease
Year White Male Black Male White Female Black Female
2000 3393 4298 227 3206
2001 3232 4445 2124 3166
2002 3118 4317 2197 3157
2003 2986 4184 1957 3001
2004 2777 3983 1783 2838
2005 2704 4009 1776 2679
2006 2644 3981 1739 2642
2007 2619 3972 1679 2532
2008 2566 3819 1687 2606
Stroke
Year White Male Black Male White Female Black Female
2000 61 768 561 703 176
2001 575 752 539 681 138
2002 573 806 528 66 15
2003 516 662 498 629 147
2004 463 743 476 562
2005 449 663 429 585
2006 434 63 411 556
2007 415 631 392 494
2008 402 606 392 509
Coronary Heart Disease
Year White Male Black Male White Female Black Female
2000 2625 329 1608 243
2001 2478 3356 1508 2314
2002 2404 3154 1419 2313
2003 2221 3093 1328 209
2004 2067 2956 119 1983
2005 1989 2885 117 1853
2006 1922 2903 1139 1825
2007 1921 2771 1074 1645
2008 1824 2592 1071 1722
Heart Failure
Year White Male Black Male White Female Black Female
2000 255 206 245 17
2001 267 225 225 167
2002 242 238 227 203
2003 256 217 222 189
2004 243 167 214 206
2005 24 218 217 172
2006 255 246 229 202
2007 23 225 208 196
2008 25 216 226 185
Not sure what this data is from previously HD Stroke
Year White Female Black Female White Female Black Female
2000 227 3206 561 703
2001 2124 3166 539 681
2002 2197 3157 528 66
2003 1957 3001 498 629
2004 1783 2838 476 562
2005 1776 2679 429 585
2006 1739 2642 411 556
2007
2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
CVD
Year US Michigan 0-34 35-64 65-84 85+
2000 3397 3694 43 140 16141 86689
2001 3265 3524 508 1348 15291 82889
2002 3174 3421 45 1338 14891 79536
2003 3061 3258 54 1324 14033 75185
2004 2885 3034 41 1242 13209 69088
2005 2773 2972 48 1283 1291 66011
2006 2898 48 1207 12246 6786
2007 2825 5 1206 1182 66153
2008 2791 43 1175 11619 66406
Heart Disease
Year US Michigan 0-34 35-64 65-84 85+
2000 2576 2851 345 1158 1247 64879
2001 2478 2719 416 112 11794 61938
2002 2408 2631 35 1103 11529 58746
2003 2323 2517 45 110 10827 56172
2004 217 2337 313 1048 10086 51609
2005 2111 2308 38 1078 9937 49828
2006 226 384 1019 9413 51918
2007 2216 42 1008 9174 50961
2008 2192 36 982 904 51209
Stroke
Year US Michigan HP 2010 0-34 35-64 65-84 85+
2000 609 603 50 068 174 2589 15841
2001 579 577 50 0638 157 2522 1504
2002 562 571 50 072 169 2397 1528
2003 535 527 50 0737 157 2249 13741
2004 50 496 50 0652 138 220 12629
2005 466 464 50 0553 145 2063 11398
2006 444 50 0734 127 196 11256
2007 425 064 1368 1832 10718
2008 419 047 134 1804 10646
79 27 243 289
Coronary Heart Disease
Year US Michigan HP 2010 0-34 35-64 65-84 85+
2000 1868 2118 162 0613 874 7701 4670
2001 1778 2006 162 0898 818 9012 44369
2002 1709 192 162 0889 799 8759 41061
2003 1628 179 162 0793 785 8018 38358
2004 1502 1656 162 0865 757 7421 34644
2005 1444 1611 162 097 773 7245 32617
2006 1564 162 088 727 6856 33503
2007 1516 117 709 6585 32727
2008 1472 102 657 6403 32504
168 11 283
Heart Failure
Year US Michigan 35-64 65-84 85+
2000 203 245 3047 936 8287
2001 202 237 2596 88 8285
2002 194 233 2648 878 8057
2003 194 233 3176 902 7722
2004 189 224 2709 863 7586
2005 189 224 2955 878 7388
2006 24 2979 884 8354
2007 219 274 828 7483
2008 233 013 333 85 8102
Heart Disease Stroke
Michigan White Michigan Black US White US Black Michigan White Michigan Black US White US Black
1990 334 4315 317 3915 1990 638 733 629 917
1991 3289 4108 3088 3865 1991 626 781 607 894
1992 3126 3987 3011 3777 1992 609 694 598 86
1993 3234 429 3046 3843 1993 614 77 609 866
1994 3134 4156 295 3661 1994 634 875 609 869
1995 3048 4131 2912 3672 1995 638 925 615 879
1996 2997 380 2842 354 1996 617 804 61 852
1997 2851 3683 2764 345 1997 604 77 598 816
1998 2884 3586 2681 3406 1998 598 729 576 803
1999 2781 3692 2634 3367 1999 609 812 598 824
2000 2757 3663 2536 3265 2000 586 737 587 824
2001 261 3695 2435 3169 2001 56 718 558 788
2002 2522 3659 2367 3084 2002 553 729 542 763
2003 2409 350 2282 3002 2003 511 655 514 743
2004 222 3311 2133 2806 2004 477 633 48 699
2005 219 3227 2005 442 616
2006 2144 320 2006 426 589
2007 2007
2008 2008
Stroke
CVD MI US
2000 3694 606 609
2001 3524 584 584
2002 3421 583 572
2003 3258 539 546
2004 3034 519 512
2005 2972 488 48
2006 2898 449 448
2007 2825 43 435
2008 2791 423 421
2009 262 396 396
2010 394 391
2011 387 379
2012 372 369
2013 363 369
2014 377 365
Page 15: Michigan and MOSAIC Data Review...Michigan and MOSAIC Data Review 2017 ANNUAL WORKSHOP 4/26/2017. Adrienne Nickles, MPH. Michigan’s Ongoing Stroke Registry to Accelerate the Improvement

CVD_RG

White Male
Black Male
White Female
Black Female
Year
Age-Adjusted Rate per 100000
4276
5424
3033
4161
4066
5524
2813
4091
3928
5468
2767
4114
3734
518
2638
3887
3448
5079
2432
3643
3366
4983
2375
3545
3276
4994
2313
3477
3236
4845
2223
327
3158
4694
2238
3327

Stroke_RG

White Male
Black Male
White Female
Black Female
Year
Age-Adjusted Rate per 100000
61
768
561
703
575
752
539
681
573
806
528
66
516
662
498
629
463
743
476
562
449
663
429
585
434
63
411
556
415
631
392
494
402
606
392
509

HD_RG

White Male
Black Male
White Female
Black Female
Year
Age-Adjusted Rate per 100000
3393
4298
227
3206
3232
4445
2124
3166
3118
4317
2197
3157
2986
4184
1957
3001
2777
3983
1783
2838
2704
4009
1776
2679
2644
3981
1739
2642
2619
3972
1679
2532
2566
3819
1687
2606

CHD_RG

White Male
Black Male
White Female
Black Female
Year
Age-Adjusted Rate per 100000
2625
329
1608
243
2478
3356
1508
2314
2404
3154
1419
2313
2221
3093
1328
209
2067
2956
119
1983
1989
2885
117
1853
1922
2903
1139
1825
1921
2771
1074
1645
1824
2592
1071
1722

HF_RG

White Male
Black Male
White Female
Black Female
Year
Age-Adjusted Rate per 100000
255
206
245
17
267
225
225
167
242
238
227
203
256
217
222
189
243
167
214
206
24
218
217
172
255
246
229
202
23
225
208
196
25
216
226
185

race_gender

Sheet3

Age-adjusted stroke mortality rates by race and gender Michigan 2000 to 2014

0

10

20

30

40

50

60

70

80

90

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014

Age

-Adj

uste

d R

ate

per 1

000

00

Year

White Male

Black Male

White Female

Black Female

Overall_Rates

CVD
CHD
HD
HF
Stroke
Year
Rate per 10000
3694
2118
2851
245
603
3524
2006
2719
237
577
3421
192
2631
233
571
3258
179
2517
233
527
3034
1656
2337
224
496
2972
1611
2308
224
464
2898
1564
226
24
444
2825
1516
2216
219
425
2791
1472
2192
233
419

CVD_Age

0-34
35-64
65-84
85+
Year
Age-Adjusted Rate per 100000
43
140
16141
86689
508
1348
15291
82889
45
1338
14891
79536
54
1324
14033
75185
41
1242
13209
69088
48
1283
1291
66011
48
1207
12246
6786
5
1206
1182
66153
43
1175
11619
66406

HD_Age

0-34
35-64
65-84
85+
Year
Age-Adjusted Rate per 100000
345
1158
1247
64879
416
112
11794
61938
35
1103
11529
58746
45
110
10827
56172
313
1048
10086
51609
38
1078
9937
49828
384
1019
9413
51918
42
1008
9174
50961
36
982
904
51209

CHD_Age

0-34
35-64
65-84
85+
Year
Age-Adjusted Rate per 100000
0613
874
7701
4670
0898
818
9012
44369
0889
799
8759
41061
0793
785
8018
38358
0865
757
7421
34644
097
773
7245
32617
088
727
6856
33503
117
709
6585
32727
102
657
6403
32504

Stroke_Age

0-34
35-64
65-84
85+
Year
Age-Adjusted Rate per 100000
068
174
2589
15841
0638
157
2522
1504
072
169
2397
1528
0737
157
2249
13741
0652
138
220
12629
0553
145
2063
11398
0734
127
196
11256
064
1368
1832
10718
047
134
1804
10646

HF_Age

35-64
65-84
85+
Year
Age-Adjusted Rate per 100000
3047
936
8287
2596
88
8285
2648
878
8057
3176
902
7722
2709
863
7586
2955
878
7388
2979
884
8354
274
828
7483
333
85
8102

total

CVD_RG

White Male
Black Male
White Female
Black Female
Year
Age-Adjusted Rate per 100000
4276
5424
3033
4161
4066
5524
2813
4091
3928
5468
2767
4114
3734
518
2638
3887
3448
5079
2432
3643
3366
4983
2375
3545
3276
4994
2313
3477
3236
4845
2223
327
3158
4694
2238
3327

Stroke_RG

White Male
Black Male
White Female
Black Female
Year
Age-Adjusted Rate per 100000
61
768
561
703
575
752
539
681
573
806
528
66
516
662
498
629
463
743
476
562
449
663
429
585
434
63
411
556
415
631
392
494
402
606
392
509
375
616
372
464
372
565
366
513
373
548
366
44
348
587
349
477
347
506
34
462
369
506
352
482

HD_RG

White Male
Black Male
White Female
Black Female
Year
Age-Adjusted Rate per 100000
3393
4298
227
3206
3232
4445
2124
3166
3118
4317
2197
3157
2986
4184
1957
3001
2777
3983
1783
2838
2704
4009
1776
2679
2644
3981
1739
2642
2619
3972
1679
2532
2566
3819
1687
2606

CHD_RG

White Male
Black Male
White Female
Black Female
Year
Age-Adjusted Rate per 100000
2625
329
1608
243
2478
3356
1508
2314
2404
3154
1419
2313
2221
3093
1328
209
2067
2956
119
1983
1989
2885
117
1853
1922
2903
1139
1825
1921
2771
1074
1645
1824
2592
1071
1722

HF_RG

White Male
Black Male
White Female
Black Female
Year
Age-Adjusted Rate per 100000
255
206
245
17
267
225
225
167
242
238
227
203
256
217
222
189
243
167
214
206
24
218
217
172
255
246
229
202
23
225
208
196
25
216
226
185

race_gender

Sheet3

Local Health Department data can be found at wwwmichigangovbrfsSource CDC BRFSS

RISK FACTORMI

2011

MI

2013

MI

2014

MI

2015US 2015

2015 NATIONAL RANKING

Current Smoking 233 214 212 207 175 11

Blood Pressure Ever Told High 342 346 NA 331 309 18

Cholesterol Ever Told High 418 406 NA 382 364 12

Overweight (BMIgt25) 342 347 349 351 355 32tied

Obese (BMIgt30) 313 315 307 312 298 16

No Leisure Time Physical Activity 236 244 255 255 262 27

Diabetes 100 104 104 107 100 18tied

Prevalence of CVD Risk Factors Michigan Adults 1990-2015Compared to 2015 National Prevalence

233214 212 207

175

10

15

20

25

30

MI 2011 MI 2013 MI 2014 MI 2015 US 2015

Current Smoking

342 346331

309

20

25

30

35

40

MI 2011 MI 2013 MI 2014 MI 2015 US 2015

Blood Pressure Ever told high

342 347 349 351 355

20

25

30

35

40

MI 2011 MI 2013 MI 2014 MI 2015 US 2015

Overweight (BMIgt25)

313 315 307 312298

20

25

30

35

40

MI 2011 MI 2013 MI 2014 MI 2015 US 2015

Obese (BMIgt30)

418406

382364

30

35

40

45

50

MI 2011 MI 2013 MI 2014 MI 2015 US 2015

Cholesterol Ever told high

10 104 104 10710

0

3

6

9

12

15

MI 2011 MI 2013 MI 2014 MI 2015 US 2015

Diabetes

236 244255 255 262

10

15

20

25

30

MI 2011 MI 2013 MI 2014 MI 2015 US 2015

No Leisure Time Physical Activity

11 1216 18

2732tied

05

101520253035404550

CurrentSmoking

CholesterolEver told high

Obese(BMIgt30)

BloodPressure Ever

told high

Diabetes No LeisureTime Physical

Activity

Overweight(BMIgt25)

2015 NATIONAL RANKING(1st is worst)

18tied

MOSAIC 2015-2020 Focus of Grant Developing Stroke Systems of

Care Community Awareness EMS In-hospital QI Transition of Care Post-Discharge

12

Pre-hospital Care

A V A I L A B L E D A T A

13

EMSMOSAIC Data Linkage

-The MOSAIC Team continues to link data from the Michigan EMS Information System (MiEMSIS) to MOSAIC Data- Reports have been created for and reviewed by the

Tri-County Area MCA and Detroit East MCA- This work will expand to other MCA regions that

serve hospitals participating in MOSAIC

GWTG Special Initiatives Tab

-A free tab that can be enabled in GWTG-The purpose of the tab is to collect data concerning patient hand-off from EMS

MOSAIC Participating Hospitals

Aspirus Keweenaw Hospital (Laurium)

Aspirus Grand View HospitalAspirus Iron River HospitalAspirus Ontonagon HospitalBixby Medical CenterBronson Methodist HospitalCovenant Health CareDetroit Receiving HospitalGenesys Regional Medical CenterHenry Ford Hospital Herrick Medical CenterHuron Valley-Sinai HospitalLakeland Regional Medical Center McLaren Bay Regional Medical CenterMcLaren Greater Medical Center

McLaren Macomb HospitalMcLaren Northern MI HospitalMcLaren Oakland Medical CenterMcLaren Port Huron HospitalMcLaren Regional Medical CenterMercy Health Saint Maryrsquos HospitalMetro Health HospitalMunson Medical Center

ProMedica Monroe Regional HospitalSparrow HospitalSt Joseph Mercy - Ann ArborSt Joseph Mercy ChelseaSt Joseph Mercy Livingston HospitalSt Mary MercySt Mary of Michigan HospitalU of M Hospital

Hospital Infrastructure19

Among all participating hospitals the average number of

Licensed beds was 374 (range 25 to 1059 beds)

Inpatient discharges was 17076 (range 1064 to 48916 patients)

Acute stroke discharges (primary diagnosis only) was 417 (range 34 to 982 patients)

Case Demographics MOSAIC Registry

VariablesN() or statistics(Total N=68906)

Age at admission (years)Median 710Range 180 - 1060Mean (SE) 697(01)

GenderMale 32886 (477)Female 36015 (523)

RaceAfrican American 9900 (197)AIAN 132 (03)Asian 320 (06)More than one race 44 (01)Unknown 3679 (73)White 36190 (720)Missing 70

EthnicityHispanic or Latino 804 (16)Others 49531 (984)

VariablesN() or statistics(Total N=68906)

Health insuranceMedicaid 2284 (45)MedicaidPrivate 211 (04)Medicare 16863 (336)Medicare Medicaid 2313 (46)

MedicareMedicaidPrivate125 (02)

MedicarePrivate 13640 (272)ND 268(05)No insurance 2123 (42)Private 12356 (246)

Arrival modeEMS 21052 (429)Private

transportationother19313 (393)

Transfer from another hospital

7733(157)

ND or unknown 1021 (21)Missing 1216

Who receives data reports on your stroke quality of care

21

7055

70

10085

65

40

Hos

pita

lC

EO

up

per

man

agem

ent

Hos

pita

lB

oard

Chi

efN

ursi

ngO

ffice

r(C

NO

)

Str

oke

Tea

m

Phy

sici

anS

trok

eC

ham

pion

Chi

ef o

fM

edic

ine

Oth

er

Data Use

1) In the most recent calendar year have you run additional analyses (beyond what was required for reporting) on your hospitalrsquos own stroke data

2)How frequently have you run and used the analyses generated

22

Yes (N=16) 80

No (N=4) 20Weekly (N=2) 125

Monthly (N=8) 500

Less than monthly but more

than 1-2 times(N=6) 375

Data Use

What is the main reason you do not run your own additional analyses (Select one best answer)

23

Not sure how to run analyses

25

Not sure what analyses are needed would be helpful 25

Other 50

Data Use

In the most recent calendar year what reports did you run

24

813 688

Pre-programmedautomated reports in thedata collection tool (eg GWTG)

Additional reports beyond pre-programmed reports from the tool

Data Use

How do you use these analyses reports

25

813 688375

Inform quality improvement (QI) efforts andor plan

ldquoaction itemsrdquo

Report to management administration on our

progress

Other

Data Use

If you run additional analysis what action items QI efforts did you plan as a result of these reports

26

o Discharge education intensive statin use

o Door to tPA time and dysphagia

o Review data between spoke amp hub hospitals regarding transfers IV-tPA administration Mechanical thrombectomy and SAH

o QI efforts were addressed in the department involving calling Stroke Alert on call for cases with FAST symptoms

o ED Medical Director works with team to fix fallouts and problematic areas We have seen improvement

o Process changes (ie fallout emails to RN manager) physician querieso Increased documentation of NIHSS ownership from individual units regarding stroke quality

improvement goalso Daily dysphagia screening determination of whowhat team responsible for documenting initial NIHSS

looking at patients beyond 2h LKW arrival

Hospital Arrival Mode Door-to Needle and Pre-Notification

Reports 2016

Percent of Cases Who Arrived via EMSMOSAIC 2009-2016

Table 1 Arrival Mode among Stroke Cases by Demographics MOSAIC 2016

Demographics N=3496 550 N=2938 450Stroke Type Ischemic 2558 542 2164 458 Hemorrhagic 560 728 209 272 TIA 378 478 413 522Age Group lt 50 Years 233 433 305 567 50-79 Years 1982 497 2008 503 ge 80 Years 1379 688 625 312Sex Female 1933 576 1422 424 Male 1661 523 1516 477Race Black 659 530 584 470 White 2824 557 2248 443 Other Missing 111 512 106 488

MOSAIC AggregateArrival Mode

EMS Private Mode

Table 2 Door-to-Needle Times by Arrival Mode among Stroke Cases MOSAIC 2016

Time Elements (in Minutes)Number of

Patients Mean (Minutes) Median

(Minutes)Range

(Minutes)Door-to-Image 4901 575 400 00-2700 Arrived via EMS 2767 463 270 00-2700 Arrived via Private Transportation 2134 720 570 00-2620

Door-to-Image (among t-PA treated) 492 155 130 00-970 Arrived via EMS 370 125 110 00-840 Arrived via Private Transportation 122 243 215 20-970Image-to Needle 492 500 450 70-2090 Arrived via EMS 370 503 460 70-2090 Arrived via Private Transportation 122 483 420 90-1770Door-to Needle 492 655 570 200-2180 Arrived via EMS 370 629 560 200-2180 Arrived via Private Transportation 122 726 650 290-2060Included ischemic or hemorrhagic cases with times that were less or equal to 270 minutes (45 hours)Transferred cases were excluded

MOSAIC Aggregate

Table 3 Pre-Notification among Stroke Cases Who Arrived Via EMS by Demographics MOSAIC 2016

Demographics N=2015 584 N=1437 416Stroke Type Ischemic 1523 622 924 378 Hemorrhagic 306 566 235 434 TIA 142 381 231 619Age Group lt 50 Years 133 607 86 393 50-79 Years 1105 585 784 415 ge 80 Years 777 578 567 422Sex Female 1075 578 786 422 Male 940 591 651 409Race Black 307 517 287 483 White 1657 602 1097 398 Other 51 490 53 510

All HospitalsPre-Notification

Yes No

MOSAIC Transitions of Care Project

Post-discharge data collection tool is being implemented into Outcome Science as a tab

Post-Discharge amp Transition of Care

Reporting on changes within 30 days of discharge from hospital via follow-up callschart review Interval events Physician follow-up visits Lifestyle changes Lab assessments Medication managementadherence Rehab amp Functional outcomes Falls

MOSAIC Website

wwwMichigangovstroke

Adrienne Nickles MPHnicklesamichigangov

Thank You

  • Michigan and MOSAIC Data Review
  • Overview
  • Age-adjusted Stroke Hospitalization Rates Michigan 2000-2015
  • Slide Number 4
  • Age-adjusted Stroke Mortality Rates Michigan 2000-2014
  • Slide Number 6
  • Slide Number 7
  • Slide Number 8
  • Slide Number 9
  • Slide Number 10
  • Slide Number 11
  • MOSAIC 2015-2020
  • Pre-hospital Care
  • EMSMOSAIC Data Linkage
  • Slide Number 15
  • GWTG Special Initiatives Tab
  • Slide Number 17
  • MOSAIC Participating Hospitals
  • Hospital Infrastructure
  • Case Demographics MOSAIC Registry
  • Who receives data reports on your stroke quality of care
  • 1) In the most recent calendar year have you run additional analyses (beyond what was required for reporting) on your hospitalrsquos own stroke data 2)How frequently have you run and used the analyses generated
  • What is the main reason you do not run your own additional analyses (Select one best answer)
  • In the most recent calendar year what reports did you run
  • How do you use these analyses reports
  • If you run additional analysis what action items QI efforts did you plan as a result of these reports
  • Hospital Arrival Mode Door-to Needle and Pre-Notification Reports 2016
  • Percent of Cases Who Arrived via EMSMOSAIC 2009-2016
  • Table 1 Arrival Mode among Stroke Cases by Demographics MOSAIC 2016
  • Table 2 Door-to-Needle Times by Arrival Mode among Stroke Cases MOSAIC 2016
  • Table 3 Pre-Notification among Stroke Cases Who Arrived Via EMS by Demographics MOSAIC 2016
  • MOSAIC Transitions of Care Project
  • Slide Number 33
  • MOSAIC Website
  • Adrienne Nickles MPHnicklesamichigangov
CVD
Year White Male Black Male White Female Black Female
2000 4276 5424 3033 4161
2001 4066 5524 2813 4091
2002 3928 5468 2767 4114
2003 3734 518 2638 3887
2004 3448 5079 2432 3643
2005 3366 4983 2375 3545
2006 3276 4994 2313 3477
2007 3236 4845 2223 327
2008 3158 4694 2238 3327
change 234 79 237 164
Heart Disease
Year White Male Black Male White Female Black Female
2000 3393 4298 227 3206
2001 3232 4445 2124 3166
2002 3118 4317 2197 3157
2003 2986 4184 1957 3001
2004 2777 3983 1783 2838
2005 2704 4009 1776 2679
2006 2644 3981 1739 2642
2007 2619 3972 1679 2532
2008 2566 3819 1687 2606
Stroke
Year White Male Black Male White Female Black Female
2000 61 768 561 703 176
2001 575 752 539 681 138
2002 573 806 528 66 15
2003 516 662 498 629 147
2004 463 743 476 562
2005 449 663 429 585
2006 434 63 411 556
2007 415 631 392 494
2008 402 606 392 509
2009 375 616 372 464
2010 372 565 366 513
2011 373 548 366 44
2012 348 587 349 477
2013 347 506 34 462
2014 369 506 352 482
Coronary Heart Disease
Year White Male Black Male White Female Black Female
2000 2625 329 1608 243
2001 2478 3356 1508 2314
2002 2404 3154 1419 2313
2003 2221 3093 1328 209
2004 2067 2956 119 1983
2005 1989 2885 117 1853
2006 1922 2903 1139 1825
2007 1921 2771 1074 1645
2008 1824 2592 1071 1722
Heart Failure
Year White Male Black Male White Female Black Female
2000 255 206 245 17
2001 267 225 225 167
2002 242 238 227 203
2003 256 217 222 189
2004 243 167 214 206
2005 24 218 217 172
2006 255 246 229 202
2007 23 225 208 196
2008 25 216 226 185
Not sure what this data is from previously HD Stroke
Year White Female Black Female White Female Black Female
2000 227 3206 561 703
2001 2124 3166 539 681
2002 2197 3157 528 66
2003 1957 3001 498 629
2004 1783 2838 476 562
2005 1776 2679 429 585
2006 1739 2642 411 556
2007
2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2009 2009 2009 2009
2010 2010 2010 2010
2011 2011 2011 2011
2012 2012 2012 2012
2013 2013 2013 2013
2014 2014 2014 2014
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
CVD
Year US Michigan 0-34 35-64 65-84 85+
2000 3397 3694 43 140 16141 86689
2001 3265 3524 508 1348 15291 82889
2002 3174 3421 45 1338 14891 79536
2003 3061 3258 54 1324 14033 75185
2004 2885 3034 41 1242 13209 69088
2005 2773 2972 48 1283 1291 66011
2006 2898 48 1207 12246 6786
2007 2825 5 1206 1182 66153
2008 2791 43 1175 11619 66406
Heart Disease
Year US Michigan 0-34 35-64 65-84 85+
2000 2576 2851 345 1158 1247 64879
2001 2478 2719 416 112 11794 61938
2002 2408 2631 35 1103 11529 58746
2003 2323 2517 45 110 10827 56172
2004 217 2337 313 1048 10086 51609
2005 2111 2308 38 1078 9937 49828
2006 226 384 1019 9413 51918
2007 2216 42 1008 9174 50961
2008 2192 36 982 904 51209
Stroke
Year US Michigan HP 2010 0-34 35-64 65-84 85+
2000 609 603 50 068 174 2589 15841
2001 579 577 50 0638 157 2522 1504
2002 562 571 50 072 169 2397 1528
2003 535 527 50 0737 157 2249 13741
2004 50 496 50 0652 138 220 12629
2005 466 464 50 0553 145 2063 11398
2006 444 50 0734 127 196 11256
2007 425 064 1368 1832 10718
2008 419 047 134 1804 10646
79 27 243 289
Coronary Heart Disease
Year US Michigan HP 2010 0-34 35-64 65-84 85+
2000 1868 2118 162 0613 874 7701 4670
2001 1778 2006 162 0898 818 9012 44369
2002 1709 192 162 0889 799 8759 41061
2003 1628 179 162 0793 785 8018 38358
2004 1502 1656 162 0865 757 7421 34644
2005 1444 1611 162 097 773 7245 32617
2006 1564 162 088 727 6856 33503
2007 1516 117 709 6585 32727
2008 1472 102 657 6403 32504
168 11 283
Heart Failure
Year US Michigan 35-64 65-84 85+
2000 203 245 3047 936 8287
2001 202 237 2596 88 8285
2002 194 233 2648 878 8057
2003 194 233 3176 902 7722
2004 189 224 2709 863 7586
2005 189 224 2955 878 7388
2006 24 2979 884 8354
2007 219 274 828 7483
2008 233 013 333 85 8102
Heart Disease Stroke
Michigan White Michigan Black US White US Black Michigan White Michigan Black US White US Black
1990 334 4315 317 3915 1990 638 733 629 917
1991 3289 4108 3088 3865 1991 626 781 607 894
1992 3126 3987 3011 3777 1992 609 694 598 86
1993 3234 429 3046 3843 1993 614 77 609 866
1994 3134 4156 295 3661 1994 634 875 609 869
1995 3048 4131 2912 3672 1995 638 925 615 879
1996 2997 380 2842 354 1996 617 804 61 852
1997 2851 3683 2764 345 1997 604 77 598 816
1998 2884 3586 2681 3406 1998 598 729 576 803
1999 2781 3692 2634 3367 1999 609 812 598 824
2000 2757 3663 2536 3265 2000 586 737 587 824
2001 261 3695 2435 3169 2001 56 718 558 788
2002 2522 3659 2367 3084 2002 553 729 542 763
2003 2409 350 2282 3002 2003 511 655 514 743
2004 222 3311 2133 2806 2004 477 633 48 699
2005 219 3227 2005 442 616
2006 2144 320 2006 426 589
2007 2007
2008 2008
CVD CHD HD HF Stroke
2000 3694 2118 2851 245 603
2001 3524 2006 2719 237 577
2002 3421 192 2631 233 571
2003 3258 179 2517 233 527
2004 3034 1656 2337 224 496
2005 2972 1611 2308 224 464
2006 2898 1564 226 24 444
2007 2825 1516 2216 219 425
2008 2791 1472 2192 233 419
2000 2000 2000
2001 2001 2001
2002 2002 2002
2003 2003 2003
2004 2004 2004
2005 2005 2005
2006 2006 2006
2007 2007 2007
2008 2008 2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2000 2000 2000 2000 2000
2001 2001 2001 2001 2001
2002 2002 2002 2002 2002
2003 2003 2003 2003 2003
2004 2004 2004 2004 2004
2005 2005 2005 2005 2005
2006 2006 2006 2006 2006
2007 2007 2007 2007 2007
2008 2008 2008 2008 2008
CVD
Year White Male Black Male White Female Black Female
2000 4276 5424 3033 4161
2001 4066 5524 2813 4091
2002 3928 5468 2767 4114
2003 3734 518 2638 3887
2004 3448 5079 2432 3643
2005 3366 4983 2375 3545
2006 3276 4994 2313 3477
2007 3236 4845 2223 327
2008 3158 4694 2238 3327
change 234 79 237 164
Heart Disease
Year White Male Black Male White Female Black Female
2000 3393 4298 227 3206
2001 3232 4445 2124 3166
2002 3118 4317 2197 3157
2003 2986 4184 1957 3001
2004 2777 3983 1783 2838
2005 2704 4009 1776 2679
2006 2644 3981 1739 2642
2007 2619 3972 1679 2532
2008 2566 3819 1687 2606
Stroke
Year White Male Black Male White Female Black Female
2000 61 768 561 703 176
2001 575 752 539 681 138
2002 573 806 528 66 15
2003 516 662 498 629 147
2004 463 743 476 562
2005 449 663 429 585
2006 434 63 411 556
2007 415 631 392 494
2008 402 606 392 509
Coronary Heart Disease
Year White Male Black Male White Female Black Female
2000 2625 329 1608 243
2001 2478 3356 1508 2314
2002 2404 3154 1419 2313
2003 2221 3093 1328 209
2004 2067 2956 119 1983
2005 1989 2885 117 1853
2006 1922 2903 1139 1825
2007 1921 2771 1074 1645
2008 1824 2592 1071 1722
Heart Failure
Year White Male Black Male White Female Black Female
2000 255 206 245 17
2001 267 225 225 167
2002 242 238 227 203
2003 256 217 222 189
2004 243 167 214 206
2005 24 218 217 172
2006 255 246 229 202
2007 23 225 208 196
2008 25 216 226 185
Not sure what this data is from previously HD Stroke
Year White Female Black Female White Female Black Female
2000 227 3206 561 703
2001 2124 3166 539 681
2002 2197 3157 528 66
2003 1957 3001 498 629
2004 1783 2838 476 562
2005 1776 2679 429 585
2006 1739 2642 411 556
2007
2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
Page 16: Michigan and MOSAIC Data Review...Michigan and MOSAIC Data Review 2017 ANNUAL WORKSHOP 4/26/2017. Adrienne Nickles, MPH. Michigan’s Ongoing Stroke Registry to Accelerate the Improvement

Stroke_RG

White Male
Black Male
White Female
Black Female
Year
Age-Adjusted Rate per 100000
61
768
561
703
575
752
539
681
573
806
528
66
516
662
498
629
463
743
476
562
449
663
429
585
434
63
411
556
415
631
392
494
402
606
392
509

HD_RG

White Male
Black Male
White Female
Black Female
Year
Age-Adjusted Rate per 100000
3393
4298
227
3206
3232
4445
2124
3166
3118
4317
2197
3157
2986
4184
1957
3001
2777
3983
1783
2838
2704
4009
1776
2679
2644
3981
1739
2642
2619
3972
1679
2532
2566
3819
1687
2606

CHD_RG

White Male
Black Male
White Female
Black Female
Year
Age-Adjusted Rate per 100000
2625
329
1608
243
2478
3356
1508
2314
2404
3154
1419
2313
2221
3093
1328
209
2067
2956
119
1983
1989
2885
117
1853
1922
2903
1139
1825
1921
2771
1074
1645
1824
2592
1071
1722

HF_RG

White Male
Black Male
White Female
Black Female
Year
Age-Adjusted Rate per 100000
255
206
245
17
267
225
225
167
242
238
227
203
256
217
222
189
243
167
214
206
24
218
217
172
255
246
229
202
23
225
208
196
25
216
226
185

race_gender

Sheet3

Age-adjusted stroke mortality rates by race and gender Michigan 2000 to 2014

0

10

20

30

40

50

60

70

80

90

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014

Age

-Adj

uste

d R

ate

per 1

000

00

Year

White Male

Black Male

White Female

Black Female

Overall_Rates

CVD
CHD
HD
HF
Stroke
Year
Rate per 10000
3694
2118
2851
245
603
3524
2006
2719
237
577
3421
192
2631
233
571
3258
179
2517
233
527
3034
1656
2337
224
496
2972
1611
2308
224
464
2898
1564
226
24
444
2825
1516
2216
219
425
2791
1472
2192
233
419

CVD_Age

0-34
35-64
65-84
85+
Year
Age-Adjusted Rate per 100000
43
140
16141
86689
508
1348
15291
82889
45
1338
14891
79536
54
1324
14033
75185
41
1242
13209
69088
48
1283
1291
66011
48
1207
12246
6786
5
1206
1182
66153
43
1175
11619
66406

HD_Age

0-34
35-64
65-84
85+
Year
Age-Adjusted Rate per 100000
345
1158
1247
64879
416
112
11794
61938
35
1103
11529
58746
45
110
10827
56172
313
1048
10086
51609
38
1078
9937
49828
384
1019
9413
51918
42
1008
9174
50961
36
982
904
51209

CHD_Age

0-34
35-64
65-84
85+
Year
Age-Adjusted Rate per 100000
0613
874
7701
4670
0898
818
9012
44369
0889
799
8759
41061
0793
785
8018
38358
0865
757
7421
34644
097
773
7245
32617
088
727
6856
33503
117
709
6585
32727
102
657
6403
32504

Stroke_Age

0-34
35-64
65-84
85+
Year
Age-Adjusted Rate per 100000
068
174
2589
15841
0638
157
2522
1504
072
169
2397
1528
0737
157
2249
13741
0652
138
220
12629
0553
145
2063
11398
0734
127
196
11256
064
1368
1832
10718
047
134
1804
10646

HF_Age

35-64
65-84
85+
Year
Age-Adjusted Rate per 100000
3047
936
8287
2596
88
8285
2648
878
8057
3176
902
7722
2709
863
7586
2955
878
7388
2979
884
8354
274
828
7483
333
85
8102

total

CVD_RG

White Male
Black Male
White Female
Black Female
Year
Age-Adjusted Rate per 100000
4276
5424
3033
4161
4066
5524
2813
4091
3928
5468
2767
4114
3734
518
2638
3887
3448
5079
2432
3643
3366
4983
2375
3545
3276
4994
2313
3477
3236
4845
2223
327
3158
4694
2238
3327

Stroke_RG

White Male
Black Male
White Female
Black Female
Year
Age-Adjusted Rate per 100000
61
768
561
703
575
752
539
681
573
806
528
66
516
662
498
629
463
743
476
562
449
663
429
585
434
63
411
556
415
631
392
494
402
606
392
509
375
616
372
464
372
565
366
513
373
548
366
44
348
587
349
477
347
506
34
462
369
506
352
482

HD_RG

White Male
Black Male
White Female
Black Female
Year
Age-Adjusted Rate per 100000
3393
4298
227
3206
3232
4445
2124
3166
3118
4317
2197
3157
2986
4184
1957
3001
2777
3983
1783
2838
2704
4009
1776
2679
2644
3981
1739
2642
2619
3972
1679
2532
2566
3819
1687
2606

CHD_RG

White Male
Black Male
White Female
Black Female
Year
Age-Adjusted Rate per 100000
2625
329
1608
243
2478
3356
1508
2314
2404
3154
1419
2313
2221
3093
1328
209
2067
2956
119
1983
1989
2885
117
1853
1922
2903
1139
1825
1921
2771
1074
1645
1824
2592
1071
1722

HF_RG

White Male
Black Male
White Female
Black Female
Year
Age-Adjusted Rate per 100000
255
206
245
17
267
225
225
167
242
238
227
203
256
217
222
189
243
167
214
206
24
218
217
172
255
246
229
202
23
225
208
196
25
216
226
185

race_gender

Sheet3

Local Health Department data can be found at wwwmichigangovbrfsSource CDC BRFSS

RISK FACTORMI

2011

MI

2013

MI

2014

MI

2015US 2015

2015 NATIONAL RANKING

Current Smoking 233 214 212 207 175 11

Blood Pressure Ever Told High 342 346 NA 331 309 18

Cholesterol Ever Told High 418 406 NA 382 364 12

Overweight (BMIgt25) 342 347 349 351 355 32tied

Obese (BMIgt30) 313 315 307 312 298 16

No Leisure Time Physical Activity 236 244 255 255 262 27

Diabetes 100 104 104 107 100 18tied

Prevalence of CVD Risk Factors Michigan Adults 1990-2015Compared to 2015 National Prevalence

233214 212 207

175

10

15

20

25

30

MI 2011 MI 2013 MI 2014 MI 2015 US 2015

Current Smoking

342 346331

309

20

25

30

35

40

MI 2011 MI 2013 MI 2014 MI 2015 US 2015

Blood Pressure Ever told high

342 347 349 351 355

20

25

30

35

40

MI 2011 MI 2013 MI 2014 MI 2015 US 2015

Overweight (BMIgt25)

313 315 307 312298

20

25

30

35

40

MI 2011 MI 2013 MI 2014 MI 2015 US 2015

Obese (BMIgt30)

418406

382364

30

35

40

45

50

MI 2011 MI 2013 MI 2014 MI 2015 US 2015

Cholesterol Ever told high

10 104 104 10710

0

3

6

9

12

15

MI 2011 MI 2013 MI 2014 MI 2015 US 2015

Diabetes

236 244255 255 262

10

15

20

25

30

MI 2011 MI 2013 MI 2014 MI 2015 US 2015

No Leisure Time Physical Activity

11 1216 18

2732tied

05

101520253035404550

CurrentSmoking

CholesterolEver told high

Obese(BMIgt30)

BloodPressure Ever

told high

Diabetes No LeisureTime Physical

Activity

Overweight(BMIgt25)

2015 NATIONAL RANKING(1st is worst)

18tied

MOSAIC 2015-2020 Focus of Grant Developing Stroke Systems of

Care Community Awareness EMS In-hospital QI Transition of Care Post-Discharge

12

Pre-hospital Care

A V A I L A B L E D A T A

13

EMSMOSAIC Data Linkage

-The MOSAIC Team continues to link data from the Michigan EMS Information System (MiEMSIS) to MOSAIC Data- Reports have been created for and reviewed by the

Tri-County Area MCA and Detroit East MCA- This work will expand to other MCA regions that

serve hospitals participating in MOSAIC

GWTG Special Initiatives Tab

-A free tab that can be enabled in GWTG-The purpose of the tab is to collect data concerning patient hand-off from EMS

MOSAIC Participating Hospitals

Aspirus Keweenaw Hospital (Laurium)

Aspirus Grand View HospitalAspirus Iron River HospitalAspirus Ontonagon HospitalBixby Medical CenterBronson Methodist HospitalCovenant Health CareDetroit Receiving HospitalGenesys Regional Medical CenterHenry Ford Hospital Herrick Medical CenterHuron Valley-Sinai HospitalLakeland Regional Medical Center McLaren Bay Regional Medical CenterMcLaren Greater Medical Center

McLaren Macomb HospitalMcLaren Northern MI HospitalMcLaren Oakland Medical CenterMcLaren Port Huron HospitalMcLaren Regional Medical CenterMercy Health Saint Maryrsquos HospitalMetro Health HospitalMunson Medical Center

ProMedica Monroe Regional HospitalSparrow HospitalSt Joseph Mercy - Ann ArborSt Joseph Mercy ChelseaSt Joseph Mercy Livingston HospitalSt Mary MercySt Mary of Michigan HospitalU of M Hospital

Hospital Infrastructure19

Among all participating hospitals the average number of

Licensed beds was 374 (range 25 to 1059 beds)

Inpatient discharges was 17076 (range 1064 to 48916 patients)

Acute stroke discharges (primary diagnosis only) was 417 (range 34 to 982 patients)

Case Demographics MOSAIC Registry

VariablesN() or statistics(Total N=68906)

Age at admission (years)Median 710Range 180 - 1060Mean (SE) 697(01)

GenderMale 32886 (477)Female 36015 (523)

RaceAfrican American 9900 (197)AIAN 132 (03)Asian 320 (06)More than one race 44 (01)Unknown 3679 (73)White 36190 (720)Missing 70

EthnicityHispanic or Latino 804 (16)Others 49531 (984)

VariablesN() or statistics(Total N=68906)

Health insuranceMedicaid 2284 (45)MedicaidPrivate 211 (04)Medicare 16863 (336)Medicare Medicaid 2313 (46)

MedicareMedicaidPrivate125 (02)

MedicarePrivate 13640 (272)ND 268(05)No insurance 2123 (42)Private 12356 (246)

Arrival modeEMS 21052 (429)Private

transportationother19313 (393)

Transfer from another hospital

7733(157)

ND or unknown 1021 (21)Missing 1216

Who receives data reports on your stroke quality of care

21

7055

70

10085

65

40

Hos

pita

lC

EO

up

per

man

agem

ent

Hos

pita

lB

oard

Chi

efN

ursi

ngO

ffice

r(C

NO

)

Str

oke

Tea

m

Phy

sici

anS

trok

eC

ham

pion

Chi

ef o

fM

edic

ine

Oth

er

Data Use

1) In the most recent calendar year have you run additional analyses (beyond what was required for reporting) on your hospitalrsquos own stroke data

2)How frequently have you run and used the analyses generated

22

Yes (N=16) 80

No (N=4) 20Weekly (N=2) 125

Monthly (N=8) 500

Less than monthly but more

than 1-2 times(N=6) 375

Data Use

What is the main reason you do not run your own additional analyses (Select one best answer)

23

Not sure how to run analyses

25

Not sure what analyses are needed would be helpful 25

Other 50

Data Use

In the most recent calendar year what reports did you run

24

813 688

Pre-programmedautomated reports in thedata collection tool (eg GWTG)

Additional reports beyond pre-programmed reports from the tool

Data Use

How do you use these analyses reports

25

813 688375

Inform quality improvement (QI) efforts andor plan

ldquoaction itemsrdquo

Report to management administration on our

progress

Other

Data Use

If you run additional analysis what action items QI efforts did you plan as a result of these reports

26

o Discharge education intensive statin use

o Door to tPA time and dysphagia

o Review data between spoke amp hub hospitals regarding transfers IV-tPA administration Mechanical thrombectomy and SAH

o QI efforts were addressed in the department involving calling Stroke Alert on call for cases with FAST symptoms

o ED Medical Director works with team to fix fallouts and problematic areas We have seen improvement

o Process changes (ie fallout emails to RN manager) physician querieso Increased documentation of NIHSS ownership from individual units regarding stroke quality

improvement goalso Daily dysphagia screening determination of whowhat team responsible for documenting initial NIHSS

looking at patients beyond 2h LKW arrival

Hospital Arrival Mode Door-to Needle and Pre-Notification

Reports 2016

Percent of Cases Who Arrived via EMSMOSAIC 2009-2016

Table 1 Arrival Mode among Stroke Cases by Demographics MOSAIC 2016

Demographics N=3496 550 N=2938 450Stroke Type Ischemic 2558 542 2164 458 Hemorrhagic 560 728 209 272 TIA 378 478 413 522Age Group lt 50 Years 233 433 305 567 50-79 Years 1982 497 2008 503 ge 80 Years 1379 688 625 312Sex Female 1933 576 1422 424 Male 1661 523 1516 477Race Black 659 530 584 470 White 2824 557 2248 443 Other Missing 111 512 106 488

MOSAIC AggregateArrival Mode

EMS Private Mode

Table 2 Door-to-Needle Times by Arrival Mode among Stroke Cases MOSAIC 2016

Time Elements (in Minutes)Number of

Patients Mean (Minutes) Median

(Minutes)Range

(Minutes)Door-to-Image 4901 575 400 00-2700 Arrived via EMS 2767 463 270 00-2700 Arrived via Private Transportation 2134 720 570 00-2620

Door-to-Image (among t-PA treated) 492 155 130 00-970 Arrived via EMS 370 125 110 00-840 Arrived via Private Transportation 122 243 215 20-970Image-to Needle 492 500 450 70-2090 Arrived via EMS 370 503 460 70-2090 Arrived via Private Transportation 122 483 420 90-1770Door-to Needle 492 655 570 200-2180 Arrived via EMS 370 629 560 200-2180 Arrived via Private Transportation 122 726 650 290-2060Included ischemic or hemorrhagic cases with times that were less or equal to 270 minutes (45 hours)Transferred cases were excluded

MOSAIC Aggregate

Table 3 Pre-Notification among Stroke Cases Who Arrived Via EMS by Demographics MOSAIC 2016

Demographics N=2015 584 N=1437 416Stroke Type Ischemic 1523 622 924 378 Hemorrhagic 306 566 235 434 TIA 142 381 231 619Age Group lt 50 Years 133 607 86 393 50-79 Years 1105 585 784 415 ge 80 Years 777 578 567 422Sex Female 1075 578 786 422 Male 940 591 651 409Race Black 307 517 287 483 White 1657 602 1097 398 Other 51 490 53 510

All HospitalsPre-Notification

Yes No

MOSAIC Transitions of Care Project

Post-discharge data collection tool is being implemented into Outcome Science as a tab

Post-Discharge amp Transition of Care

Reporting on changes within 30 days of discharge from hospital via follow-up callschart review Interval events Physician follow-up visits Lifestyle changes Lab assessments Medication managementadherence Rehab amp Functional outcomes Falls

MOSAIC Website

wwwMichigangovstroke

Adrienne Nickles MPHnicklesamichigangov

Thank You

  • Michigan and MOSAIC Data Review
  • Overview
  • Age-adjusted Stroke Hospitalization Rates Michigan 2000-2015
  • Slide Number 4
  • Age-adjusted Stroke Mortality Rates Michigan 2000-2014
  • Slide Number 6
  • Slide Number 7
  • Slide Number 8
  • Slide Number 9
  • Slide Number 10
  • Slide Number 11
  • MOSAIC 2015-2020
  • Pre-hospital Care
  • EMSMOSAIC Data Linkage
  • Slide Number 15
  • GWTG Special Initiatives Tab
  • Slide Number 17
  • MOSAIC Participating Hospitals
  • Hospital Infrastructure
  • Case Demographics MOSAIC Registry
  • Who receives data reports on your stroke quality of care
  • 1) In the most recent calendar year have you run additional analyses (beyond what was required for reporting) on your hospitalrsquos own stroke data 2)How frequently have you run and used the analyses generated
  • What is the main reason you do not run your own additional analyses (Select one best answer)
  • In the most recent calendar year what reports did you run
  • How do you use these analyses reports
  • If you run additional analysis what action items QI efforts did you plan as a result of these reports
  • Hospital Arrival Mode Door-to Needle and Pre-Notification Reports 2016
  • Percent of Cases Who Arrived via EMSMOSAIC 2009-2016
  • Table 1 Arrival Mode among Stroke Cases by Demographics MOSAIC 2016
  • Table 2 Door-to-Needle Times by Arrival Mode among Stroke Cases MOSAIC 2016
  • Table 3 Pre-Notification among Stroke Cases Who Arrived Via EMS by Demographics MOSAIC 2016
  • MOSAIC Transitions of Care Project
  • Slide Number 33
  • MOSAIC Website
  • Adrienne Nickles MPHnicklesamichigangov
CVD
Year White Male Black Male White Female Black Female
2000 4276 5424 3033 4161
2001 4066 5524 2813 4091
2002 3928 5468 2767 4114
2003 3734 518 2638 3887
2004 3448 5079 2432 3643
2005 3366 4983 2375 3545
2006 3276 4994 2313 3477
2007 3236 4845 2223 327
2008 3158 4694 2238 3327
change 234 79 237 164
Heart Disease
Year White Male Black Male White Female Black Female
2000 3393 4298 227 3206
2001 3232 4445 2124 3166
2002 3118 4317 2197 3157
2003 2986 4184 1957 3001
2004 2777 3983 1783 2838
2005 2704 4009 1776 2679
2006 2644 3981 1739 2642
2007 2619 3972 1679 2532
2008 2566 3819 1687 2606
Stroke
Year White Male Black Male White Female Black Female
2000 61 768 561 703 176
2001 575 752 539 681 138
2002 573 806 528 66 15
2003 516 662 498 629 147
2004 463 743 476 562
2005 449 663 429 585
2006 434 63 411 556
2007 415 631 392 494
2008 402 606 392 509
2009 375 616 372 464
2010 372 565 366 513
2011 373 548 366 44
2012 348 587 349 477
2013 347 506 34 462
2014 369 506 352 482
Coronary Heart Disease
Year White Male Black Male White Female Black Female
2000 2625 329 1608 243
2001 2478 3356 1508 2314
2002 2404 3154 1419 2313
2003 2221 3093 1328 209
2004 2067 2956 119 1983
2005 1989 2885 117 1853
2006 1922 2903 1139 1825
2007 1921 2771 1074 1645
2008 1824 2592 1071 1722
Heart Failure
Year White Male Black Male White Female Black Female
2000 255 206 245 17
2001 267 225 225 167
2002 242 238 227 203
2003 256 217 222 189
2004 243 167 214 206
2005 24 218 217 172
2006 255 246 229 202
2007 23 225 208 196
2008 25 216 226 185
Not sure what this data is from previously HD Stroke
Year White Female Black Female White Female Black Female
2000 227 3206 561 703
2001 2124 3166 539 681
2002 2197 3157 528 66
2003 1957 3001 498 629
2004 1783 2838 476 562
2005 1776 2679 429 585
2006 1739 2642 411 556
2007
2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2009 2009 2009 2009
2010 2010 2010 2010
2011 2011 2011 2011
2012 2012 2012 2012
2013 2013 2013 2013
2014 2014 2014 2014
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
CVD
Year US Michigan 0-34 35-64 65-84 85+
2000 3397 3694 43 140 16141 86689
2001 3265 3524 508 1348 15291 82889
2002 3174 3421 45 1338 14891 79536
2003 3061 3258 54 1324 14033 75185
2004 2885 3034 41 1242 13209 69088
2005 2773 2972 48 1283 1291 66011
2006 2898 48 1207 12246 6786
2007 2825 5 1206 1182 66153
2008 2791 43 1175 11619 66406
Heart Disease
Year US Michigan 0-34 35-64 65-84 85+
2000 2576 2851 345 1158 1247 64879
2001 2478 2719 416 112 11794 61938
2002 2408 2631 35 1103 11529 58746
2003 2323 2517 45 110 10827 56172
2004 217 2337 313 1048 10086 51609
2005 2111 2308 38 1078 9937 49828
2006 226 384 1019 9413 51918
2007 2216 42 1008 9174 50961
2008 2192 36 982 904 51209
Stroke
Year US Michigan HP 2010 0-34 35-64 65-84 85+
2000 609 603 50 068 174 2589 15841
2001 579 577 50 0638 157 2522 1504
2002 562 571 50 072 169 2397 1528
2003 535 527 50 0737 157 2249 13741
2004 50 496 50 0652 138 220 12629
2005 466 464 50 0553 145 2063 11398
2006 444 50 0734 127 196 11256
2007 425 064 1368 1832 10718
2008 419 047 134 1804 10646
79 27 243 289
Coronary Heart Disease
Year US Michigan HP 2010 0-34 35-64 65-84 85+
2000 1868 2118 162 0613 874 7701 4670
2001 1778 2006 162 0898 818 9012 44369
2002 1709 192 162 0889 799 8759 41061
2003 1628 179 162 0793 785 8018 38358
2004 1502 1656 162 0865 757 7421 34644
2005 1444 1611 162 097 773 7245 32617
2006 1564 162 088 727 6856 33503
2007 1516 117 709 6585 32727
2008 1472 102 657 6403 32504
168 11 283
Heart Failure
Year US Michigan 35-64 65-84 85+
2000 203 245 3047 936 8287
2001 202 237 2596 88 8285
2002 194 233 2648 878 8057
2003 194 233 3176 902 7722
2004 189 224 2709 863 7586
2005 189 224 2955 878 7388
2006 24 2979 884 8354
2007 219 274 828 7483
2008 233 013 333 85 8102
Heart Disease Stroke
Michigan White Michigan Black US White US Black Michigan White Michigan Black US White US Black
1990 334 4315 317 3915 1990 638 733 629 917
1991 3289 4108 3088 3865 1991 626 781 607 894
1992 3126 3987 3011 3777 1992 609 694 598 86
1993 3234 429 3046 3843 1993 614 77 609 866
1994 3134 4156 295 3661 1994 634 875 609 869
1995 3048 4131 2912 3672 1995 638 925 615 879
1996 2997 380 2842 354 1996 617 804 61 852
1997 2851 3683 2764 345 1997 604 77 598 816
1998 2884 3586 2681 3406 1998 598 729 576 803
1999 2781 3692 2634 3367 1999 609 812 598 824
2000 2757 3663 2536 3265 2000 586 737 587 824
2001 261 3695 2435 3169 2001 56 718 558 788
2002 2522 3659 2367 3084 2002 553 729 542 763
2003 2409 350 2282 3002 2003 511 655 514 743
2004 222 3311 2133 2806 2004 477 633 48 699
2005 219 3227 2005 442 616
2006 2144 320 2006 426 589
2007 2007
2008 2008
CVD CHD HD HF Stroke
2000 3694 2118 2851 245 603
2001 3524 2006 2719 237 577
2002 3421 192 2631 233 571
2003 3258 179 2517 233 527
2004 3034 1656 2337 224 496
2005 2972 1611 2308 224 464
2006 2898 1564 226 24 444
2007 2825 1516 2216 219 425
2008 2791 1472 2192 233 419
2000 2000 2000
2001 2001 2001
2002 2002 2002
2003 2003 2003
2004 2004 2004
2005 2005 2005
2006 2006 2006
2007 2007 2007
2008 2008 2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2000 2000 2000 2000 2000
2001 2001 2001 2001 2001
2002 2002 2002 2002 2002
2003 2003 2003 2003 2003
2004 2004 2004 2004 2004
2005 2005 2005 2005 2005
2006 2006 2006 2006 2006
2007 2007 2007 2007 2007
2008 2008 2008 2008 2008
CVD
Year White Male Black Male White Female Black Female
2000 4276 5424 3033 4161
2001 4066 5524 2813 4091
2002 3928 5468 2767 4114
2003 3734 518 2638 3887
2004 3448 5079 2432 3643
2005 3366 4983 2375 3545
2006 3276 4994 2313 3477
2007 3236 4845 2223 327
2008 3158 4694 2238 3327
change 234 79 237 164
Heart Disease
Year White Male Black Male White Female Black Female
2000 3393 4298 227 3206
2001 3232 4445 2124 3166
2002 3118 4317 2197 3157
2003 2986 4184 1957 3001
2004 2777 3983 1783 2838
2005 2704 4009 1776 2679
2006 2644 3981 1739 2642
2007 2619 3972 1679 2532
2008 2566 3819 1687 2606
Stroke
Year White Male Black Male White Female Black Female
2000 61 768 561 703 176
2001 575 752 539 681 138
2002 573 806 528 66 15
2003 516 662 498 629 147
2004 463 743 476 562
2005 449 663 429 585
2006 434 63 411 556
2007 415 631 392 494
2008 402 606 392 509
Coronary Heart Disease
Year White Male Black Male White Female Black Female
2000 2625 329 1608 243
2001 2478 3356 1508 2314
2002 2404 3154 1419 2313
2003 2221 3093 1328 209
2004 2067 2956 119 1983
2005 1989 2885 117 1853
2006 1922 2903 1139 1825
2007 1921 2771 1074 1645
2008 1824 2592 1071 1722
Heart Failure
Year White Male Black Male White Female Black Female
2000 255 206 245 17
2001 267 225 225 167
2002 242 238 227 203
2003 256 217 222 189
2004 243 167 214 206
2005 24 218 217 172
2006 255 246 229 202
2007 23 225 208 196
2008 25 216 226 185
Not sure what this data is from previously HD Stroke
Year White Female Black Female White Female Black Female
2000 227 3206 561 703
2001 2124 3166 539 681
2002 2197 3157 528 66
2003 1957 3001 498 629
2004 1783 2838 476 562
2005 1776 2679 429 585
2006 1739 2642 411 556
2007
2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
Page 17: Michigan and MOSAIC Data Review...Michigan and MOSAIC Data Review 2017 ANNUAL WORKSHOP 4/26/2017. Adrienne Nickles, MPH. Michigan’s Ongoing Stroke Registry to Accelerate the Improvement

HD_RG

White Male
Black Male
White Female
Black Female
Year
Age-Adjusted Rate per 100000
3393
4298
227
3206
3232
4445
2124
3166
3118
4317
2197
3157
2986
4184
1957
3001
2777
3983
1783
2838
2704
4009
1776
2679
2644
3981
1739
2642
2619
3972
1679
2532
2566
3819
1687
2606

CHD_RG

White Male
Black Male
White Female
Black Female
Year
Age-Adjusted Rate per 100000
2625
329
1608
243
2478
3356
1508
2314
2404
3154
1419
2313
2221
3093
1328
209
2067
2956
119
1983
1989
2885
117
1853
1922
2903
1139
1825
1921
2771
1074
1645
1824
2592
1071
1722

HF_RG

White Male
Black Male
White Female
Black Female
Year
Age-Adjusted Rate per 100000
255
206
245
17
267
225
225
167
242
238
227
203
256
217
222
189
243
167
214
206
24
218
217
172
255
246
229
202
23
225
208
196
25
216
226
185

race_gender

Sheet3

Age-adjusted stroke mortality rates by race and gender Michigan 2000 to 2014

0

10

20

30

40

50

60

70

80

90

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014

Age

-Adj

uste

d R

ate

per 1

000

00

Year

White Male

Black Male

White Female

Black Female

Overall_Rates

CVD
CHD
HD
HF
Stroke
Year
Rate per 10000
3694
2118
2851
245
603
3524
2006
2719
237
577
3421
192
2631
233
571
3258
179
2517
233
527
3034
1656
2337
224
496
2972
1611
2308
224
464
2898
1564
226
24
444
2825
1516
2216
219
425
2791
1472
2192
233
419

CVD_Age

0-34
35-64
65-84
85+
Year
Age-Adjusted Rate per 100000
43
140
16141
86689
508
1348
15291
82889
45
1338
14891
79536
54
1324
14033
75185
41
1242
13209
69088
48
1283
1291
66011
48
1207
12246
6786
5
1206
1182
66153
43
1175
11619
66406

HD_Age

0-34
35-64
65-84
85+
Year
Age-Adjusted Rate per 100000
345
1158
1247
64879
416
112
11794
61938
35
1103
11529
58746
45
110
10827
56172
313
1048
10086
51609
38
1078
9937
49828
384
1019
9413
51918
42
1008
9174
50961
36
982
904
51209

CHD_Age

0-34
35-64
65-84
85+
Year
Age-Adjusted Rate per 100000
0613
874
7701
4670
0898
818
9012
44369
0889
799
8759
41061
0793
785
8018
38358
0865
757
7421
34644
097
773
7245
32617
088
727
6856
33503
117
709
6585
32727
102
657
6403
32504

Stroke_Age

0-34
35-64
65-84
85+
Year
Age-Adjusted Rate per 100000
068
174
2589
15841
0638
157
2522
1504
072
169
2397
1528
0737
157
2249
13741
0652
138
220
12629
0553
145
2063
11398
0734
127
196
11256
064
1368
1832
10718
047
134
1804
10646

HF_Age

35-64
65-84
85+
Year
Age-Adjusted Rate per 100000
3047
936
8287
2596
88
8285
2648
878
8057
3176
902
7722
2709
863
7586
2955
878
7388
2979
884
8354
274
828
7483
333
85
8102

total

CVD_RG

White Male
Black Male
White Female
Black Female
Year
Age-Adjusted Rate per 100000
4276
5424
3033
4161
4066
5524
2813
4091
3928
5468
2767
4114
3734
518
2638
3887
3448
5079
2432
3643
3366
4983
2375
3545
3276
4994
2313
3477
3236
4845
2223
327
3158
4694
2238
3327

Stroke_RG

White Male
Black Male
White Female
Black Female
Year
Age-Adjusted Rate per 100000
61
768
561
703
575
752
539
681
573
806
528
66
516
662
498
629
463
743
476
562
449
663
429
585
434
63
411
556
415
631
392
494
402
606
392
509
375
616
372
464
372
565
366
513
373
548
366
44
348
587
349
477
347
506
34
462
369
506
352
482

HD_RG

White Male
Black Male
White Female
Black Female
Year
Age-Adjusted Rate per 100000
3393
4298
227
3206
3232
4445
2124
3166
3118
4317
2197
3157
2986
4184
1957
3001
2777
3983
1783
2838
2704
4009
1776
2679
2644
3981
1739
2642
2619
3972
1679
2532
2566
3819
1687
2606

CHD_RG

White Male
Black Male
White Female
Black Female
Year
Age-Adjusted Rate per 100000
2625
329
1608
243
2478
3356
1508
2314
2404
3154
1419
2313
2221
3093
1328
209
2067
2956
119
1983
1989
2885
117
1853
1922
2903
1139
1825
1921
2771
1074
1645
1824
2592
1071
1722

HF_RG

White Male
Black Male
White Female
Black Female
Year
Age-Adjusted Rate per 100000
255
206
245
17
267
225
225
167
242
238
227
203
256
217
222
189
243
167
214
206
24
218
217
172
255
246
229
202
23
225
208
196
25
216
226
185

race_gender

Sheet3

Local Health Department data can be found at wwwmichigangovbrfsSource CDC BRFSS

RISK FACTORMI

2011

MI

2013

MI

2014

MI

2015US 2015

2015 NATIONAL RANKING

Current Smoking 233 214 212 207 175 11

Blood Pressure Ever Told High 342 346 NA 331 309 18

Cholesterol Ever Told High 418 406 NA 382 364 12

Overweight (BMIgt25) 342 347 349 351 355 32tied

Obese (BMIgt30) 313 315 307 312 298 16

No Leisure Time Physical Activity 236 244 255 255 262 27

Diabetes 100 104 104 107 100 18tied

Prevalence of CVD Risk Factors Michigan Adults 1990-2015Compared to 2015 National Prevalence

233214 212 207

175

10

15

20

25

30

MI 2011 MI 2013 MI 2014 MI 2015 US 2015

Current Smoking

342 346331

309

20

25

30

35

40

MI 2011 MI 2013 MI 2014 MI 2015 US 2015

Blood Pressure Ever told high

342 347 349 351 355

20

25

30

35

40

MI 2011 MI 2013 MI 2014 MI 2015 US 2015

Overweight (BMIgt25)

313 315 307 312298

20

25

30

35

40

MI 2011 MI 2013 MI 2014 MI 2015 US 2015

Obese (BMIgt30)

418406

382364

30

35

40

45

50

MI 2011 MI 2013 MI 2014 MI 2015 US 2015

Cholesterol Ever told high

10 104 104 10710

0

3

6

9

12

15

MI 2011 MI 2013 MI 2014 MI 2015 US 2015

Diabetes

236 244255 255 262

10

15

20

25

30

MI 2011 MI 2013 MI 2014 MI 2015 US 2015

No Leisure Time Physical Activity

11 1216 18

2732tied

05

101520253035404550

CurrentSmoking

CholesterolEver told high

Obese(BMIgt30)

BloodPressure Ever

told high

Diabetes No LeisureTime Physical

Activity

Overweight(BMIgt25)

2015 NATIONAL RANKING(1st is worst)

18tied

MOSAIC 2015-2020 Focus of Grant Developing Stroke Systems of

Care Community Awareness EMS In-hospital QI Transition of Care Post-Discharge

12

Pre-hospital Care

A V A I L A B L E D A T A

13

EMSMOSAIC Data Linkage

-The MOSAIC Team continues to link data from the Michigan EMS Information System (MiEMSIS) to MOSAIC Data- Reports have been created for and reviewed by the

Tri-County Area MCA and Detroit East MCA- This work will expand to other MCA regions that

serve hospitals participating in MOSAIC

GWTG Special Initiatives Tab

-A free tab that can be enabled in GWTG-The purpose of the tab is to collect data concerning patient hand-off from EMS

MOSAIC Participating Hospitals

Aspirus Keweenaw Hospital (Laurium)

Aspirus Grand View HospitalAspirus Iron River HospitalAspirus Ontonagon HospitalBixby Medical CenterBronson Methodist HospitalCovenant Health CareDetroit Receiving HospitalGenesys Regional Medical CenterHenry Ford Hospital Herrick Medical CenterHuron Valley-Sinai HospitalLakeland Regional Medical Center McLaren Bay Regional Medical CenterMcLaren Greater Medical Center

McLaren Macomb HospitalMcLaren Northern MI HospitalMcLaren Oakland Medical CenterMcLaren Port Huron HospitalMcLaren Regional Medical CenterMercy Health Saint Maryrsquos HospitalMetro Health HospitalMunson Medical Center

ProMedica Monroe Regional HospitalSparrow HospitalSt Joseph Mercy - Ann ArborSt Joseph Mercy ChelseaSt Joseph Mercy Livingston HospitalSt Mary MercySt Mary of Michigan HospitalU of M Hospital

Hospital Infrastructure19

Among all participating hospitals the average number of

Licensed beds was 374 (range 25 to 1059 beds)

Inpatient discharges was 17076 (range 1064 to 48916 patients)

Acute stroke discharges (primary diagnosis only) was 417 (range 34 to 982 patients)

Case Demographics MOSAIC Registry

VariablesN() or statistics(Total N=68906)

Age at admission (years)Median 710Range 180 - 1060Mean (SE) 697(01)

GenderMale 32886 (477)Female 36015 (523)

RaceAfrican American 9900 (197)AIAN 132 (03)Asian 320 (06)More than one race 44 (01)Unknown 3679 (73)White 36190 (720)Missing 70

EthnicityHispanic or Latino 804 (16)Others 49531 (984)

VariablesN() or statistics(Total N=68906)

Health insuranceMedicaid 2284 (45)MedicaidPrivate 211 (04)Medicare 16863 (336)Medicare Medicaid 2313 (46)

MedicareMedicaidPrivate125 (02)

MedicarePrivate 13640 (272)ND 268(05)No insurance 2123 (42)Private 12356 (246)

Arrival modeEMS 21052 (429)Private

transportationother19313 (393)

Transfer from another hospital

7733(157)

ND or unknown 1021 (21)Missing 1216

Who receives data reports on your stroke quality of care

21

7055

70

10085

65

40

Hos

pita

lC

EO

up

per

man

agem

ent

Hos

pita

lB

oard

Chi

efN

ursi

ngO

ffice

r(C

NO

)

Str

oke

Tea

m

Phy

sici

anS

trok

eC

ham

pion

Chi

ef o

fM

edic

ine

Oth

er

Data Use

1) In the most recent calendar year have you run additional analyses (beyond what was required for reporting) on your hospitalrsquos own stroke data

2)How frequently have you run and used the analyses generated

22

Yes (N=16) 80

No (N=4) 20Weekly (N=2) 125

Monthly (N=8) 500

Less than monthly but more

than 1-2 times(N=6) 375

Data Use

What is the main reason you do not run your own additional analyses (Select one best answer)

23

Not sure how to run analyses

25

Not sure what analyses are needed would be helpful 25

Other 50

Data Use

In the most recent calendar year what reports did you run

24

813 688

Pre-programmedautomated reports in thedata collection tool (eg GWTG)

Additional reports beyond pre-programmed reports from the tool

Data Use

How do you use these analyses reports

25

813 688375

Inform quality improvement (QI) efforts andor plan

ldquoaction itemsrdquo

Report to management administration on our

progress

Other

Data Use

If you run additional analysis what action items QI efforts did you plan as a result of these reports

26

o Discharge education intensive statin use

o Door to tPA time and dysphagia

o Review data between spoke amp hub hospitals regarding transfers IV-tPA administration Mechanical thrombectomy and SAH

o QI efforts were addressed in the department involving calling Stroke Alert on call for cases with FAST symptoms

o ED Medical Director works with team to fix fallouts and problematic areas We have seen improvement

o Process changes (ie fallout emails to RN manager) physician querieso Increased documentation of NIHSS ownership from individual units regarding stroke quality

improvement goalso Daily dysphagia screening determination of whowhat team responsible for documenting initial NIHSS

looking at patients beyond 2h LKW arrival

Hospital Arrival Mode Door-to Needle and Pre-Notification

Reports 2016

Percent of Cases Who Arrived via EMSMOSAIC 2009-2016

Table 1 Arrival Mode among Stroke Cases by Demographics MOSAIC 2016

Demographics N=3496 550 N=2938 450Stroke Type Ischemic 2558 542 2164 458 Hemorrhagic 560 728 209 272 TIA 378 478 413 522Age Group lt 50 Years 233 433 305 567 50-79 Years 1982 497 2008 503 ge 80 Years 1379 688 625 312Sex Female 1933 576 1422 424 Male 1661 523 1516 477Race Black 659 530 584 470 White 2824 557 2248 443 Other Missing 111 512 106 488

MOSAIC AggregateArrival Mode

EMS Private Mode

Table 2 Door-to-Needle Times by Arrival Mode among Stroke Cases MOSAIC 2016

Time Elements (in Minutes)Number of

Patients Mean (Minutes) Median

(Minutes)Range

(Minutes)Door-to-Image 4901 575 400 00-2700 Arrived via EMS 2767 463 270 00-2700 Arrived via Private Transportation 2134 720 570 00-2620

Door-to-Image (among t-PA treated) 492 155 130 00-970 Arrived via EMS 370 125 110 00-840 Arrived via Private Transportation 122 243 215 20-970Image-to Needle 492 500 450 70-2090 Arrived via EMS 370 503 460 70-2090 Arrived via Private Transportation 122 483 420 90-1770Door-to Needle 492 655 570 200-2180 Arrived via EMS 370 629 560 200-2180 Arrived via Private Transportation 122 726 650 290-2060Included ischemic or hemorrhagic cases with times that were less or equal to 270 minutes (45 hours)Transferred cases were excluded

MOSAIC Aggregate

Table 3 Pre-Notification among Stroke Cases Who Arrived Via EMS by Demographics MOSAIC 2016

Demographics N=2015 584 N=1437 416Stroke Type Ischemic 1523 622 924 378 Hemorrhagic 306 566 235 434 TIA 142 381 231 619Age Group lt 50 Years 133 607 86 393 50-79 Years 1105 585 784 415 ge 80 Years 777 578 567 422Sex Female 1075 578 786 422 Male 940 591 651 409Race Black 307 517 287 483 White 1657 602 1097 398 Other 51 490 53 510

All HospitalsPre-Notification

Yes No

MOSAIC Transitions of Care Project

Post-discharge data collection tool is being implemented into Outcome Science as a tab

Post-Discharge amp Transition of Care

Reporting on changes within 30 days of discharge from hospital via follow-up callschart review Interval events Physician follow-up visits Lifestyle changes Lab assessments Medication managementadherence Rehab amp Functional outcomes Falls

MOSAIC Website

wwwMichigangovstroke

Adrienne Nickles MPHnicklesamichigangov

Thank You

  • Michigan and MOSAIC Data Review
  • Overview
  • Age-adjusted Stroke Hospitalization Rates Michigan 2000-2015
  • Slide Number 4
  • Age-adjusted Stroke Mortality Rates Michigan 2000-2014
  • Slide Number 6
  • Slide Number 7
  • Slide Number 8
  • Slide Number 9
  • Slide Number 10
  • Slide Number 11
  • MOSAIC 2015-2020
  • Pre-hospital Care
  • EMSMOSAIC Data Linkage
  • Slide Number 15
  • GWTG Special Initiatives Tab
  • Slide Number 17
  • MOSAIC Participating Hospitals
  • Hospital Infrastructure
  • Case Demographics MOSAIC Registry
  • Who receives data reports on your stroke quality of care
  • 1) In the most recent calendar year have you run additional analyses (beyond what was required for reporting) on your hospitalrsquos own stroke data 2)How frequently have you run and used the analyses generated
  • What is the main reason you do not run your own additional analyses (Select one best answer)
  • In the most recent calendar year what reports did you run
  • How do you use these analyses reports
  • If you run additional analysis what action items QI efforts did you plan as a result of these reports
  • Hospital Arrival Mode Door-to Needle and Pre-Notification Reports 2016
  • Percent of Cases Who Arrived via EMSMOSAIC 2009-2016
  • Table 1 Arrival Mode among Stroke Cases by Demographics MOSAIC 2016
  • Table 2 Door-to-Needle Times by Arrival Mode among Stroke Cases MOSAIC 2016
  • Table 3 Pre-Notification among Stroke Cases Who Arrived Via EMS by Demographics MOSAIC 2016
  • MOSAIC Transitions of Care Project
  • Slide Number 33
  • MOSAIC Website
  • Adrienne Nickles MPHnicklesamichigangov
CVD
Year White Male Black Male White Female Black Female
2000 4276 5424 3033 4161
2001 4066 5524 2813 4091
2002 3928 5468 2767 4114
2003 3734 518 2638 3887
2004 3448 5079 2432 3643
2005 3366 4983 2375 3545
2006 3276 4994 2313 3477
2007 3236 4845 2223 327
2008 3158 4694 2238 3327
change 234 79 237 164
Heart Disease
Year White Male Black Male White Female Black Female
2000 3393 4298 227 3206
2001 3232 4445 2124 3166
2002 3118 4317 2197 3157
2003 2986 4184 1957 3001
2004 2777 3983 1783 2838
2005 2704 4009 1776 2679
2006 2644 3981 1739 2642
2007 2619 3972 1679 2532
2008 2566 3819 1687 2606
Stroke
Year White Male Black Male White Female Black Female
2000 61 768 561 703 176
2001 575 752 539 681 138
2002 573 806 528 66 15
2003 516 662 498 629 147
2004 463 743 476 562
2005 449 663 429 585
2006 434 63 411 556
2007 415 631 392 494
2008 402 606 392 509
2009 375 616 372 464
2010 372 565 366 513
2011 373 548 366 44
2012 348 587 349 477
2013 347 506 34 462
2014 369 506 352 482
Coronary Heart Disease
Year White Male Black Male White Female Black Female
2000 2625 329 1608 243
2001 2478 3356 1508 2314
2002 2404 3154 1419 2313
2003 2221 3093 1328 209
2004 2067 2956 119 1983
2005 1989 2885 117 1853
2006 1922 2903 1139 1825
2007 1921 2771 1074 1645
2008 1824 2592 1071 1722
Heart Failure
Year White Male Black Male White Female Black Female
2000 255 206 245 17
2001 267 225 225 167
2002 242 238 227 203
2003 256 217 222 189
2004 243 167 214 206
2005 24 218 217 172
2006 255 246 229 202
2007 23 225 208 196
2008 25 216 226 185
Not sure what this data is from previously HD Stroke
Year White Female Black Female White Female Black Female
2000 227 3206 561 703
2001 2124 3166 539 681
2002 2197 3157 528 66
2003 1957 3001 498 629
2004 1783 2838 476 562
2005 1776 2679 429 585
2006 1739 2642 411 556
2007
2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2009 2009 2009 2009
2010 2010 2010 2010
2011 2011 2011 2011
2012 2012 2012 2012
2013 2013 2013 2013
2014 2014 2014 2014
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
CVD
Year US Michigan 0-34 35-64 65-84 85+
2000 3397 3694 43 140 16141 86689
2001 3265 3524 508 1348 15291 82889
2002 3174 3421 45 1338 14891 79536
2003 3061 3258 54 1324 14033 75185
2004 2885 3034 41 1242 13209 69088
2005 2773 2972 48 1283 1291 66011
2006 2898 48 1207 12246 6786
2007 2825 5 1206 1182 66153
2008 2791 43 1175 11619 66406
Heart Disease
Year US Michigan 0-34 35-64 65-84 85+
2000 2576 2851 345 1158 1247 64879
2001 2478 2719 416 112 11794 61938
2002 2408 2631 35 1103 11529 58746
2003 2323 2517 45 110 10827 56172
2004 217 2337 313 1048 10086 51609
2005 2111 2308 38 1078 9937 49828
2006 226 384 1019 9413 51918
2007 2216 42 1008 9174 50961
2008 2192 36 982 904 51209
Stroke
Year US Michigan HP 2010 0-34 35-64 65-84 85+
2000 609 603 50 068 174 2589 15841
2001 579 577 50 0638 157 2522 1504
2002 562 571 50 072 169 2397 1528
2003 535 527 50 0737 157 2249 13741
2004 50 496 50 0652 138 220 12629
2005 466 464 50 0553 145 2063 11398
2006 444 50 0734 127 196 11256
2007 425 064 1368 1832 10718
2008 419 047 134 1804 10646
79 27 243 289
Coronary Heart Disease
Year US Michigan HP 2010 0-34 35-64 65-84 85+
2000 1868 2118 162 0613 874 7701 4670
2001 1778 2006 162 0898 818 9012 44369
2002 1709 192 162 0889 799 8759 41061
2003 1628 179 162 0793 785 8018 38358
2004 1502 1656 162 0865 757 7421 34644
2005 1444 1611 162 097 773 7245 32617
2006 1564 162 088 727 6856 33503
2007 1516 117 709 6585 32727
2008 1472 102 657 6403 32504
168 11 283
Heart Failure
Year US Michigan 35-64 65-84 85+
2000 203 245 3047 936 8287
2001 202 237 2596 88 8285
2002 194 233 2648 878 8057
2003 194 233 3176 902 7722
2004 189 224 2709 863 7586
2005 189 224 2955 878 7388
2006 24 2979 884 8354
2007 219 274 828 7483
2008 233 013 333 85 8102
Heart Disease Stroke
Michigan White Michigan Black US White US Black Michigan White Michigan Black US White US Black
1990 334 4315 317 3915 1990 638 733 629 917
1991 3289 4108 3088 3865 1991 626 781 607 894
1992 3126 3987 3011 3777 1992 609 694 598 86
1993 3234 429 3046 3843 1993 614 77 609 866
1994 3134 4156 295 3661 1994 634 875 609 869
1995 3048 4131 2912 3672 1995 638 925 615 879
1996 2997 380 2842 354 1996 617 804 61 852
1997 2851 3683 2764 345 1997 604 77 598 816
1998 2884 3586 2681 3406 1998 598 729 576 803
1999 2781 3692 2634 3367 1999 609 812 598 824
2000 2757 3663 2536 3265 2000 586 737 587 824
2001 261 3695 2435 3169 2001 56 718 558 788
2002 2522 3659 2367 3084 2002 553 729 542 763
2003 2409 350 2282 3002 2003 511 655 514 743
2004 222 3311 2133 2806 2004 477 633 48 699
2005 219 3227 2005 442 616
2006 2144 320 2006 426 589
2007 2007
2008 2008
CVD CHD HD HF Stroke
2000 3694 2118 2851 245 603
2001 3524 2006 2719 237 577
2002 3421 192 2631 233 571
2003 3258 179 2517 233 527
2004 3034 1656 2337 224 496
2005 2972 1611 2308 224 464
2006 2898 1564 226 24 444
2007 2825 1516 2216 219 425
2008 2791 1472 2192 233 419
2000 2000 2000
2001 2001 2001
2002 2002 2002
2003 2003 2003
2004 2004 2004
2005 2005 2005
2006 2006 2006
2007 2007 2007
2008 2008 2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2000 2000 2000 2000 2000
2001 2001 2001 2001 2001
2002 2002 2002 2002 2002
2003 2003 2003 2003 2003
2004 2004 2004 2004 2004
2005 2005 2005 2005 2005
2006 2006 2006 2006 2006
2007 2007 2007 2007 2007
2008 2008 2008 2008 2008
CVD
Year White Male Black Male White Female Black Female
2000 4276 5424 3033 4161
2001 4066 5524 2813 4091
2002 3928 5468 2767 4114
2003 3734 518 2638 3887
2004 3448 5079 2432 3643
2005 3366 4983 2375 3545
2006 3276 4994 2313 3477
2007 3236 4845 2223 327
2008 3158 4694 2238 3327
change 234 79 237 164
Heart Disease
Year White Male Black Male White Female Black Female
2000 3393 4298 227 3206
2001 3232 4445 2124 3166
2002 3118 4317 2197 3157
2003 2986 4184 1957 3001
2004 2777 3983 1783 2838
2005 2704 4009 1776 2679
2006 2644 3981 1739 2642
2007 2619 3972 1679 2532
2008 2566 3819 1687 2606
Stroke
Year White Male Black Male White Female Black Female
2000 61 768 561 703 176
2001 575 752 539 681 138
2002 573 806 528 66 15
2003 516 662 498 629 147
2004 463 743 476 562
2005 449 663 429 585
2006 434 63 411 556
2007 415 631 392 494
2008 402 606 392 509
Coronary Heart Disease
Year White Male Black Male White Female Black Female
2000 2625 329 1608 243
2001 2478 3356 1508 2314
2002 2404 3154 1419 2313
2003 2221 3093 1328 209
2004 2067 2956 119 1983
2005 1989 2885 117 1853
2006 1922 2903 1139 1825
2007 1921 2771 1074 1645
2008 1824 2592 1071 1722
Heart Failure
Year White Male Black Male White Female Black Female
2000 255 206 245 17
2001 267 225 225 167
2002 242 238 227 203
2003 256 217 222 189
2004 243 167 214 206
2005 24 218 217 172
2006 255 246 229 202
2007 23 225 208 196
2008 25 216 226 185
Not sure what this data is from previously HD Stroke
Year White Female Black Female White Female Black Female
2000 227 3206 561 703
2001 2124 3166 539 681
2002 2197 3157 528 66
2003 1957 3001 498 629
2004 1783 2838 476 562
2005 1776 2679 429 585
2006 1739 2642 411 556
2007
2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
Page 18: Michigan and MOSAIC Data Review...Michigan and MOSAIC Data Review 2017 ANNUAL WORKSHOP 4/26/2017. Adrienne Nickles, MPH. Michigan’s Ongoing Stroke Registry to Accelerate the Improvement

CHD_RG

White Male
Black Male
White Female
Black Female
Year
Age-Adjusted Rate per 100000
2625
329
1608
243
2478
3356
1508
2314
2404
3154
1419
2313
2221
3093
1328
209
2067
2956
119
1983
1989
2885
117
1853
1922
2903
1139
1825
1921
2771
1074
1645
1824
2592
1071
1722

HF_RG

White Male
Black Male
White Female
Black Female
Year
Age-Adjusted Rate per 100000
255
206
245
17
267
225
225
167
242
238
227
203
256
217
222
189
243
167
214
206
24
218
217
172
255
246
229
202
23
225
208
196
25
216
226
185

race_gender

Sheet3

Age-adjusted stroke mortality rates by race and gender Michigan 2000 to 2014

0

10

20

30

40

50

60

70

80

90

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014

Age

-Adj

uste

d R

ate

per 1

000

00

Year

White Male

Black Male

White Female

Black Female

Overall_Rates

CVD
CHD
HD
HF
Stroke
Year
Rate per 10000
3694
2118
2851
245
603
3524
2006
2719
237
577
3421
192
2631
233
571
3258
179
2517
233
527
3034
1656
2337
224
496
2972
1611
2308
224
464
2898
1564
226
24
444
2825
1516
2216
219
425
2791
1472
2192
233
419

CVD_Age

0-34
35-64
65-84
85+
Year
Age-Adjusted Rate per 100000
43
140
16141
86689
508
1348
15291
82889
45
1338
14891
79536
54
1324
14033
75185
41
1242
13209
69088
48
1283
1291
66011
48
1207
12246
6786
5
1206
1182
66153
43
1175
11619
66406

HD_Age

0-34
35-64
65-84
85+
Year
Age-Adjusted Rate per 100000
345
1158
1247
64879
416
112
11794
61938
35
1103
11529
58746
45
110
10827
56172
313
1048
10086
51609
38
1078
9937
49828
384
1019
9413
51918
42
1008
9174
50961
36
982
904
51209

CHD_Age

0-34
35-64
65-84
85+
Year
Age-Adjusted Rate per 100000
0613
874
7701
4670
0898
818
9012
44369
0889
799
8759
41061
0793
785
8018
38358
0865
757
7421
34644
097
773
7245
32617
088
727
6856
33503
117
709
6585
32727
102
657
6403
32504

Stroke_Age

0-34
35-64
65-84
85+
Year
Age-Adjusted Rate per 100000
068
174
2589
15841
0638
157
2522
1504
072
169
2397
1528
0737
157
2249
13741
0652
138
220
12629
0553
145
2063
11398
0734
127
196
11256
064
1368
1832
10718
047
134
1804
10646

HF_Age

35-64
65-84
85+
Year
Age-Adjusted Rate per 100000
3047
936
8287
2596
88
8285
2648
878
8057
3176
902
7722
2709
863
7586
2955
878
7388
2979
884
8354
274
828
7483
333
85
8102

total

CVD_RG

White Male
Black Male
White Female
Black Female
Year
Age-Adjusted Rate per 100000
4276
5424
3033
4161
4066
5524
2813
4091
3928
5468
2767
4114
3734
518
2638
3887
3448
5079
2432
3643
3366
4983
2375
3545
3276
4994
2313
3477
3236
4845
2223
327
3158
4694
2238
3327

Stroke_RG

White Male
Black Male
White Female
Black Female
Year
Age-Adjusted Rate per 100000
61
768
561
703
575
752
539
681
573
806
528
66
516
662
498
629
463
743
476
562
449
663
429
585
434
63
411
556
415
631
392
494
402
606
392
509
375
616
372
464
372
565
366
513
373
548
366
44
348
587
349
477
347
506
34
462
369
506
352
482

HD_RG

White Male
Black Male
White Female
Black Female
Year
Age-Adjusted Rate per 100000
3393
4298
227
3206
3232
4445
2124
3166
3118
4317
2197
3157
2986
4184
1957
3001
2777
3983
1783
2838
2704
4009
1776
2679
2644
3981
1739
2642
2619
3972
1679
2532
2566
3819
1687
2606

CHD_RG

White Male
Black Male
White Female
Black Female
Year
Age-Adjusted Rate per 100000
2625
329
1608
243
2478
3356
1508
2314
2404
3154
1419
2313
2221
3093
1328
209
2067
2956
119
1983
1989
2885
117
1853
1922
2903
1139
1825
1921
2771
1074
1645
1824
2592
1071
1722

HF_RG

White Male
Black Male
White Female
Black Female
Year
Age-Adjusted Rate per 100000
255
206
245
17
267
225
225
167
242
238
227
203
256
217
222
189
243
167
214
206
24
218
217
172
255
246
229
202
23
225
208
196
25
216
226
185

race_gender

Sheet3

Local Health Department data can be found at wwwmichigangovbrfsSource CDC BRFSS

RISK FACTORMI

2011

MI

2013

MI

2014

MI

2015US 2015

2015 NATIONAL RANKING

Current Smoking 233 214 212 207 175 11

Blood Pressure Ever Told High 342 346 NA 331 309 18

Cholesterol Ever Told High 418 406 NA 382 364 12

Overweight (BMIgt25) 342 347 349 351 355 32tied

Obese (BMIgt30) 313 315 307 312 298 16

No Leisure Time Physical Activity 236 244 255 255 262 27

Diabetes 100 104 104 107 100 18tied

Prevalence of CVD Risk Factors Michigan Adults 1990-2015Compared to 2015 National Prevalence

233214 212 207

175

10

15

20

25

30

MI 2011 MI 2013 MI 2014 MI 2015 US 2015

Current Smoking

342 346331

309

20

25

30

35

40

MI 2011 MI 2013 MI 2014 MI 2015 US 2015

Blood Pressure Ever told high

342 347 349 351 355

20

25

30

35

40

MI 2011 MI 2013 MI 2014 MI 2015 US 2015

Overweight (BMIgt25)

313 315 307 312298

20

25

30

35

40

MI 2011 MI 2013 MI 2014 MI 2015 US 2015

Obese (BMIgt30)

418406

382364

30

35

40

45

50

MI 2011 MI 2013 MI 2014 MI 2015 US 2015

Cholesterol Ever told high

10 104 104 10710

0

3

6

9

12

15

MI 2011 MI 2013 MI 2014 MI 2015 US 2015

Diabetes

236 244255 255 262

10

15

20

25

30

MI 2011 MI 2013 MI 2014 MI 2015 US 2015

No Leisure Time Physical Activity

11 1216 18

2732tied

05

101520253035404550

CurrentSmoking

CholesterolEver told high

Obese(BMIgt30)

BloodPressure Ever

told high

Diabetes No LeisureTime Physical

Activity

Overweight(BMIgt25)

2015 NATIONAL RANKING(1st is worst)

18tied

MOSAIC 2015-2020 Focus of Grant Developing Stroke Systems of

Care Community Awareness EMS In-hospital QI Transition of Care Post-Discharge

12

Pre-hospital Care

A V A I L A B L E D A T A

13

EMSMOSAIC Data Linkage

-The MOSAIC Team continues to link data from the Michigan EMS Information System (MiEMSIS) to MOSAIC Data- Reports have been created for and reviewed by the

Tri-County Area MCA and Detroit East MCA- This work will expand to other MCA regions that

serve hospitals participating in MOSAIC

GWTG Special Initiatives Tab

-A free tab that can be enabled in GWTG-The purpose of the tab is to collect data concerning patient hand-off from EMS

MOSAIC Participating Hospitals

Aspirus Keweenaw Hospital (Laurium)

Aspirus Grand View HospitalAspirus Iron River HospitalAspirus Ontonagon HospitalBixby Medical CenterBronson Methodist HospitalCovenant Health CareDetroit Receiving HospitalGenesys Regional Medical CenterHenry Ford Hospital Herrick Medical CenterHuron Valley-Sinai HospitalLakeland Regional Medical Center McLaren Bay Regional Medical CenterMcLaren Greater Medical Center

McLaren Macomb HospitalMcLaren Northern MI HospitalMcLaren Oakland Medical CenterMcLaren Port Huron HospitalMcLaren Regional Medical CenterMercy Health Saint Maryrsquos HospitalMetro Health HospitalMunson Medical Center

ProMedica Monroe Regional HospitalSparrow HospitalSt Joseph Mercy - Ann ArborSt Joseph Mercy ChelseaSt Joseph Mercy Livingston HospitalSt Mary MercySt Mary of Michigan HospitalU of M Hospital

Hospital Infrastructure19

Among all participating hospitals the average number of

Licensed beds was 374 (range 25 to 1059 beds)

Inpatient discharges was 17076 (range 1064 to 48916 patients)

Acute stroke discharges (primary diagnosis only) was 417 (range 34 to 982 patients)

Case Demographics MOSAIC Registry

VariablesN() or statistics(Total N=68906)

Age at admission (years)Median 710Range 180 - 1060Mean (SE) 697(01)

GenderMale 32886 (477)Female 36015 (523)

RaceAfrican American 9900 (197)AIAN 132 (03)Asian 320 (06)More than one race 44 (01)Unknown 3679 (73)White 36190 (720)Missing 70

EthnicityHispanic or Latino 804 (16)Others 49531 (984)

VariablesN() or statistics(Total N=68906)

Health insuranceMedicaid 2284 (45)MedicaidPrivate 211 (04)Medicare 16863 (336)Medicare Medicaid 2313 (46)

MedicareMedicaidPrivate125 (02)

MedicarePrivate 13640 (272)ND 268(05)No insurance 2123 (42)Private 12356 (246)

Arrival modeEMS 21052 (429)Private

transportationother19313 (393)

Transfer from another hospital

7733(157)

ND or unknown 1021 (21)Missing 1216

Who receives data reports on your stroke quality of care

21

7055

70

10085

65

40

Hos

pita

lC

EO

up

per

man

agem

ent

Hos

pita

lB

oard

Chi

efN

ursi

ngO

ffice

r(C

NO

)

Str

oke

Tea

m

Phy

sici

anS

trok

eC

ham

pion

Chi

ef o

fM

edic

ine

Oth

er

Data Use

1) In the most recent calendar year have you run additional analyses (beyond what was required for reporting) on your hospitalrsquos own stroke data

2)How frequently have you run and used the analyses generated

22

Yes (N=16) 80

No (N=4) 20Weekly (N=2) 125

Monthly (N=8) 500

Less than monthly but more

than 1-2 times(N=6) 375

Data Use

What is the main reason you do not run your own additional analyses (Select one best answer)

23

Not sure how to run analyses

25

Not sure what analyses are needed would be helpful 25

Other 50

Data Use

In the most recent calendar year what reports did you run

24

813 688

Pre-programmedautomated reports in thedata collection tool (eg GWTG)

Additional reports beyond pre-programmed reports from the tool

Data Use

How do you use these analyses reports

25

813 688375

Inform quality improvement (QI) efforts andor plan

ldquoaction itemsrdquo

Report to management administration on our

progress

Other

Data Use

If you run additional analysis what action items QI efforts did you plan as a result of these reports

26

o Discharge education intensive statin use

o Door to tPA time and dysphagia

o Review data between spoke amp hub hospitals regarding transfers IV-tPA administration Mechanical thrombectomy and SAH

o QI efforts were addressed in the department involving calling Stroke Alert on call for cases with FAST symptoms

o ED Medical Director works with team to fix fallouts and problematic areas We have seen improvement

o Process changes (ie fallout emails to RN manager) physician querieso Increased documentation of NIHSS ownership from individual units regarding stroke quality

improvement goalso Daily dysphagia screening determination of whowhat team responsible for documenting initial NIHSS

looking at patients beyond 2h LKW arrival

Hospital Arrival Mode Door-to Needle and Pre-Notification

Reports 2016

Percent of Cases Who Arrived via EMSMOSAIC 2009-2016

Table 1 Arrival Mode among Stroke Cases by Demographics MOSAIC 2016

Demographics N=3496 550 N=2938 450Stroke Type Ischemic 2558 542 2164 458 Hemorrhagic 560 728 209 272 TIA 378 478 413 522Age Group lt 50 Years 233 433 305 567 50-79 Years 1982 497 2008 503 ge 80 Years 1379 688 625 312Sex Female 1933 576 1422 424 Male 1661 523 1516 477Race Black 659 530 584 470 White 2824 557 2248 443 Other Missing 111 512 106 488

MOSAIC AggregateArrival Mode

EMS Private Mode

Table 2 Door-to-Needle Times by Arrival Mode among Stroke Cases MOSAIC 2016

Time Elements (in Minutes)Number of

Patients Mean (Minutes) Median

(Minutes)Range

(Minutes)Door-to-Image 4901 575 400 00-2700 Arrived via EMS 2767 463 270 00-2700 Arrived via Private Transportation 2134 720 570 00-2620

Door-to-Image (among t-PA treated) 492 155 130 00-970 Arrived via EMS 370 125 110 00-840 Arrived via Private Transportation 122 243 215 20-970Image-to Needle 492 500 450 70-2090 Arrived via EMS 370 503 460 70-2090 Arrived via Private Transportation 122 483 420 90-1770Door-to Needle 492 655 570 200-2180 Arrived via EMS 370 629 560 200-2180 Arrived via Private Transportation 122 726 650 290-2060Included ischemic or hemorrhagic cases with times that were less or equal to 270 minutes (45 hours)Transferred cases were excluded

MOSAIC Aggregate

Table 3 Pre-Notification among Stroke Cases Who Arrived Via EMS by Demographics MOSAIC 2016

Demographics N=2015 584 N=1437 416Stroke Type Ischemic 1523 622 924 378 Hemorrhagic 306 566 235 434 TIA 142 381 231 619Age Group lt 50 Years 133 607 86 393 50-79 Years 1105 585 784 415 ge 80 Years 777 578 567 422Sex Female 1075 578 786 422 Male 940 591 651 409Race Black 307 517 287 483 White 1657 602 1097 398 Other 51 490 53 510

All HospitalsPre-Notification

Yes No

MOSAIC Transitions of Care Project

Post-discharge data collection tool is being implemented into Outcome Science as a tab

Post-Discharge amp Transition of Care

Reporting on changes within 30 days of discharge from hospital via follow-up callschart review Interval events Physician follow-up visits Lifestyle changes Lab assessments Medication managementadherence Rehab amp Functional outcomes Falls

MOSAIC Website

wwwMichigangovstroke

Adrienne Nickles MPHnicklesamichigangov

Thank You

  • Michigan and MOSAIC Data Review
  • Overview
  • Age-adjusted Stroke Hospitalization Rates Michigan 2000-2015
  • Slide Number 4
  • Age-adjusted Stroke Mortality Rates Michigan 2000-2014
  • Slide Number 6
  • Slide Number 7
  • Slide Number 8
  • Slide Number 9
  • Slide Number 10
  • Slide Number 11
  • MOSAIC 2015-2020
  • Pre-hospital Care
  • EMSMOSAIC Data Linkage
  • Slide Number 15
  • GWTG Special Initiatives Tab
  • Slide Number 17
  • MOSAIC Participating Hospitals
  • Hospital Infrastructure
  • Case Demographics MOSAIC Registry
  • Who receives data reports on your stroke quality of care
  • 1) In the most recent calendar year have you run additional analyses (beyond what was required for reporting) on your hospitalrsquos own stroke data 2)How frequently have you run and used the analyses generated
  • What is the main reason you do not run your own additional analyses (Select one best answer)
  • In the most recent calendar year what reports did you run
  • How do you use these analyses reports
  • If you run additional analysis what action items QI efforts did you plan as a result of these reports
  • Hospital Arrival Mode Door-to Needle and Pre-Notification Reports 2016
  • Percent of Cases Who Arrived via EMSMOSAIC 2009-2016
  • Table 1 Arrival Mode among Stroke Cases by Demographics MOSAIC 2016
  • Table 2 Door-to-Needle Times by Arrival Mode among Stroke Cases MOSAIC 2016
  • Table 3 Pre-Notification among Stroke Cases Who Arrived Via EMS by Demographics MOSAIC 2016
  • MOSAIC Transitions of Care Project
  • Slide Number 33
  • MOSAIC Website
  • Adrienne Nickles MPHnicklesamichigangov
CVD
Year White Male Black Male White Female Black Female
2000 4276 5424 3033 4161
2001 4066 5524 2813 4091
2002 3928 5468 2767 4114
2003 3734 518 2638 3887
2004 3448 5079 2432 3643
2005 3366 4983 2375 3545
2006 3276 4994 2313 3477
2007 3236 4845 2223 327
2008 3158 4694 2238 3327
change 234 79 237 164
Heart Disease
Year White Male Black Male White Female Black Female
2000 3393 4298 227 3206
2001 3232 4445 2124 3166
2002 3118 4317 2197 3157
2003 2986 4184 1957 3001
2004 2777 3983 1783 2838
2005 2704 4009 1776 2679
2006 2644 3981 1739 2642
2007 2619 3972 1679 2532
2008 2566 3819 1687 2606
Stroke
Year White Male Black Male White Female Black Female
2000 61 768 561 703 176
2001 575 752 539 681 138
2002 573 806 528 66 15
2003 516 662 498 629 147
2004 463 743 476 562
2005 449 663 429 585
2006 434 63 411 556
2007 415 631 392 494
2008 402 606 392 509
2009 375 616 372 464
2010 372 565 366 513
2011 373 548 366 44
2012 348 587 349 477
2013 347 506 34 462
2014 369 506 352 482
Coronary Heart Disease
Year White Male Black Male White Female Black Female
2000 2625 329 1608 243
2001 2478 3356 1508 2314
2002 2404 3154 1419 2313
2003 2221 3093 1328 209
2004 2067 2956 119 1983
2005 1989 2885 117 1853
2006 1922 2903 1139 1825
2007 1921 2771 1074 1645
2008 1824 2592 1071 1722
Heart Failure
Year White Male Black Male White Female Black Female
2000 255 206 245 17
2001 267 225 225 167
2002 242 238 227 203
2003 256 217 222 189
2004 243 167 214 206
2005 24 218 217 172
2006 255 246 229 202
2007 23 225 208 196
2008 25 216 226 185
Not sure what this data is from previously HD Stroke
Year White Female Black Female White Female Black Female
2000 227 3206 561 703
2001 2124 3166 539 681
2002 2197 3157 528 66
2003 1957 3001 498 629
2004 1783 2838 476 562
2005 1776 2679 429 585
2006 1739 2642 411 556
2007
2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2009 2009 2009 2009
2010 2010 2010 2010
2011 2011 2011 2011
2012 2012 2012 2012
2013 2013 2013 2013
2014 2014 2014 2014
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
CVD
Year US Michigan 0-34 35-64 65-84 85+
2000 3397 3694 43 140 16141 86689
2001 3265 3524 508 1348 15291 82889
2002 3174 3421 45 1338 14891 79536
2003 3061 3258 54 1324 14033 75185
2004 2885 3034 41 1242 13209 69088
2005 2773 2972 48 1283 1291 66011
2006 2898 48 1207 12246 6786
2007 2825 5 1206 1182 66153
2008 2791 43 1175 11619 66406
Heart Disease
Year US Michigan 0-34 35-64 65-84 85+
2000 2576 2851 345 1158 1247 64879
2001 2478 2719 416 112 11794 61938
2002 2408 2631 35 1103 11529 58746
2003 2323 2517 45 110 10827 56172
2004 217 2337 313 1048 10086 51609
2005 2111 2308 38 1078 9937 49828
2006 226 384 1019 9413 51918
2007 2216 42 1008 9174 50961
2008 2192 36 982 904 51209
Stroke
Year US Michigan HP 2010 0-34 35-64 65-84 85+
2000 609 603 50 068 174 2589 15841
2001 579 577 50 0638 157 2522 1504
2002 562 571 50 072 169 2397 1528
2003 535 527 50 0737 157 2249 13741
2004 50 496 50 0652 138 220 12629
2005 466 464 50 0553 145 2063 11398
2006 444 50 0734 127 196 11256
2007 425 064 1368 1832 10718
2008 419 047 134 1804 10646
79 27 243 289
Coronary Heart Disease
Year US Michigan HP 2010 0-34 35-64 65-84 85+
2000 1868 2118 162 0613 874 7701 4670
2001 1778 2006 162 0898 818 9012 44369
2002 1709 192 162 0889 799 8759 41061
2003 1628 179 162 0793 785 8018 38358
2004 1502 1656 162 0865 757 7421 34644
2005 1444 1611 162 097 773 7245 32617
2006 1564 162 088 727 6856 33503
2007 1516 117 709 6585 32727
2008 1472 102 657 6403 32504
168 11 283
Heart Failure
Year US Michigan 35-64 65-84 85+
2000 203 245 3047 936 8287
2001 202 237 2596 88 8285
2002 194 233 2648 878 8057
2003 194 233 3176 902 7722
2004 189 224 2709 863 7586
2005 189 224 2955 878 7388
2006 24 2979 884 8354
2007 219 274 828 7483
2008 233 013 333 85 8102
Heart Disease Stroke
Michigan White Michigan Black US White US Black Michigan White Michigan Black US White US Black
1990 334 4315 317 3915 1990 638 733 629 917
1991 3289 4108 3088 3865 1991 626 781 607 894
1992 3126 3987 3011 3777 1992 609 694 598 86
1993 3234 429 3046 3843 1993 614 77 609 866
1994 3134 4156 295 3661 1994 634 875 609 869
1995 3048 4131 2912 3672 1995 638 925 615 879
1996 2997 380 2842 354 1996 617 804 61 852
1997 2851 3683 2764 345 1997 604 77 598 816
1998 2884 3586 2681 3406 1998 598 729 576 803
1999 2781 3692 2634 3367 1999 609 812 598 824
2000 2757 3663 2536 3265 2000 586 737 587 824
2001 261 3695 2435 3169 2001 56 718 558 788
2002 2522 3659 2367 3084 2002 553 729 542 763
2003 2409 350 2282 3002 2003 511 655 514 743
2004 222 3311 2133 2806 2004 477 633 48 699
2005 219 3227 2005 442 616
2006 2144 320 2006 426 589
2007 2007
2008 2008
CVD CHD HD HF Stroke
2000 3694 2118 2851 245 603
2001 3524 2006 2719 237 577
2002 3421 192 2631 233 571
2003 3258 179 2517 233 527
2004 3034 1656 2337 224 496
2005 2972 1611 2308 224 464
2006 2898 1564 226 24 444
2007 2825 1516 2216 219 425
2008 2791 1472 2192 233 419
2000 2000 2000
2001 2001 2001
2002 2002 2002
2003 2003 2003
2004 2004 2004
2005 2005 2005
2006 2006 2006
2007 2007 2007
2008 2008 2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2000 2000 2000 2000 2000
2001 2001 2001 2001 2001
2002 2002 2002 2002 2002
2003 2003 2003 2003 2003
2004 2004 2004 2004 2004
2005 2005 2005 2005 2005
2006 2006 2006 2006 2006
2007 2007 2007 2007 2007
2008 2008 2008 2008 2008
CVD
Year White Male Black Male White Female Black Female
2000 4276 5424 3033 4161
2001 4066 5524 2813 4091
2002 3928 5468 2767 4114
2003 3734 518 2638 3887
2004 3448 5079 2432 3643
2005 3366 4983 2375 3545
2006 3276 4994 2313 3477
2007 3236 4845 2223 327
2008 3158 4694 2238 3327
change 234 79 237 164
Heart Disease
Year White Male Black Male White Female Black Female
2000 3393 4298 227 3206
2001 3232 4445 2124 3166
2002 3118 4317 2197 3157
2003 2986 4184 1957 3001
2004 2777 3983 1783 2838
2005 2704 4009 1776 2679
2006 2644 3981 1739 2642
2007 2619 3972 1679 2532
2008 2566 3819 1687 2606
Stroke
Year White Male Black Male White Female Black Female
2000 61 768 561 703 176
2001 575 752 539 681 138
2002 573 806 528 66 15
2003 516 662 498 629 147
2004 463 743 476 562
2005 449 663 429 585
2006 434 63 411 556
2007 415 631 392 494
2008 402 606 392 509
Coronary Heart Disease
Year White Male Black Male White Female Black Female
2000 2625 329 1608 243
2001 2478 3356 1508 2314
2002 2404 3154 1419 2313
2003 2221 3093 1328 209
2004 2067 2956 119 1983
2005 1989 2885 117 1853
2006 1922 2903 1139 1825
2007 1921 2771 1074 1645
2008 1824 2592 1071 1722
Heart Failure
Year White Male Black Male White Female Black Female
2000 255 206 245 17
2001 267 225 225 167
2002 242 238 227 203
2003 256 217 222 189
2004 243 167 214 206
2005 24 218 217 172
2006 255 246 229 202
2007 23 225 208 196
2008 25 216 226 185
Not sure what this data is from previously HD Stroke
Year White Female Black Female White Female Black Female
2000 227 3206 561 703
2001 2124 3166 539 681
2002 2197 3157 528 66
2003 1957 3001 498 629
2004 1783 2838 476 562
2005 1776 2679 429 585
2006 1739 2642 411 556
2007
2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
Page 19: Michigan and MOSAIC Data Review...Michigan and MOSAIC Data Review 2017 ANNUAL WORKSHOP 4/26/2017. Adrienne Nickles, MPH. Michigan’s Ongoing Stroke Registry to Accelerate the Improvement

HF_RG

White Male
Black Male
White Female
Black Female
Year
Age-Adjusted Rate per 100000
255
206
245
17
267
225
225
167
242
238
227
203
256
217
222
189
243
167
214
206
24
218
217
172
255
246
229
202
23
225
208
196
25
216
226
185

race_gender

Sheet3

Age-adjusted stroke mortality rates by race and gender Michigan 2000 to 2014

0

10

20

30

40

50

60

70

80

90

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014

Age

-Adj

uste

d R

ate

per 1

000

00

Year

White Male

Black Male

White Female

Black Female

Overall_Rates

CVD
CHD
HD
HF
Stroke
Year
Rate per 10000
3694
2118
2851
245
603
3524
2006
2719
237
577
3421
192
2631
233
571
3258
179
2517
233
527
3034
1656
2337
224
496
2972
1611
2308
224
464
2898
1564
226
24
444
2825
1516
2216
219
425
2791
1472
2192
233
419

CVD_Age

0-34
35-64
65-84
85+
Year
Age-Adjusted Rate per 100000
43
140
16141
86689
508
1348
15291
82889
45
1338
14891
79536
54
1324
14033
75185
41
1242
13209
69088
48
1283
1291
66011
48
1207
12246
6786
5
1206
1182
66153
43
1175
11619
66406

HD_Age

0-34
35-64
65-84
85+
Year
Age-Adjusted Rate per 100000
345
1158
1247
64879
416
112
11794
61938
35
1103
11529
58746
45
110
10827
56172
313
1048
10086
51609
38
1078
9937
49828
384
1019
9413
51918
42
1008
9174
50961
36
982
904
51209

CHD_Age

0-34
35-64
65-84
85+
Year
Age-Adjusted Rate per 100000
0613
874
7701
4670
0898
818
9012
44369
0889
799
8759
41061
0793
785
8018
38358
0865
757
7421
34644
097
773
7245
32617
088
727
6856
33503
117
709
6585
32727
102
657
6403
32504

Stroke_Age

0-34
35-64
65-84
85+
Year
Age-Adjusted Rate per 100000
068
174
2589
15841
0638
157
2522
1504
072
169
2397
1528
0737
157
2249
13741
0652
138
220
12629
0553
145
2063
11398
0734
127
196
11256
064
1368
1832
10718
047
134
1804
10646

HF_Age

35-64
65-84
85+
Year
Age-Adjusted Rate per 100000
3047
936
8287
2596
88
8285
2648
878
8057
3176
902
7722
2709
863
7586
2955
878
7388
2979
884
8354
274
828
7483
333
85
8102

total

CVD_RG

White Male
Black Male
White Female
Black Female
Year
Age-Adjusted Rate per 100000
4276
5424
3033
4161
4066
5524
2813
4091
3928
5468
2767
4114
3734
518
2638
3887
3448
5079
2432
3643
3366
4983
2375
3545
3276
4994
2313
3477
3236
4845
2223
327
3158
4694
2238
3327

Stroke_RG

White Male
Black Male
White Female
Black Female
Year
Age-Adjusted Rate per 100000
61
768
561
703
575
752
539
681
573
806
528
66
516
662
498
629
463
743
476
562
449
663
429
585
434
63
411
556
415
631
392
494
402
606
392
509
375
616
372
464
372
565
366
513
373
548
366
44
348
587
349
477
347
506
34
462
369
506
352
482

HD_RG

White Male
Black Male
White Female
Black Female
Year
Age-Adjusted Rate per 100000
3393
4298
227
3206
3232
4445
2124
3166
3118
4317
2197
3157
2986
4184
1957
3001
2777
3983
1783
2838
2704
4009
1776
2679
2644
3981
1739
2642
2619
3972
1679
2532
2566
3819
1687
2606

CHD_RG

White Male
Black Male
White Female
Black Female
Year
Age-Adjusted Rate per 100000
2625
329
1608
243
2478
3356
1508
2314
2404
3154
1419
2313
2221
3093
1328
209
2067
2956
119
1983
1989
2885
117
1853
1922
2903
1139
1825
1921
2771
1074
1645
1824
2592
1071
1722

HF_RG

White Male
Black Male
White Female
Black Female
Year
Age-Adjusted Rate per 100000
255
206
245
17
267
225
225
167
242
238
227
203
256
217
222
189
243
167
214
206
24
218
217
172
255
246
229
202
23
225
208
196
25
216
226
185

race_gender

Sheet3

Local Health Department data can be found at wwwmichigangovbrfsSource CDC BRFSS

RISK FACTORMI

2011

MI

2013

MI

2014

MI

2015US 2015

2015 NATIONAL RANKING

Current Smoking 233 214 212 207 175 11

Blood Pressure Ever Told High 342 346 NA 331 309 18

Cholesterol Ever Told High 418 406 NA 382 364 12

Overweight (BMIgt25) 342 347 349 351 355 32tied

Obese (BMIgt30) 313 315 307 312 298 16

No Leisure Time Physical Activity 236 244 255 255 262 27

Diabetes 100 104 104 107 100 18tied

Prevalence of CVD Risk Factors Michigan Adults 1990-2015Compared to 2015 National Prevalence

233214 212 207

175

10

15

20

25

30

MI 2011 MI 2013 MI 2014 MI 2015 US 2015

Current Smoking

342 346331

309

20

25

30

35

40

MI 2011 MI 2013 MI 2014 MI 2015 US 2015

Blood Pressure Ever told high

342 347 349 351 355

20

25

30

35

40

MI 2011 MI 2013 MI 2014 MI 2015 US 2015

Overweight (BMIgt25)

313 315 307 312298

20

25

30

35

40

MI 2011 MI 2013 MI 2014 MI 2015 US 2015

Obese (BMIgt30)

418406

382364

30

35

40

45

50

MI 2011 MI 2013 MI 2014 MI 2015 US 2015

Cholesterol Ever told high

10 104 104 10710

0

3

6

9

12

15

MI 2011 MI 2013 MI 2014 MI 2015 US 2015

Diabetes

236 244255 255 262

10

15

20

25

30

MI 2011 MI 2013 MI 2014 MI 2015 US 2015

No Leisure Time Physical Activity

11 1216 18

2732tied

05

101520253035404550

CurrentSmoking

CholesterolEver told high

Obese(BMIgt30)

BloodPressure Ever

told high

Diabetes No LeisureTime Physical

Activity

Overweight(BMIgt25)

2015 NATIONAL RANKING(1st is worst)

18tied

MOSAIC 2015-2020 Focus of Grant Developing Stroke Systems of

Care Community Awareness EMS In-hospital QI Transition of Care Post-Discharge

12

Pre-hospital Care

A V A I L A B L E D A T A

13

EMSMOSAIC Data Linkage

-The MOSAIC Team continues to link data from the Michigan EMS Information System (MiEMSIS) to MOSAIC Data- Reports have been created for and reviewed by the

Tri-County Area MCA and Detroit East MCA- This work will expand to other MCA regions that

serve hospitals participating in MOSAIC

GWTG Special Initiatives Tab

-A free tab that can be enabled in GWTG-The purpose of the tab is to collect data concerning patient hand-off from EMS

MOSAIC Participating Hospitals

Aspirus Keweenaw Hospital (Laurium)

Aspirus Grand View HospitalAspirus Iron River HospitalAspirus Ontonagon HospitalBixby Medical CenterBronson Methodist HospitalCovenant Health CareDetroit Receiving HospitalGenesys Regional Medical CenterHenry Ford Hospital Herrick Medical CenterHuron Valley-Sinai HospitalLakeland Regional Medical Center McLaren Bay Regional Medical CenterMcLaren Greater Medical Center

McLaren Macomb HospitalMcLaren Northern MI HospitalMcLaren Oakland Medical CenterMcLaren Port Huron HospitalMcLaren Regional Medical CenterMercy Health Saint Maryrsquos HospitalMetro Health HospitalMunson Medical Center

ProMedica Monroe Regional HospitalSparrow HospitalSt Joseph Mercy - Ann ArborSt Joseph Mercy ChelseaSt Joseph Mercy Livingston HospitalSt Mary MercySt Mary of Michigan HospitalU of M Hospital

Hospital Infrastructure19

Among all participating hospitals the average number of

Licensed beds was 374 (range 25 to 1059 beds)

Inpatient discharges was 17076 (range 1064 to 48916 patients)

Acute stroke discharges (primary diagnosis only) was 417 (range 34 to 982 patients)

Case Demographics MOSAIC Registry

VariablesN() or statistics(Total N=68906)

Age at admission (years)Median 710Range 180 - 1060Mean (SE) 697(01)

GenderMale 32886 (477)Female 36015 (523)

RaceAfrican American 9900 (197)AIAN 132 (03)Asian 320 (06)More than one race 44 (01)Unknown 3679 (73)White 36190 (720)Missing 70

EthnicityHispanic or Latino 804 (16)Others 49531 (984)

VariablesN() or statistics(Total N=68906)

Health insuranceMedicaid 2284 (45)MedicaidPrivate 211 (04)Medicare 16863 (336)Medicare Medicaid 2313 (46)

MedicareMedicaidPrivate125 (02)

MedicarePrivate 13640 (272)ND 268(05)No insurance 2123 (42)Private 12356 (246)

Arrival modeEMS 21052 (429)Private

transportationother19313 (393)

Transfer from another hospital

7733(157)

ND or unknown 1021 (21)Missing 1216

Who receives data reports on your stroke quality of care

21

7055

70

10085

65

40

Hos

pita

lC

EO

up

per

man

agem

ent

Hos

pita

lB

oard

Chi

efN

ursi

ngO

ffice

r(C

NO

)

Str

oke

Tea

m

Phy

sici

anS

trok

eC

ham

pion

Chi

ef o

fM

edic

ine

Oth

er

Data Use

1) In the most recent calendar year have you run additional analyses (beyond what was required for reporting) on your hospitalrsquos own stroke data

2)How frequently have you run and used the analyses generated

22

Yes (N=16) 80

No (N=4) 20Weekly (N=2) 125

Monthly (N=8) 500

Less than monthly but more

than 1-2 times(N=6) 375

Data Use

What is the main reason you do not run your own additional analyses (Select one best answer)

23

Not sure how to run analyses

25

Not sure what analyses are needed would be helpful 25

Other 50

Data Use

In the most recent calendar year what reports did you run

24

813 688

Pre-programmedautomated reports in thedata collection tool (eg GWTG)

Additional reports beyond pre-programmed reports from the tool

Data Use

How do you use these analyses reports

25

813 688375

Inform quality improvement (QI) efforts andor plan

ldquoaction itemsrdquo

Report to management administration on our

progress

Other

Data Use

If you run additional analysis what action items QI efforts did you plan as a result of these reports

26

o Discharge education intensive statin use

o Door to tPA time and dysphagia

o Review data between spoke amp hub hospitals regarding transfers IV-tPA administration Mechanical thrombectomy and SAH

o QI efforts were addressed in the department involving calling Stroke Alert on call for cases with FAST symptoms

o ED Medical Director works with team to fix fallouts and problematic areas We have seen improvement

o Process changes (ie fallout emails to RN manager) physician querieso Increased documentation of NIHSS ownership from individual units regarding stroke quality

improvement goalso Daily dysphagia screening determination of whowhat team responsible for documenting initial NIHSS

looking at patients beyond 2h LKW arrival

Hospital Arrival Mode Door-to Needle and Pre-Notification

Reports 2016

Percent of Cases Who Arrived via EMSMOSAIC 2009-2016

Table 1 Arrival Mode among Stroke Cases by Demographics MOSAIC 2016

Demographics N=3496 550 N=2938 450Stroke Type Ischemic 2558 542 2164 458 Hemorrhagic 560 728 209 272 TIA 378 478 413 522Age Group lt 50 Years 233 433 305 567 50-79 Years 1982 497 2008 503 ge 80 Years 1379 688 625 312Sex Female 1933 576 1422 424 Male 1661 523 1516 477Race Black 659 530 584 470 White 2824 557 2248 443 Other Missing 111 512 106 488

MOSAIC AggregateArrival Mode

EMS Private Mode

Table 2 Door-to-Needle Times by Arrival Mode among Stroke Cases MOSAIC 2016

Time Elements (in Minutes)Number of

Patients Mean (Minutes) Median

(Minutes)Range

(Minutes)Door-to-Image 4901 575 400 00-2700 Arrived via EMS 2767 463 270 00-2700 Arrived via Private Transportation 2134 720 570 00-2620

Door-to-Image (among t-PA treated) 492 155 130 00-970 Arrived via EMS 370 125 110 00-840 Arrived via Private Transportation 122 243 215 20-970Image-to Needle 492 500 450 70-2090 Arrived via EMS 370 503 460 70-2090 Arrived via Private Transportation 122 483 420 90-1770Door-to Needle 492 655 570 200-2180 Arrived via EMS 370 629 560 200-2180 Arrived via Private Transportation 122 726 650 290-2060Included ischemic or hemorrhagic cases with times that were less or equal to 270 minutes (45 hours)Transferred cases were excluded

MOSAIC Aggregate

Table 3 Pre-Notification among Stroke Cases Who Arrived Via EMS by Demographics MOSAIC 2016

Demographics N=2015 584 N=1437 416Stroke Type Ischemic 1523 622 924 378 Hemorrhagic 306 566 235 434 TIA 142 381 231 619Age Group lt 50 Years 133 607 86 393 50-79 Years 1105 585 784 415 ge 80 Years 777 578 567 422Sex Female 1075 578 786 422 Male 940 591 651 409Race Black 307 517 287 483 White 1657 602 1097 398 Other 51 490 53 510

All HospitalsPre-Notification

Yes No

MOSAIC Transitions of Care Project

Post-discharge data collection tool is being implemented into Outcome Science as a tab

Post-Discharge amp Transition of Care

Reporting on changes within 30 days of discharge from hospital via follow-up callschart review Interval events Physician follow-up visits Lifestyle changes Lab assessments Medication managementadherence Rehab amp Functional outcomes Falls

MOSAIC Website

wwwMichigangovstroke

Adrienne Nickles MPHnicklesamichigangov

Thank You

  • Michigan and MOSAIC Data Review
  • Overview
  • Age-adjusted Stroke Hospitalization Rates Michigan 2000-2015
  • Slide Number 4
  • Age-adjusted Stroke Mortality Rates Michigan 2000-2014
  • Slide Number 6
  • Slide Number 7
  • Slide Number 8
  • Slide Number 9
  • Slide Number 10
  • Slide Number 11
  • MOSAIC 2015-2020
  • Pre-hospital Care
  • EMSMOSAIC Data Linkage
  • Slide Number 15
  • GWTG Special Initiatives Tab
  • Slide Number 17
  • MOSAIC Participating Hospitals
  • Hospital Infrastructure
  • Case Demographics MOSAIC Registry
  • Who receives data reports on your stroke quality of care
  • 1) In the most recent calendar year have you run additional analyses (beyond what was required for reporting) on your hospitalrsquos own stroke data 2)How frequently have you run and used the analyses generated
  • What is the main reason you do not run your own additional analyses (Select one best answer)
  • In the most recent calendar year what reports did you run
  • How do you use these analyses reports
  • If you run additional analysis what action items QI efforts did you plan as a result of these reports
  • Hospital Arrival Mode Door-to Needle and Pre-Notification Reports 2016
  • Percent of Cases Who Arrived via EMSMOSAIC 2009-2016
  • Table 1 Arrival Mode among Stroke Cases by Demographics MOSAIC 2016
  • Table 2 Door-to-Needle Times by Arrival Mode among Stroke Cases MOSAIC 2016
  • Table 3 Pre-Notification among Stroke Cases Who Arrived Via EMS by Demographics MOSAIC 2016
  • MOSAIC Transitions of Care Project
  • Slide Number 33
  • MOSAIC Website
  • Adrienne Nickles MPHnicklesamichigangov
CVD
Year White Male Black Male White Female Black Female
2000 4276 5424 3033 4161
2001 4066 5524 2813 4091
2002 3928 5468 2767 4114
2003 3734 518 2638 3887
2004 3448 5079 2432 3643
2005 3366 4983 2375 3545
2006 3276 4994 2313 3477
2007 3236 4845 2223 327
2008 3158 4694 2238 3327
change 234 79 237 164
Heart Disease
Year White Male Black Male White Female Black Female
2000 3393 4298 227 3206
2001 3232 4445 2124 3166
2002 3118 4317 2197 3157
2003 2986 4184 1957 3001
2004 2777 3983 1783 2838
2005 2704 4009 1776 2679
2006 2644 3981 1739 2642
2007 2619 3972 1679 2532
2008 2566 3819 1687 2606
Stroke
Year White Male Black Male White Female Black Female
2000 61 768 561 703 176
2001 575 752 539 681 138
2002 573 806 528 66 15
2003 516 662 498 629 147
2004 463 743 476 562
2005 449 663 429 585
2006 434 63 411 556
2007 415 631 392 494
2008 402 606 392 509
2009 375 616 372 464
2010 372 565 366 513
2011 373 548 366 44
2012 348 587 349 477
2013 347 506 34 462
2014 369 506 352 482
Coronary Heart Disease
Year White Male Black Male White Female Black Female
2000 2625 329 1608 243
2001 2478 3356 1508 2314
2002 2404 3154 1419 2313
2003 2221 3093 1328 209
2004 2067 2956 119 1983
2005 1989 2885 117 1853
2006 1922 2903 1139 1825
2007 1921 2771 1074 1645
2008 1824 2592 1071 1722
Heart Failure
Year White Male Black Male White Female Black Female
2000 255 206 245 17
2001 267 225 225 167
2002 242 238 227 203
2003 256 217 222 189
2004 243 167 214 206
2005 24 218 217 172
2006 255 246 229 202
2007 23 225 208 196
2008 25 216 226 185
Not sure what this data is from previously HD Stroke
Year White Female Black Female White Female Black Female
2000 227 3206 561 703
2001 2124 3166 539 681
2002 2197 3157 528 66
2003 1957 3001 498 629
2004 1783 2838 476 562
2005 1776 2679 429 585
2006 1739 2642 411 556
2007
2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2009 2009 2009 2009
2010 2010 2010 2010
2011 2011 2011 2011
2012 2012 2012 2012
2013 2013 2013 2013
2014 2014 2014 2014
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
CVD
Year US Michigan 0-34 35-64 65-84 85+
2000 3397 3694 43 140 16141 86689
2001 3265 3524 508 1348 15291 82889
2002 3174 3421 45 1338 14891 79536
2003 3061 3258 54 1324 14033 75185
2004 2885 3034 41 1242 13209 69088
2005 2773 2972 48 1283 1291 66011
2006 2898 48 1207 12246 6786
2007 2825 5 1206 1182 66153
2008 2791 43 1175 11619 66406
Heart Disease
Year US Michigan 0-34 35-64 65-84 85+
2000 2576 2851 345 1158 1247 64879
2001 2478 2719 416 112 11794 61938
2002 2408 2631 35 1103 11529 58746
2003 2323 2517 45 110 10827 56172
2004 217 2337 313 1048 10086 51609
2005 2111 2308 38 1078 9937 49828
2006 226 384 1019 9413 51918
2007 2216 42 1008 9174 50961
2008 2192 36 982 904 51209
Stroke
Year US Michigan HP 2010 0-34 35-64 65-84 85+
2000 609 603 50 068 174 2589 15841
2001 579 577 50 0638 157 2522 1504
2002 562 571 50 072 169 2397 1528
2003 535 527 50 0737 157 2249 13741
2004 50 496 50 0652 138 220 12629
2005 466 464 50 0553 145 2063 11398
2006 444 50 0734 127 196 11256
2007 425 064 1368 1832 10718
2008 419 047 134 1804 10646
79 27 243 289
Coronary Heart Disease
Year US Michigan HP 2010 0-34 35-64 65-84 85+
2000 1868 2118 162 0613 874 7701 4670
2001 1778 2006 162 0898 818 9012 44369
2002 1709 192 162 0889 799 8759 41061
2003 1628 179 162 0793 785 8018 38358
2004 1502 1656 162 0865 757 7421 34644
2005 1444 1611 162 097 773 7245 32617
2006 1564 162 088 727 6856 33503
2007 1516 117 709 6585 32727
2008 1472 102 657 6403 32504
168 11 283
Heart Failure
Year US Michigan 35-64 65-84 85+
2000 203 245 3047 936 8287
2001 202 237 2596 88 8285
2002 194 233 2648 878 8057
2003 194 233 3176 902 7722
2004 189 224 2709 863 7586
2005 189 224 2955 878 7388
2006 24 2979 884 8354
2007 219 274 828 7483
2008 233 013 333 85 8102
Heart Disease Stroke
Michigan White Michigan Black US White US Black Michigan White Michigan Black US White US Black
1990 334 4315 317 3915 1990 638 733 629 917
1991 3289 4108 3088 3865 1991 626 781 607 894
1992 3126 3987 3011 3777 1992 609 694 598 86
1993 3234 429 3046 3843 1993 614 77 609 866
1994 3134 4156 295 3661 1994 634 875 609 869
1995 3048 4131 2912 3672 1995 638 925 615 879
1996 2997 380 2842 354 1996 617 804 61 852
1997 2851 3683 2764 345 1997 604 77 598 816
1998 2884 3586 2681 3406 1998 598 729 576 803
1999 2781 3692 2634 3367 1999 609 812 598 824
2000 2757 3663 2536 3265 2000 586 737 587 824
2001 261 3695 2435 3169 2001 56 718 558 788
2002 2522 3659 2367 3084 2002 553 729 542 763
2003 2409 350 2282 3002 2003 511 655 514 743
2004 222 3311 2133 2806 2004 477 633 48 699
2005 219 3227 2005 442 616
2006 2144 320 2006 426 589
2007 2007
2008 2008
CVD CHD HD HF Stroke
2000 3694 2118 2851 245 603
2001 3524 2006 2719 237 577
2002 3421 192 2631 233 571
2003 3258 179 2517 233 527
2004 3034 1656 2337 224 496
2005 2972 1611 2308 224 464
2006 2898 1564 226 24 444
2007 2825 1516 2216 219 425
2008 2791 1472 2192 233 419
2000 2000 2000
2001 2001 2001
2002 2002 2002
2003 2003 2003
2004 2004 2004
2005 2005 2005
2006 2006 2006
2007 2007 2007
2008 2008 2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2000 2000 2000 2000 2000
2001 2001 2001 2001 2001
2002 2002 2002 2002 2002
2003 2003 2003 2003 2003
2004 2004 2004 2004 2004
2005 2005 2005 2005 2005
2006 2006 2006 2006 2006
2007 2007 2007 2007 2007
2008 2008 2008 2008 2008
CVD
Year White Male Black Male White Female Black Female
2000 4276 5424 3033 4161
2001 4066 5524 2813 4091
2002 3928 5468 2767 4114
2003 3734 518 2638 3887
2004 3448 5079 2432 3643
2005 3366 4983 2375 3545
2006 3276 4994 2313 3477
2007 3236 4845 2223 327
2008 3158 4694 2238 3327
change 234 79 237 164
Heart Disease
Year White Male Black Male White Female Black Female
2000 3393 4298 227 3206
2001 3232 4445 2124 3166
2002 3118 4317 2197 3157
2003 2986 4184 1957 3001
2004 2777 3983 1783 2838
2005 2704 4009 1776 2679
2006 2644 3981 1739 2642
2007 2619 3972 1679 2532
2008 2566 3819 1687 2606
Stroke
Year White Male Black Male White Female Black Female
2000 61 768 561 703 176
2001 575 752 539 681 138
2002 573 806 528 66 15
2003 516 662 498 629 147
2004 463 743 476 562
2005 449 663 429 585
2006 434 63 411 556
2007 415 631 392 494
2008 402 606 392 509
Coronary Heart Disease
Year White Male Black Male White Female Black Female
2000 2625 329 1608 243
2001 2478 3356 1508 2314
2002 2404 3154 1419 2313
2003 2221 3093 1328 209
2004 2067 2956 119 1983
2005 1989 2885 117 1853
2006 1922 2903 1139 1825
2007 1921 2771 1074 1645
2008 1824 2592 1071 1722
Heart Failure
Year White Male Black Male White Female Black Female
2000 255 206 245 17
2001 267 225 225 167
2002 242 238 227 203
2003 256 217 222 189
2004 243 167 214 206
2005 24 218 217 172
2006 255 246 229 202
2007 23 225 208 196
2008 25 216 226 185
Not sure what this data is from previously HD Stroke
Year White Female Black Female White Female Black Female
2000 227 3206 561 703
2001 2124 3166 539 681
2002 2197 3157 528 66
2003 1957 3001 498 629
2004 1783 2838 476 562
2005 1776 2679 429 585
2006 1739 2642 411 556
2007
2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
Page 20: Michigan and MOSAIC Data Review...Michigan and MOSAIC Data Review 2017 ANNUAL WORKSHOP 4/26/2017. Adrienne Nickles, MPH. Michigan’s Ongoing Stroke Registry to Accelerate the Improvement

race_gender

Sheet3

Age-adjusted stroke mortality rates by race and gender Michigan 2000 to 2014

0

10

20

30

40

50

60

70

80

90

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014

Age

-Adj

uste

d R

ate

per 1

000

00

Year

White Male

Black Male

White Female

Black Female

Overall_Rates

CVD
CHD
HD
HF
Stroke
Year
Rate per 10000
3694
2118
2851
245
603
3524
2006
2719
237
577
3421
192
2631
233
571
3258
179
2517
233
527
3034
1656
2337
224
496
2972
1611
2308
224
464
2898
1564
226
24
444
2825
1516
2216
219
425
2791
1472
2192
233
419

CVD_Age

0-34
35-64
65-84
85+
Year
Age-Adjusted Rate per 100000
43
140
16141
86689
508
1348
15291
82889
45
1338
14891
79536
54
1324
14033
75185
41
1242
13209
69088
48
1283
1291
66011
48
1207
12246
6786
5
1206
1182
66153
43
1175
11619
66406

HD_Age

0-34
35-64
65-84
85+
Year
Age-Adjusted Rate per 100000
345
1158
1247
64879
416
112
11794
61938
35
1103
11529
58746
45
110
10827
56172
313
1048
10086
51609
38
1078
9937
49828
384
1019
9413
51918
42
1008
9174
50961
36
982
904
51209

CHD_Age

0-34
35-64
65-84
85+
Year
Age-Adjusted Rate per 100000
0613
874
7701
4670
0898
818
9012
44369
0889
799
8759
41061
0793
785
8018
38358
0865
757
7421
34644
097
773
7245
32617
088
727
6856
33503
117
709
6585
32727
102
657
6403
32504

Stroke_Age

0-34
35-64
65-84
85+
Year
Age-Adjusted Rate per 100000
068
174
2589
15841
0638
157
2522
1504
072
169
2397
1528
0737
157
2249
13741
0652
138
220
12629
0553
145
2063
11398
0734
127
196
11256
064
1368
1832
10718
047
134
1804
10646

HF_Age

35-64
65-84
85+
Year
Age-Adjusted Rate per 100000
3047
936
8287
2596
88
8285
2648
878
8057
3176
902
7722
2709
863
7586
2955
878
7388
2979
884
8354
274
828
7483
333
85
8102

total

CVD_RG

White Male
Black Male
White Female
Black Female
Year
Age-Adjusted Rate per 100000
4276
5424
3033
4161
4066
5524
2813
4091
3928
5468
2767
4114
3734
518
2638
3887
3448
5079
2432
3643
3366
4983
2375
3545
3276
4994
2313
3477
3236
4845
2223
327
3158
4694
2238
3327

Stroke_RG

White Male
Black Male
White Female
Black Female
Year
Age-Adjusted Rate per 100000
61
768
561
703
575
752
539
681
573
806
528
66
516
662
498
629
463
743
476
562
449
663
429
585
434
63
411
556
415
631
392
494
402
606
392
509
375
616
372
464
372
565
366
513
373
548
366
44
348
587
349
477
347
506
34
462
369
506
352
482

HD_RG

White Male
Black Male
White Female
Black Female
Year
Age-Adjusted Rate per 100000
3393
4298
227
3206
3232
4445
2124
3166
3118
4317
2197
3157
2986
4184
1957
3001
2777
3983
1783
2838
2704
4009
1776
2679
2644
3981
1739
2642
2619
3972
1679
2532
2566
3819
1687
2606

CHD_RG

White Male
Black Male
White Female
Black Female
Year
Age-Adjusted Rate per 100000
2625
329
1608
243
2478
3356
1508
2314
2404
3154
1419
2313
2221
3093
1328
209
2067
2956
119
1983
1989
2885
117
1853
1922
2903
1139
1825
1921
2771
1074
1645
1824
2592
1071
1722

HF_RG

White Male
Black Male
White Female
Black Female
Year
Age-Adjusted Rate per 100000
255
206
245
17
267
225
225
167
242
238
227
203
256
217
222
189
243
167
214
206
24
218
217
172
255
246
229
202
23
225
208
196
25
216
226
185

race_gender

Sheet3

Local Health Department data can be found at wwwmichigangovbrfsSource CDC BRFSS

RISK FACTORMI

2011

MI

2013

MI

2014

MI

2015US 2015

2015 NATIONAL RANKING

Current Smoking 233 214 212 207 175 11

Blood Pressure Ever Told High 342 346 NA 331 309 18

Cholesterol Ever Told High 418 406 NA 382 364 12

Overweight (BMIgt25) 342 347 349 351 355 32tied

Obese (BMIgt30) 313 315 307 312 298 16

No Leisure Time Physical Activity 236 244 255 255 262 27

Diabetes 100 104 104 107 100 18tied

Prevalence of CVD Risk Factors Michigan Adults 1990-2015Compared to 2015 National Prevalence

233214 212 207

175

10

15

20

25

30

MI 2011 MI 2013 MI 2014 MI 2015 US 2015

Current Smoking

342 346331

309

20

25

30

35

40

MI 2011 MI 2013 MI 2014 MI 2015 US 2015

Blood Pressure Ever told high

342 347 349 351 355

20

25

30

35

40

MI 2011 MI 2013 MI 2014 MI 2015 US 2015

Overweight (BMIgt25)

313 315 307 312298

20

25

30

35

40

MI 2011 MI 2013 MI 2014 MI 2015 US 2015

Obese (BMIgt30)

418406

382364

30

35

40

45

50

MI 2011 MI 2013 MI 2014 MI 2015 US 2015

Cholesterol Ever told high

10 104 104 10710

0

3

6

9

12

15

MI 2011 MI 2013 MI 2014 MI 2015 US 2015

Diabetes

236 244255 255 262

10

15

20

25

30

MI 2011 MI 2013 MI 2014 MI 2015 US 2015

No Leisure Time Physical Activity

11 1216 18

2732tied

05

101520253035404550

CurrentSmoking

CholesterolEver told high

Obese(BMIgt30)

BloodPressure Ever

told high

Diabetes No LeisureTime Physical

Activity

Overweight(BMIgt25)

2015 NATIONAL RANKING(1st is worst)

18tied

MOSAIC 2015-2020 Focus of Grant Developing Stroke Systems of

Care Community Awareness EMS In-hospital QI Transition of Care Post-Discharge

12

Pre-hospital Care

A V A I L A B L E D A T A

13

EMSMOSAIC Data Linkage

-The MOSAIC Team continues to link data from the Michigan EMS Information System (MiEMSIS) to MOSAIC Data- Reports have been created for and reviewed by the

Tri-County Area MCA and Detroit East MCA- This work will expand to other MCA regions that

serve hospitals participating in MOSAIC

GWTG Special Initiatives Tab

-A free tab that can be enabled in GWTG-The purpose of the tab is to collect data concerning patient hand-off from EMS

MOSAIC Participating Hospitals

Aspirus Keweenaw Hospital (Laurium)

Aspirus Grand View HospitalAspirus Iron River HospitalAspirus Ontonagon HospitalBixby Medical CenterBronson Methodist HospitalCovenant Health CareDetroit Receiving HospitalGenesys Regional Medical CenterHenry Ford Hospital Herrick Medical CenterHuron Valley-Sinai HospitalLakeland Regional Medical Center McLaren Bay Regional Medical CenterMcLaren Greater Medical Center

McLaren Macomb HospitalMcLaren Northern MI HospitalMcLaren Oakland Medical CenterMcLaren Port Huron HospitalMcLaren Regional Medical CenterMercy Health Saint Maryrsquos HospitalMetro Health HospitalMunson Medical Center

ProMedica Monroe Regional HospitalSparrow HospitalSt Joseph Mercy - Ann ArborSt Joseph Mercy ChelseaSt Joseph Mercy Livingston HospitalSt Mary MercySt Mary of Michigan HospitalU of M Hospital

Hospital Infrastructure19

Among all participating hospitals the average number of

Licensed beds was 374 (range 25 to 1059 beds)

Inpatient discharges was 17076 (range 1064 to 48916 patients)

Acute stroke discharges (primary diagnosis only) was 417 (range 34 to 982 patients)

Case Demographics MOSAIC Registry

VariablesN() or statistics(Total N=68906)

Age at admission (years)Median 710Range 180 - 1060Mean (SE) 697(01)

GenderMale 32886 (477)Female 36015 (523)

RaceAfrican American 9900 (197)AIAN 132 (03)Asian 320 (06)More than one race 44 (01)Unknown 3679 (73)White 36190 (720)Missing 70

EthnicityHispanic or Latino 804 (16)Others 49531 (984)

VariablesN() or statistics(Total N=68906)

Health insuranceMedicaid 2284 (45)MedicaidPrivate 211 (04)Medicare 16863 (336)Medicare Medicaid 2313 (46)

MedicareMedicaidPrivate125 (02)

MedicarePrivate 13640 (272)ND 268(05)No insurance 2123 (42)Private 12356 (246)

Arrival modeEMS 21052 (429)Private

transportationother19313 (393)

Transfer from another hospital

7733(157)

ND or unknown 1021 (21)Missing 1216

Who receives data reports on your stroke quality of care

21

7055

70

10085

65

40

Hos

pita

lC

EO

up

per

man

agem

ent

Hos

pita

lB

oard

Chi

efN

ursi

ngO

ffice

r(C

NO

)

Str

oke

Tea

m

Phy

sici

anS

trok

eC

ham

pion

Chi

ef o

fM

edic

ine

Oth

er

Data Use

1) In the most recent calendar year have you run additional analyses (beyond what was required for reporting) on your hospitalrsquos own stroke data

2)How frequently have you run and used the analyses generated

22

Yes (N=16) 80

No (N=4) 20Weekly (N=2) 125

Monthly (N=8) 500

Less than monthly but more

than 1-2 times(N=6) 375

Data Use

What is the main reason you do not run your own additional analyses (Select one best answer)

23

Not sure how to run analyses

25

Not sure what analyses are needed would be helpful 25

Other 50

Data Use

In the most recent calendar year what reports did you run

24

813 688

Pre-programmedautomated reports in thedata collection tool (eg GWTG)

Additional reports beyond pre-programmed reports from the tool

Data Use

How do you use these analyses reports

25

813 688375

Inform quality improvement (QI) efforts andor plan

ldquoaction itemsrdquo

Report to management administration on our

progress

Other

Data Use

If you run additional analysis what action items QI efforts did you plan as a result of these reports

26

o Discharge education intensive statin use

o Door to tPA time and dysphagia

o Review data between spoke amp hub hospitals regarding transfers IV-tPA administration Mechanical thrombectomy and SAH

o QI efforts were addressed in the department involving calling Stroke Alert on call for cases with FAST symptoms

o ED Medical Director works with team to fix fallouts and problematic areas We have seen improvement

o Process changes (ie fallout emails to RN manager) physician querieso Increased documentation of NIHSS ownership from individual units regarding stroke quality

improvement goalso Daily dysphagia screening determination of whowhat team responsible for documenting initial NIHSS

looking at patients beyond 2h LKW arrival

Hospital Arrival Mode Door-to Needle and Pre-Notification

Reports 2016

Percent of Cases Who Arrived via EMSMOSAIC 2009-2016

Table 1 Arrival Mode among Stroke Cases by Demographics MOSAIC 2016

Demographics N=3496 550 N=2938 450Stroke Type Ischemic 2558 542 2164 458 Hemorrhagic 560 728 209 272 TIA 378 478 413 522Age Group lt 50 Years 233 433 305 567 50-79 Years 1982 497 2008 503 ge 80 Years 1379 688 625 312Sex Female 1933 576 1422 424 Male 1661 523 1516 477Race Black 659 530 584 470 White 2824 557 2248 443 Other Missing 111 512 106 488

MOSAIC AggregateArrival Mode

EMS Private Mode

Table 2 Door-to-Needle Times by Arrival Mode among Stroke Cases MOSAIC 2016

Time Elements (in Minutes)Number of

Patients Mean (Minutes) Median

(Minutes)Range

(Minutes)Door-to-Image 4901 575 400 00-2700 Arrived via EMS 2767 463 270 00-2700 Arrived via Private Transportation 2134 720 570 00-2620

Door-to-Image (among t-PA treated) 492 155 130 00-970 Arrived via EMS 370 125 110 00-840 Arrived via Private Transportation 122 243 215 20-970Image-to Needle 492 500 450 70-2090 Arrived via EMS 370 503 460 70-2090 Arrived via Private Transportation 122 483 420 90-1770Door-to Needle 492 655 570 200-2180 Arrived via EMS 370 629 560 200-2180 Arrived via Private Transportation 122 726 650 290-2060Included ischemic or hemorrhagic cases with times that were less or equal to 270 minutes (45 hours)Transferred cases were excluded

MOSAIC Aggregate

Table 3 Pre-Notification among Stroke Cases Who Arrived Via EMS by Demographics MOSAIC 2016

Demographics N=2015 584 N=1437 416Stroke Type Ischemic 1523 622 924 378 Hemorrhagic 306 566 235 434 TIA 142 381 231 619Age Group lt 50 Years 133 607 86 393 50-79 Years 1105 585 784 415 ge 80 Years 777 578 567 422Sex Female 1075 578 786 422 Male 940 591 651 409Race Black 307 517 287 483 White 1657 602 1097 398 Other 51 490 53 510

All HospitalsPre-Notification

Yes No

MOSAIC Transitions of Care Project

Post-discharge data collection tool is being implemented into Outcome Science as a tab

Post-Discharge amp Transition of Care

Reporting on changes within 30 days of discharge from hospital via follow-up callschart review Interval events Physician follow-up visits Lifestyle changes Lab assessments Medication managementadherence Rehab amp Functional outcomes Falls

MOSAIC Website

wwwMichigangovstroke

Adrienne Nickles MPHnicklesamichigangov

Thank You

  • Michigan and MOSAIC Data Review
  • Overview
  • Age-adjusted Stroke Hospitalization Rates Michigan 2000-2015
  • Slide Number 4
  • Age-adjusted Stroke Mortality Rates Michigan 2000-2014
  • Slide Number 6
  • Slide Number 7
  • Slide Number 8
  • Slide Number 9
  • Slide Number 10
  • Slide Number 11
  • MOSAIC 2015-2020
  • Pre-hospital Care
  • EMSMOSAIC Data Linkage
  • Slide Number 15
  • GWTG Special Initiatives Tab
  • Slide Number 17
  • MOSAIC Participating Hospitals
  • Hospital Infrastructure
  • Case Demographics MOSAIC Registry
  • Who receives data reports on your stroke quality of care
  • 1) In the most recent calendar year have you run additional analyses (beyond what was required for reporting) on your hospitalrsquos own stroke data 2)How frequently have you run and used the analyses generated
  • What is the main reason you do not run your own additional analyses (Select one best answer)
  • In the most recent calendar year what reports did you run
  • How do you use these analyses reports
  • If you run additional analysis what action items QI efforts did you plan as a result of these reports
  • Hospital Arrival Mode Door-to Needle and Pre-Notification Reports 2016
  • Percent of Cases Who Arrived via EMSMOSAIC 2009-2016
  • Table 1 Arrival Mode among Stroke Cases by Demographics MOSAIC 2016
  • Table 2 Door-to-Needle Times by Arrival Mode among Stroke Cases MOSAIC 2016
  • Table 3 Pre-Notification among Stroke Cases Who Arrived Via EMS by Demographics MOSAIC 2016
  • MOSAIC Transitions of Care Project
  • Slide Number 33
  • MOSAIC Website
  • Adrienne Nickles MPHnicklesamichigangov
CVD
Year White Male Black Male White Female Black Female
2000 4276 5424 3033 4161
2001 4066 5524 2813 4091
2002 3928 5468 2767 4114
2003 3734 518 2638 3887
2004 3448 5079 2432 3643
2005 3366 4983 2375 3545
2006 3276 4994 2313 3477
2007 3236 4845 2223 327
2008 3158 4694 2238 3327
change 234 79 237 164
Heart Disease
Year White Male Black Male White Female Black Female
2000 3393 4298 227 3206
2001 3232 4445 2124 3166
2002 3118 4317 2197 3157
2003 2986 4184 1957 3001
2004 2777 3983 1783 2838
2005 2704 4009 1776 2679
2006 2644 3981 1739 2642
2007 2619 3972 1679 2532
2008 2566 3819 1687 2606
Stroke
Year White Male Black Male White Female Black Female
2000 61 768 561 703 176
2001 575 752 539 681 138
2002 573 806 528 66 15
2003 516 662 498 629 147
2004 463 743 476 562
2005 449 663 429 585
2006 434 63 411 556
2007 415 631 392 494
2008 402 606 392 509
2009 375 616 372 464
2010 372 565 366 513
2011 373 548 366 44
2012 348 587 349 477
2013 347 506 34 462
2014 369 506 352 482
Coronary Heart Disease
Year White Male Black Male White Female Black Female
2000 2625 329 1608 243
2001 2478 3356 1508 2314
2002 2404 3154 1419 2313
2003 2221 3093 1328 209
2004 2067 2956 119 1983
2005 1989 2885 117 1853
2006 1922 2903 1139 1825
2007 1921 2771 1074 1645
2008 1824 2592 1071 1722
Heart Failure
Year White Male Black Male White Female Black Female
2000 255 206 245 17
2001 267 225 225 167
2002 242 238 227 203
2003 256 217 222 189
2004 243 167 214 206
2005 24 218 217 172
2006 255 246 229 202
2007 23 225 208 196
2008 25 216 226 185
Not sure what this data is from previously HD Stroke
Year White Female Black Female White Female Black Female
2000 227 3206 561 703
2001 2124 3166 539 681
2002 2197 3157 528 66
2003 1957 3001 498 629
2004 1783 2838 476 562
2005 1776 2679 429 585
2006 1739 2642 411 556
2007
2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2009 2009 2009 2009
2010 2010 2010 2010
2011 2011 2011 2011
2012 2012 2012 2012
2013 2013 2013 2013
2014 2014 2014 2014
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
CVD
Year US Michigan 0-34 35-64 65-84 85+
2000 3397 3694 43 140 16141 86689
2001 3265 3524 508 1348 15291 82889
2002 3174 3421 45 1338 14891 79536
2003 3061 3258 54 1324 14033 75185
2004 2885 3034 41 1242 13209 69088
2005 2773 2972 48 1283 1291 66011
2006 2898 48 1207 12246 6786
2007 2825 5 1206 1182 66153
2008 2791 43 1175 11619 66406
Heart Disease
Year US Michigan 0-34 35-64 65-84 85+
2000 2576 2851 345 1158 1247 64879
2001 2478 2719 416 112 11794 61938
2002 2408 2631 35 1103 11529 58746
2003 2323 2517 45 110 10827 56172
2004 217 2337 313 1048 10086 51609
2005 2111 2308 38 1078 9937 49828
2006 226 384 1019 9413 51918
2007 2216 42 1008 9174 50961
2008 2192 36 982 904 51209
Stroke
Year US Michigan HP 2010 0-34 35-64 65-84 85+
2000 609 603 50 068 174 2589 15841
2001 579 577 50 0638 157 2522 1504
2002 562 571 50 072 169 2397 1528
2003 535 527 50 0737 157 2249 13741
2004 50 496 50 0652 138 220 12629
2005 466 464 50 0553 145 2063 11398
2006 444 50 0734 127 196 11256
2007 425 064 1368 1832 10718
2008 419 047 134 1804 10646
79 27 243 289
Coronary Heart Disease
Year US Michigan HP 2010 0-34 35-64 65-84 85+
2000 1868 2118 162 0613 874 7701 4670
2001 1778 2006 162 0898 818 9012 44369
2002 1709 192 162 0889 799 8759 41061
2003 1628 179 162 0793 785 8018 38358
2004 1502 1656 162 0865 757 7421 34644
2005 1444 1611 162 097 773 7245 32617
2006 1564 162 088 727 6856 33503
2007 1516 117 709 6585 32727
2008 1472 102 657 6403 32504
168 11 283
Heart Failure
Year US Michigan 35-64 65-84 85+
2000 203 245 3047 936 8287
2001 202 237 2596 88 8285
2002 194 233 2648 878 8057
2003 194 233 3176 902 7722
2004 189 224 2709 863 7586
2005 189 224 2955 878 7388
2006 24 2979 884 8354
2007 219 274 828 7483
2008 233 013 333 85 8102
Heart Disease Stroke
Michigan White Michigan Black US White US Black Michigan White Michigan Black US White US Black
1990 334 4315 317 3915 1990 638 733 629 917
1991 3289 4108 3088 3865 1991 626 781 607 894
1992 3126 3987 3011 3777 1992 609 694 598 86
1993 3234 429 3046 3843 1993 614 77 609 866
1994 3134 4156 295 3661 1994 634 875 609 869
1995 3048 4131 2912 3672 1995 638 925 615 879
1996 2997 380 2842 354 1996 617 804 61 852
1997 2851 3683 2764 345 1997 604 77 598 816
1998 2884 3586 2681 3406 1998 598 729 576 803
1999 2781 3692 2634 3367 1999 609 812 598 824
2000 2757 3663 2536 3265 2000 586 737 587 824
2001 261 3695 2435 3169 2001 56 718 558 788
2002 2522 3659 2367 3084 2002 553 729 542 763
2003 2409 350 2282 3002 2003 511 655 514 743
2004 222 3311 2133 2806 2004 477 633 48 699
2005 219 3227 2005 442 616
2006 2144 320 2006 426 589
2007 2007
2008 2008
CVD CHD HD HF Stroke
2000 3694 2118 2851 245 603
2001 3524 2006 2719 237 577
2002 3421 192 2631 233 571
2003 3258 179 2517 233 527
2004 3034 1656 2337 224 496
2005 2972 1611 2308 224 464
2006 2898 1564 226 24 444
2007 2825 1516 2216 219 425
2008 2791 1472 2192 233 419
2000 2000 2000
2001 2001 2001
2002 2002 2002
2003 2003 2003
2004 2004 2004
2005 2005 2005
2006 2006 2006
2007 2007 2007
2008 2008 2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2000 2000 2000 2000 2000
2001 2001 2001 2001 2001
2002 2002 2002 2002 2002
2003 2003 2003 2003 2003
2004 2004 2004 2004 2004
2005 2005 2005 2005 2005
2006 2006 2006 2006 2006
2007 2007 2007 2007 2007
2008 2008 2008 2008 2008
CVD
Year White Male Black Male White Female Black Female
2000 4276 5424 3033 4161
2001 4066 5524 2813 4091
2002 3928 5468 2767 4114
2003 3734 518 2638 3887
2004 3448 5079 2432 3643
2005 3366 4983 2375 3545
2006 3276 4994 2313 3477
2007 3236 4845 2223 327
2008 3158 4694 2238 3327
change 234 79 237 164
Heart Disease
Year White Male Black Male White Female Black Female
2000 3393 4298 227 3206
2001 3232 4445 2124 3166
2002 3118 4317 2197 3157
2003 2986 4184 1957 3001
2004 2777 3983 1783 2838
2005 2704 4009 1776 2679
2006 2644 3981 1739 2642
2007 2619 3972 1679 2532
2008 2566 3819 1687 2606
Stroke
Year White Male Black Male White Female Black Female
2000 61 768 561 703 176
2001 575 752 539 681 138
2002 573 806 528 66 15
2003 516 662 498 629 147
2004 463 743 476 562
2005 449 663 429 585
2006 434 63 411 556
2007 415 631 392 494
2008 402 606 392 509
Coronary Heart Disease
Year White Male Black Male White Female Black Female
2000 2625 329 1608 243
2001 2478 3356 1508 2314
2002 2404 3154 1419 2313
2003 2221 3093 1328 209
2004 2067 2956 119 1983
2005 1989 2885 117 1853
2006 1922 2903 1139 1825
2007 1921 2771 1074 1645
2008 1824 2592 1071 1722
Heart Failure
Year White Male Black Male White Female Black Female
2000 255 206 245 17
2001 267 225 225 167
2002 242 238 227 203
2003 256 217 222 189
2004 243 167 214 206
2005 24 218 217 172
2006 255 246 229 202
2007 23 225 208 196
2008 25 216 226 185
Not sure what this data is from previously HD Stroke
Year White Female Black Female White Female Black Female
2000 227 3206 561 703
2001 2124 3166 539 681
2002 2197 3157 528 66
2003 1957 3001 498 629
2004 1783 2838 476 562
2005 1776 2679 429 585
2006 1739 2642 411 556
2007
2008
Page 21: Michigan and MOSAIC Data Review...Michigan and MOSAIC Data Review 2017 ANNUAL WORKSHOP 4/26/2017. Adrienne Nickles, MPH. Michigan’s Ongoing Stroke Registry to Accelerate the Improvement

Sheet3

Age-adjusted stroke mortality rates by race and gender Michigan 2000 to 2014

0

10

20

30

40

50

60

70

80

90

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014

Age

-Adj

uste

d R

ate

per 1

000

00

Year

White Male

Black Male

White Female

Black Female

Overall_Rates

CVD
CHD
HD
HF
Stroke
Year
Rate per 10000
3694
2118
2851
245
603
3524
2006
2719
237
577
3421
192
2631
233
571
3258
179
2517
233
527
3034
1656
2337
224
496
2972
1611
2308
224
464
2898
1564
226
24
444
2825
1516
2216
219
425
2791
1472
2192
233
419

CVD_Age

0-34
35-64
65-84
85+
Year
Age-Adjusted Rate per 100000
43
140
16141
86689
508
1348
15291
82889
45
1338
14891
79536
54
1324
14033
75185
41
1242
13209
69088
48
1283
1291
66011
48
1207
12246
6786
5
1206
1182
66153
43
1175
11619
66406

HD_Age

0-34
35-64
65-84
85+
Year
Age-Adjusted Rate per 100000
345
1158
1247
64879
416
112
11794
61938
35
1103
11529
58746
45
110
10827
56172
313
1048
10086
51609
38
1078
9937
49828
384
1019
9413
51918
42
1008
9174
50961
36
982
904
51209

CHD_Age

0-34
35-64
65-84
85+
Year
Age-Adjusted Rate per 100000
0613
874
7701
4670
0898
818
9012
44369
0889
799
8759
41061
0793
785
8018
38358
0865
757
7421
34644
097
773
7245
32617
088
727
6856
33503
117
709
6585
32727
102
657
6403
32504

Stroke_Age

0-34
35-64
65-84
85+
Year
Age-Adjusted Rate per 100000
068
174
2589
15841
0638
157
2522
1504
072
169
2397
1528
0737
157
2249
13741
0652
138
220
12629
0553
145
2063
11398
0734
127
196
11256
064
1368
1832
10718
047
134
1804
10646

HF_Age

35-64
65-84
85+
Year
Age-Adjusted Rate per 100000
3047
936
8287
2596
88
8285
2648
878
8057
3176
902
7722
2709
863
7586
2955
878
7388
2979
884
8354
274
828
7483
333
85
8102

total

CVD_RG

White Male
Black Male
White Female
Black Female
Year
Age-Adjusted Rate per 100000
4276
5424
3033
4161
4066
5524
2813
4091
3928
5468
2767
4114
3734
518
2638
3887
3448
5079
2432
3643
3366
4983
2375
3545
3276
4994
2313
3477
3236
4845
2223
327
3158
4694
2238
3327

Stroke_RG

White Male
Black Male
White Female
Black Female
Year
Age-Adjusted Rate per 100000
61
768
561
703
575
752
539
681
573
806
528
66
516
662
498
629
463
743
476
562
449
663
429
585
434
63
411
556
415
631
392
494
402
606
392
509
375
616
372
464
372
565
366
513
373
548
366
44
348
587
349
477
347
506
34
462
369
506
352
482

HD_RG

White Male
Black Male
White Female
Black Female
Year
Age-Adjusted Rate per 100000
3393
4298
227
3206
3232
4445
2124
3166
3118
4317
2197
3157
2986
4184
1957
3001
2777
3983
1783
2838
2704
4009
1776
2679
2644
3981
1739
2642
2619
3972
1679
2532
2566
3819
1687
2606

CHD_RG

White Male
Black Male
White Female
Black Female
Year
Age-Adjusted Rate per 100000
2625
329
1608
243
2478
3356
1508
2314
2404
3154
1419
2313
2221
3093
1328
209
2067
2956
119
1983
1989
2885
117
1853
1922
2903
1139
1825
1921
2771
1074
1645
1824
2592
1071
1722

HF_RG

White Male
Black Male
White Female
Black Female
Year
Age-Adjusted Rate per 100000
255
206
245
17
267
225
225
167
242
238
227
203
256
217
222
189
243
167
214
206
24
218
217
172
255
246
229
202
23
225
208
196
25
216
226
185

race_gender

Sheet3

Local Health Department data can be found at wwwmichigangovbrfsSource CDC BRFSS

RISK FACTORMI

2011

MI

2013

MI

2014

MI

2015US 2015

2015 NATIONAL RANKING

Current Smoking 233 214 212 207 175 11

Blood Pressure Ever Told High 342 346 NA 331 309 18

Cholesterol Ever Told High 418 406 NA 382 364 12

Overweight (BMIgt25) 342 347 349 351 355 32tied

Obese (BMIgt30) 313 315 307 312 298 16

No Leisure Time Physical Activity 236 244 255 255 262 27

Diabetes 100 104 104 107 100 18tied

Prevalence of CVD Risk Factors Michigan Adults 1990-2015Compared to 2015 National Prevalence

233214 212 207

175

10

15

20

25

30

MI 2011 MI 2013 MI 2014 MI 2015 US 2015

Current Smoking

342 346331

309

20

25

30

35

40

MI 2011 MI 2013 MI 2014 MI 2015 US 2015

Blood Pressure Ever told high

342 347 349 351 355

20

25

30

35

40

MI 2011 MI 2013 MI 2014 MI 2015 US 2015

Overweight (BMIgt25)

313 315 307 312298

20

25

30

35

40

MI 2011 MI 2013 MI 2014 MI 2015 US 2015

Obese (BMIgt30)

418406

382364

30

35

40

45

50

MI 2011 MI 2013 MI 2014 MI 2015 US 2015

Cholesterol Ever told high

10 104 104 10710

0

3

6

9

12

15

MI 2011 MI 2013 MI 2014 MI 2015 US 2015

Diabetes

236 244255 255 262

10

15

20

25

30

MI 2011 MI 2013 MI 2014 MI 2015 US 2015

No Leisure Time Physical Activity

11 1216 18

2732tied

05

101520253035404550

CurrentSmoking

CholesterolEver told high

Obese(BMIgt30)

BloodPressure Ever

told high

Diabetes No LeisureTime Physical

Activity

Overweight(BMIgt25)

2015 NATIONAL RANKING(1st is worst)

18tied

MOSAIC 2015-2020 Focus of Grant Developing Stroke Systems of

Care Community Awareness EMS In-hospital QI Transition of Care Post-Discharge

12

Pre-hospital Care

A V A I L A B L E D A T A

13

EMSMOSAIC Data Linkage

-The MOSAIC Team continues to link data from the Michigan EMS Information System (MiEMSIS) to MOSAIC Data- Reports have been created for and reviewed by the

Tri-County Area MCA and Detroit East MCA- This work will expand to other MCA regions that

serve hospitals participating in MOSAIC

GWTG Special Initiatives Tab

-A free tab that can be enabled in GWTG-The purpose of the tab is to collect data concerning patient hand-off from EMS

MOSAIC Participating Hospitals

Aspirus Keweenaw Hospital (Laurium)

Aspirus Grand View HospitalAspirus Iron River HospitalAspirus Ontonagon HospitalBixby Medical CenterBronson Methodist HospitalCovenant Health CareDetroit Receiving HospitalGenesys Regional Medical CenterHenry Ford Hospital Herrick Medical CenterHuron Valley-Sinai HospitalLakeland Regional Medical Center McLaren Bay Regional Medical CenterMcLaren Greater Medical Center

McLaren Macomb HospitalMcLaren Northern MI HospitalMcLaren Oakland Medical CenterMcLaren Port Huron HospitalMcLaren Regional Medical CenterMercy Health Saint Maryrsquos HospitalMetro Health HospitalMunson Medical Center

ProMedica Monroe Regional HospitalSparrow HospitalSt Joseph Mercy - Ann ArborSt Joseph Mercy ChelseaSt Joseph Mercy Livingston HospitalSt Mary MercySt Mary of Michigan HospitalU of M Hospital

Hospital Infrastructure19

Among all participating hospitals the average number of

Licensed beds was 374 (range 25 to 1059 beds)

Inpatient discharges was 17076 (range 1064 to 48916 patients)

Acute stroke discharges (primary diagnosis only) was 417 (range 34 to 982 patients)

Case Demographics MOSAIC Registry

VariablesN() or statistics(Total N=68906)

Age at admission (years)Median 710Range 180 - 1060Mean (SE) 697(01)

GenderMale 32886 (477)Female 36015 (523)

RaceAfrican American 9900 (197)AIAN 132 (03)Asian 320 (06)More than one race 44 (01)Unknown 3679 (73)White 36190 (720)Missing 70

EthnicityHispanic or Latino 804 (16)Others 49531 (984)

VariablesN() or statistics(Total N=68906)

Health insuranceMedicaid 2284 (45)MedicaidPrivate 211 (04)Medicare 16863 (336)Medicare Medicaid 2313 (46)

MedicareMedicaidPrivate125 (02)

MedicarePrivate 13640 (272)ND 268(05)No insurance 2123 (42)Private 12356 (246)

Arrival modeEMS 21052 (429)Private

transportationother19313 (393)

Transfer from another hospital

7733(157)

ND or unknown 1021 (21)Missing 1216

Who receives data reports on your stroke quality of care

21

7055

70

10085

65

40

Hos

pita

lC

EO

up

per

man

agem

ent

Hos

pita

lB

oard

Chi

efN

ursi

ngO

ffice

r(C

NO

)

Str

oke

Tea

m

Phy

sici

anS

trok

eC

ham

pion

Chi

ef o

fM

edic

ine

Oth

er

Data Use

1) In the most recent calendar year have you run additional analyses (beyond what was required for reporting) on your hospitalrsquos own stroke data

2)How frequently have you run and used the analyses generated

22

Yes (N=16) 80

No (N=4) 20Weekly (N=2) 125

Monthly (N=8) 500

Less than monthly but more

than 1-2 times(N=6) 375

Data Use

What is the main reason you do not run your own additional analyses (Select one best answer)

23

Not sure how to run analyses

25

Not sure what analyses are needed would be helpful 25

Other 50

Data Use

In the most recent calendar year what reports did you run

24

813 688

Pre-programmedautomated reports in thedata collection tool (eg GWTG)

Additional reports beyond pre-programmed reports from the tool

Data Use

How do you use these analyses reports

25

813 688375

Inform quality improvement (QI) efforts andor plan

ldquoaction itemsrdquo

Report to management administration on our

progress

Other

Data Use

If you run additional analysis what action items QI efforts did you plan as a result of these reports

26

o Discharge education intensive statin use

o Door to tPA time and dysphagia

o Review data between spoke amp hub hospitals regarding transfers IV-tPA administration Mechanical thrombectomy and SAH

o QI efforts were addressed in the department involving calling Stroke Alert on call for cases with FAST symptoms

o ED Medical Director works with team to fix fallouts and problematic areas We have seen improvement

o Process changes (ie fallout emails to RN manager) physician querieso Increased documentation of NIHSS ownership from individual units regarding stroke quality

improvement goalso Daily dysphagia screening determination of whowhat team responsible for documenting initial NIHSS

looking at patients beyond 2h LKW arrival

Hospital Arrival Mode Door-to Needle and Pre-Notification

Reports 2016

Percent of Cases Who Arrived via EMSMOSAIC 2009-2016

Table 1 Arrival Mode among Stroke Cases by Demographics MOSAIC 2016

Demographics N=3496 550 N=2938 450Stroke Type Ischemic 2558 542 2164 458 Hemorrhagic 560 728 209 272 TIA 378 478 413 522Age Group lt 50 Years 233 433 305 567 50-79 Years 1982 497 2008 503 ge 80 Years 1379 688 625 312Sex Female 1933 576 1422 424 Male 1661 523 1516 477Race Black 659 530 584 470 White 2824 557 2248 443 Other Missing 111 512 106 488

MOSAIC AggregateArrival Mode

EMS Private Mode

Table 2 Door-to-Needle Times by Arrival Mode among Stroke Cases MOSAIC 2016

Time Elements (in Minutes)Number of

Patients Mean (Minutes) Median

(Minutes)Range

(Minutes)Door-to-Image 4901 575 400 00-2700 Arrived via EMS 2767 463 270 00-2700 Arrived via Private Transportation 2134 720 570 00-2620

Door-to-Image (among t-PA treated) 492 155 130 00-970 Arrived via EMS 370 125 110 00-840 Arrived via Private Transportation 122 243 215 20-970Image-to Needle 492 500 450 70-2090 Arrived via EMS 370 503 460 70-2090 Arrived via Private Transportation 122 483 420 90-1770Door-to Needle 492 655 570 200-2180 Arrived via EMS 370 629 560 200-2180 Arrived via Private Transportation 122 726 650 290-2060Included ischemic or hemorrhagic cases with times that were less or equal to 270 minutes (45 hours)Transferred cases were excluded

MOSAIC Aggregate

Table 3 Pre-Notification among Stroke Cases Who Arrived Via EMS by Demographics MOSAIC 2016

Demographics N=2015 584 N=1437 416Stroke Type Ischemic 1523 622 924 378 Hemorrhagic 306 566 235 434 TIA 142 381 231 619Age Group lt 50 Years 133 607 86 393 50-79 Years 1105 585 784 415 ge 80 Years 777 578 567 422Sex Female 1075 578 786 422 Male 940 591 651 409Race Black 307 517 287 483 White 1657 602 1097 398 Other 51 490 53 510

All HospitalsPre-Notification

Yes No

MOSAIC Transitions of Care Project

Post-discharge data collection tool is being implemented into Outcome Science as a tab

Post-Discharge amp Transition of Care

Reporting on changes within 30 days of discharge from hospital via follow-up callschart review Interval events Physician follow-up visits Lifestyle changes Lab assessments Medication managementadherence Rehab amp Functional outcomes Falls

MOSAIC Website

wwwMichigangovstroke

Adrienne Nickles MPHnicklesamichigangov

Thank You

  • Michigan and MOSAIC Data Review
  • Overview
  • Age-adjusted Stroke Hospitalization Rates Michigan 2000-2015
  • Slide Number 4
  • Age-adjusted Stroke Mortality Rates Michigan 2000-2014
  • Slide Number 6
  • Slide Number 7
  • Slide Number 8
  • Slide Number 9
  • Slide Number 10
  • Slide Number 11
  • MOSAIC 2015-2020
  • Pre-hospital Care
  • EMSMOSAIC Data Linkage
  • Slide Number 15
  • GWTG Special Initiatives Tab
  • Slide Number 17
  • MOSAIC Participating Hospitals
  • Hospital Infrastructure
  • Case Demographics MOSAIC Registry
  • Who receives data reports on your stroke quality of care
  • 1) In the most recent calendar year have you run additional analyses (beyond what was required for reporting) on your hospitalrsquos own stroke data 2)How frequently have you run and used the analyses generated
  • What is the main reason you do not run your own additional analyses (Select one best answer)
  • In the most recent calendar year what reports did you run
  • How do you use these analyses reports
  • If you run additional analysis what action items QI efforts did you plan as a result of these reports
  • Hospital Arrival Mode Door-to Needle and Pre-Notification Reports 2016
  • Percent of Cases Who Arrived via EMSMOSAIC 2009-2016
  • Table 1 Arrival Mode among Stroke Cases by Demographics MOSAIC 2016
  • Table 2 Door-to-Needle Times by Arrival Mode among Stroke Cases MOSAIC 2016
  • Table 3 Pre-Notification among Stroke Cases Who Arrived Via EMS by Demographics MOSAIC 2016
  • MOSAIC Transitions of Care Project
  • Slide Number 33
  • MOSAIC Website
  • Adrienne Nickles MPHnicklesamichigangov
CVD
Year White Male Black Male White Female Black Female
2000 4276 5424 3033 4161
2001 4066 5524 2813 4091
2002 3928 5468 2767 4114
2003 3734 518 2638 3887
2004 3448 5079 2432 3643
2005 3366 4983 2375 3545
2006 3276 4994 2313 3477
2007 3236 4845 2223 327
2008 3158 4694 2238 3327
change 234 79 237 164
Heart Disease
Year White Male Black Male White Female Black Female
2000 3393 4298 227 3206
2001 3232 4445 2124 3166
2002 3118 4317 2197 3157
2003 2986 4184 1957 3001
2004 2777 3983 1783 2838
2005 2704 4009 1776 2679
2006 2644 3981 1739 2642
2007 2619 3972 1679 2532
2008 2566 3819 1687 2606
Stroke
Year White Male Black Male White Female Black Female
2000 61 768 561 703 176
2001 575 752 539 681 138
2002 573 806 528 66 15
2003 516 662 498 629 147
2004 463 743 476 562
2005 449 663 429 585
2006 434 63 411 556
2007 415 631 392 494
2008 402 606 392 509
2009 375 616 372 464
2010 372 565 366 513
2011 373 548 366 44
2012 348 587 349 477
2013 347 506 34 462
2014 369 506 352 482
Coronary Heart Disease
Year White Male Black Male White Female Black Female
2000 2625 329 1608 243
2001 2478 3356 1508 2314
2002 2404 3154 1419 2313
2003 2221 3093 1328 209
2004 2067 2956 119 1983
2005 1989 2885 117 1853
2006 1922 2903 1139 1825
2007 1921 2771 1074 1645
2008 1824 2592 1071 1722
Heart Failure
Year White Male Black Male White Female Black Female
2000 255 206 245 17
2001 267 225 225 167
2002 242 238 227 203
2003 256 217 222 189
2004 243 167 214 206
2005 24 218 217 172
2006 255 246 229 202
2007 23 225 208 196
2008 25 216 226 185
Not sure what this data is from previously HD Stroke
Year White Female Black Female White Female Black Female
2000 227 3206 561 703
2001 2124 3166 539 681
2002 2197 3157 528 66
2003 1957 3001 498 629
2004 1783 2838 476 562
2005 1776 2679 429 585
2006 1739 2642 411 556
2007
2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2009 2009 2009 2009
2010 2010 2010 2010
2011 2011 2011 2011
2012 2012 2012 2012
2013 2013 2013 2013
2014 2014 2014 2014
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
CVD
Year US Michigan 0-34 35-64 65-84 85+
2000 3397 3694 43 140 16141 86689
2001 3265 3524 508 1348 15291 82889
2002 3174 3421 45 1338 14891 79536
2003 3061 3258 54 1324 14033 75185
2004 2885 3034 41 1242 13209 69088
2005 2773 2972 48 1283 1291 66011
2006 2898 48 1207 12246 6786
2007 2825 5 1206 1182 66153
2008 2791 43 1175 11619 66406
Heart Disease
Year US Michigan 0-34 35-64 65-84 85+
2000 2576 2851 345 1158 1247 64879
2001 2478 2719 416 112 11794 61938
2002 2408 2631 35 1103 11529 58746
2003 2323 2517 45 110 10827 56172
2004 217 2337 313 1048 10086 51609
2005 2111 2308 38 1078 9937 49828
2006 226 384 1019 9413 51918
2007 2216 42 1008 9174 50961
2008 2192 36 982 904 51209
Stroke
Year US Michigan HP 2010 0-34 35-64 65-84 85+
2000 609 603 50 068 174 2589 15841
2001 579 577 50 0638 157 2522 1504
2002 562 571 50 072 169 2397 1528
2003 535 527 50 0737 157 2249 13741
2004 50 496 50 0652 138 220 12629
2005 466 464 50 0553 145 2063 11398
2006 444 50 0734 127 196 11256
2007 425 064 1368 1832 10718
2008 419 047 134 1804 10646
79 27 243 289
Coronary Heart Disease
Year US Michigan HP 2010 0-34 35-64 65-84 85+
2000 1868 2118 162 0613 874 7701 4670
2001 1778 2006 162 0898 818 9012 44369
2002 1709 192 162 0889 799 8759 41061
2003 1628 179 162 0793 785 8018 38358
2004 1502 1656 162 0865 757 7421 34644
2005 1444 1611 162 097 773 7245 32617
2006 1564 162 088 727 6856 33503
2007 1516 117 709 6585 32727
2008 1472 102 657 6403 32504
168 11 283
Heart Failure
Year US Michigan 35-64 65-84 85+
2000 203 245 3047 936 8287
2001 202 237 2596 88 8285
2002 194 233 2648 878 8057
2003 194 233 3176 902 7722
2004 189 224 2709 863 7586
2005 189 224 2955 878 7388
2006 24 2979 884 8354
2007 219 274 828 7483
2008 233 013 333 85 8102
Heart Disease Stroke
Michigan White Michigan Black US White US Black Michigan White Michigan Black US White US Black
1990 334 4315 317 3915 1990 638 733 629 917
1991 3289 4108 3088 3865 1991 626 781 607 894
1992 3126 3987 3011 3777 1992 609 694 598 86
1993 3234 429 3046 3843 1993 614 77 609 866
1994 3134 4156 295 3661 1994 634 875 609 869
1995 3048 4131 2912 3672 1995 638 925 615 879
1996 2997 380 2842 354 1996 617 804 61 852
1997 2851 3683 2764 345 1997 604 77 598 816
1998 2884 3586 2681 3406 1998 598 729 576 803
1999 2781 3692 2634 3367 1999 609 812 598 824
2000 2757 3663 2536 3265 2000 586 737 587 824
2001 261 3695 2435 3169 2001 56 718 558 788
2002 2522 3659 2367 3084 2002 553 729 542 763
2003 2409 350 2282 3002 2003 511 655 514 743
2004 222 3311 2133 2806 2004 477 633 48 699
2005 219 3227 2005 442 616
2006 2144 320 2006 426 589
2007 2007
2008 2008
CVD CHD HD HF Stroke
2000 3694 2118 2851 245 603
2001 3524 2006 2719 237 577
2002 3421 192 2631 233 571
2003 3258 179 2517 233 527
2004 3034 1656 2337 224 496
2005 2972 1611 2308 224 464
2006 2898 1564 226 24 444
2007 2825 1516 2216 219 425
2008 2791 1472 2192 233 419
2000 2000 2000
2001 2001 2001
2002 2002 2002
2003 2003 2003
2004 2004 2004
2005 2005 2005
2006 2006 2006
2007 2007 2007
2008 2008 2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2000 2000 2000 2000 2000
2001 2001 2001 2001 2001
2002 2002 2002 2002 2002
2003 2003 2003 2003 2003
2004 2004 2004 2004 2004
2005 2005 2005 2005 2005
2006 2006 2006 2006 2006
2007 2007 2007 2007 2007
2008 2008 2008 2008 2008
Page 22: Michigan and MOSAIC Data Review...Michigan and MOSAIC Data Review 2017 ANNUAL WORKSHOP 4/26/2017. Adrienne Nickles, MPH. Michigan’s Ongoing Stroke Registry to Accelerate the Improvement

Age-adjusted stroke mortality rates by race and gender Michigan 2000 to 2014

0

10

20

30

40

50

60

70

80

90

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014

Age

-Adj

uste

d R

ate

per 1

000

00

Year

White Male

Black Male

White Female

Black Female

Overall_Rates

CVD
CHD
HD
HF
Stroke
Year
Rate per 10000
3694
2118
2851
245
603
3524
2006
2719
237
577
3421
192
2631
233
571
3258
179
2517
233
527
3034
1656
2337
224
496
2972
1611
2308
224
464
2898
1564
226
24
444
2825
1516
2216
219
425
2791
1472
2192
233
419

CVD_Age

0-34
35-64
65-84
85+
Year
Age-Adjusted Rate per 100000
43
140
16141
86689
508
1348
15291
82889
45
1338
14891
79536
54
1324
14033
75185
41
1242
13209
69088
48
1283
1291
66011
48
1207
12246
6786
5
1206
1182
66153
43
1175
11619
66406

HD_Age

0-34
35-64
65-84
85+
Year
Age-Adjusted Rate per 100000
345
1158
1247
64879
416
112
11794
61938
35
1103
11529
58746
45
110
10827
56172
313
1048
10086
51609
38
1078
9937
49828
384
1019
9413
51918
42
1008
9174
50961
36
982
904
51209

CHD_Age

0-34
35-64
65-84
85+
Year
Age-Adjusted Rate per 100000
0613
874
7701
4670
0898
818
9012
44369
0889
799
8759
41061
0793
785
8018
38358
0865
757
7421
34644
097
773
7245
32617
088
727
6856
33503
117
709
6585
32727
102
657
6403
32504

Stroke_Age

0-34
35-64
65-84
85+
Year
Age-Adjusted Rate per 100000
068
174
2589
15841
0638
157
2522
1504
072
169
2397
1528
0737
157
2249
13741
0652
138
220
12629
0553
145
2063
11398
0734
127
196
11256
064
1368
1832
10718
047
134
1804
10646

HF_Age

35-64
65-84
85+
Year
Age-Adjusted Rate per 100000
3047
936
8287
2596
88
8285
2648
878
8057
3176
902
7722
2709
863
7586
2955
878
7388
2979
884
8354
274
828
7483
333
85
8102

total

CVD_RG

White Male
Black Male
White Female
Black Female
Year
Age-Adjusted Rate per 100000
4276
5424
3033
4161
4066
5524
2813
4091
3928
5468
2767
4114
3734
518
2638
3887
3448
5079
2432
3643
3366
4983
2375
3545
3276
4994
2313
3477
3236
4845
2223
327
3158
4694
2238
3327

Stroke_RG

White Male
Black Male
White Female
Black Female
Year
Age-Adjusted Rate per 100000
61
768
561
703
575
752
539
681
573
806
528
66
516
662
498
629
463
743
476
562
449
663
429
585
434
63
411
556
415
631
392
494
402
606
392
509
375
616
372
464
372
565
366
513
373
548
366
44
348
587
349
477
347
506
34
462
369
506
352
482

HD_RG

White Male
Black Male
White Female
Black Female
Year
Age-Adjusted Rate per 100000
3393
4298
227
3206
3232
4445
2124
3166
3118
4317
2197
3157
2986
4184
1957
3001
2777
3983
1783
2838
2704
4009
1776
2679
2644
3981
1739
2642
2619
3972
1679
2532
2566
3819
1687
2606

CHD_RG

White Male
Black Male
White Female
Black Female
Year
Age-Adjusted Rate per 100000
2625
329
1608
243
2478
3356
1508
2314
2404
3154
1419
2313
2221
3093
1328
209
2067
2956
119
1983
1989
2885
117
1853
1922
2903
1139
1825
1921
2771
1074
1645
1824
2592
1071
1722

HF_RG

White Male
Black Male
White Female
Black Female
Year
Age-Adjusted Rate per 100000
255
206
245
17
267
225
225
167
242
238
227
203
256
217
222
189
243
167
214
206
24
218
217
172
255
246
229
202
23
225
208
196
25
216
226
185

race_gender

Sheet3

Local Health Department data can be found at wwwmichigangovbrfsSource CDC BRFSS

RISK FACTORMI

2011

MI

2013

MI

2014

MI

2015US 2015

2015 NATIONAL RANKING

Current Smoking 233 214 212 207 175 11

Blood Pressure Ever Told High 342 346 NA 331 309 18

Cholesterol Ever Told High 418 406 NA 382 364 12

Overweight (BMIgt25) 342 347 349 351 355 32tied

Obese (BMIgt30) 313 315 307 312 298 16

No Leisure Time Physical Activity 236 244 255 255 262 27

Diabetes 100 104 104 107 100 18tied

Prevalence of CVD Risk Factors Michigan Adults 1990-2015Compared to 2015 National Prevalence

233214 212 207

175

10

15

20

25

30

MI 2011 MI 2013 MI 2014 MI 2015 US 2015

Current Smoking

342 346331

309

20

25

30

35

40

MI 2011 MI 2013 MI 2014 MI 2015 US 2015

Blood Pressure Ever told high

342 347 349 351 355

20

25

30

35

40

MI 2011 MI 2013 MI 2014 MI 2015 US 2015

Overweight (BMIgt25)

313 315 307 312298

20

25

30

35

40

MI 2011 MI 2013 MI 2014 MI 2015 US 2015

Obese (BMIgt30)

418406

382364

30

35

40

45

50

MI 2011 MI 2013 MI 2014 MI 2015 US 2015

Cholesterol Ever told high

10 104 104 10710

0

3

6

9

12

15

MI 2011 MI 2013 MI 2014 MI 2015 US 2015

Diabetes

236 244255 255 262

10

15

20

25

30

MI 2011 MI 2013 MI 2014 MI 2015 US 2015

No Leisure Time Physical Activity

11 1216 18

2732tied

05

101520253035404550

CurrentSmoking

CholesterolEver told high

Obese(BMIgt30)

BloodPressure Ever

told high

Diabetes No LeisureTime Physical

Activity

Overweight(BMIgt25)

2015 NATIONAL RANKING(1st is worst)

18tied

MOSAIC 2015-2020 Focus of Grant Developing Stroke Systems of

Care Community Awareness EMS In-hospital QI Transition of Care Post-Discharge

12

Pre-hospital Care

A V A I L A B L E D A T A

13

EMSMOSAIC Data Linkage

-The MOSAIC Team continues to link data from the Michigan EMS Information System (MiEMSIS) to MOSAIC Data- Reports have been created for and reviewed by the

Tri-County Area MCA and Detroit East MCA- This work will expand to other MCA regions that

serve hospitals participating in MOSAIC

GWTG Special Initiatives Tab

-A free tab that can be enabled in GWTG-The purpose of the tab is to collect data concerning patient hand-off from EMS

MOSAIC Participating Hospitals

Aspirus Keweenaw Hospital (Laurium)

Aspirus Grand View HospitalAspirus Iron River HospitalAspirus Ontonagon HospitalBixby Medical CenterBronson Methodist HospitalCovenant Health CareDetroit Receiving HospitalGenesys Regional Medical CenterHenry Ford Hospital Herrick Medical CenterHuron Valley-Sinai HospitalLakeland Regional Medical Center McLaren Bay Regional Medical CenterMcLaren Greater Medical Center

McLaren Macomb HospitalMcLaren Northern MI HospitalMcLaren Oakland Medical CenterMcLaren Port Huron HospitalMcLaren Regional Medical CenterMercy Health Saint Maryrsquos HospitalMetro Health HospitalMunson Medical Center

ProMedica Monroe Regional HospitalSparrow HospitalSt Joseph Mercy - Ann ArborSt Joseph Mercy ChelseaSt Joseph Mercy Livingston HospitalSt Mary MercySt Mary of Michigan HospitalU of M Hospital

Hospital Infrastructure19

Among all participating hospitals the average number of

Licensed beds was 374 (range 25 to 1059 beds)

Inpatient discharges was 17076 (range 1064 to 48916 patients)

Acute stroke discharges (primary diagnosis only) was 417 (range 34 to 982 patients)

Case Demographics MOSAIC Registry

VariablesN() or statistics(Total N=68906)

Age at admission (years)Median 710Range 180 - 1060Mean (SE) 697(01)

GenderMale 32886 (477)Female 36015 (523)

RaceAfrican American 9900 (197)AIAN 132 (03)Asian 320 (06)More than one race 44 (01)Unknown 3679 (73)White 36190 (720)Missing 70

EthnicityHispanic or Latino 804 (16)Others 49531 (984)

VariablesN() or statistics(Total N=68906)

Health insuranceMedicaid 2284 (45)MedicaidPrivate 211 (04)Medicare 16863 (336)Medicare Medicaid 2313 (46)

MedicareMedicaidPrivate125 (02)

MedicarePrivate 13640 (272)ND 268(05)No insurance 2123 (42)Private 12356 (246)

Arrival modeEMS 21052 (429)Private

transportationother19313 (393)

Transfer from another hospital

7733(157)

ND or unknown 1021 (21)Missing 1216

Who receives data reports on your stroke quality of care

21

7055

70

10085

65

40

Hos

pita

lC

EO

up

per

man

agem

ent

Hos

pita

lB

oard

Chi

efN

ursi

ngO

ffice

r(C

NO

)

Str

oke

Tea

m

Phy

sici

anS

trok

eC

ham

pion

Chi

ef o

fM

edic

ine

Oth

er

Data Use

1) In the most recent calendar year have you run additional analyses (beyond what was required for reporting) on your hospitalrsquos own stroke data

2)How frequently have you run and used the analyses generated

22

Yes (N=16) 80

No (N=4) 20Weekly (N=2) 125

Monthly (N=8) 500

Less than monthly but more

than 1-2 times(N=6) 375

Data Use

What is the main reason you do not run your own additional analyses (Select one best answer)

23

Not sure how to run analyses

25

Not sure what analyses are needed would be helpful 25

Other 50

Data Use

In the most recent calendar year what reports did you run

24

813 688

Pre-programmedautomated reports in thedata collection tool (eg GWTG)

Additional reports beyond pre-programmed reports from the tool

Data Use

How do you use these analyses reports

25

813 688375

Inform quality improvement (QI) efforts andor plan

ldquoaction itemsrdquo

Report to management administration on our

progress

Other

Data Use

If you run additional analysis what action items QI efforts did you plan as a result of these reports

26

o Discharge education intensive statin use

o Door to tPA time and dysphagia

o Review data between spoke amp hub hospitals regarding transfers IV-tPA administration Mechanical thrombectomy and SAH

o QI efforts were addressed in the department involving calling Stroke Alert on call for cases with FAST symptoms

o ED Medical Director works with team to fix fallouts and problematic areas We have seen improvement

o Process changes (ie fallout emails to RN manager) physician querieso Increased documentation of NIHSS ownership from individual units regarding stroke quality

improvement goalso Daily dysphagia screening determination of whowhat team responsible for documenting initial NIHSS

looking at patients beyond 2h LKW arrival

Hospital Arrival Mode Door-to Needle and Pre-Notification

Reports 2016

Percent of Cases Who Arrived via EMSMOSAIC 2009-2016

Table 1 Arrival Mode among Stroke Cases by Demographics MOSAIC 2016

Demographics N=3496 550 N=2938 450Stroke Type Ischemic 2558 542 2164 458 Hemorrhagic 560 728 209 272 TIA 378 478 413 522Age Group lt 50 Years 233 433 305 567 50-79 Years 1982 497 2008 503 ge 80 Years 1379 688 625 312Sex Female 1933 576 1422 424 Male 1661 523 1516 477Race Black 659 530 584 470 White 2824 557 2248 443 Other Missing 111 512 106 488

MOSAIC AggregateArrival Mode

EMS Private Mode

Table 2 Door-to-Needle Times by Arrival Mode among Stroke Cases MOSAIC 2016

Time Elements (in Minutes)Number of

Patients Mean (Minutes) Median

(Minutes)Range

(Minutes)Door-to-Image 4901 575 400 00-2700 Arrived via EMS 2767 463 270 00-2700 Arrived via Private Transportation 2134 720 570 00-2620

Door-to-Image (among t-PA treated) 492 155 130 00-970 Arrived via EMS 370 125 110 00-840 Arrived via Private Transportation 122 243 215 20-970Image-to Needle 492 500 450 70-2090 Arrived via EMS 370 503 460 70-2090 Arrived via Private Transportation 122 483 420 90-1770Door-to Needle 492 655 570 200-2180 Arrived via EMS 370 629 560 200-2180 Arrived via Private Transportation 122 726 650 290-2060Included ischemic or hemorrhagic cases with times that were less or equal to 270 minutes (45 hours)Transferred cases were excluded

MOSAIC Aggregate

Table 3 Pre-Notification among Stroke Cases Who Arrived Via EMS by Demographics MOSAIC 2016

Demographics N=2015 584 N=1437 416Stroke Type Ischemic 1523 622 924 378 Hemorrhagic 306 566 235 434 TIA 142 381 231 619Age Group lt 50 Years 133 607 86 393 50-79 Years 1105 585 784 415 ge 80 Years 777 578 567 422Sex Female 1075 578 786 422 Male 940 591 651 409Race Black 307 517 287 483 White 1657 602 1097 398 Other 51 490 53 510

All HospitalsPre-Notification

Yes No

MOSAIC Transitions of Care Project

Post-discharge data collection tool is being implemented into Outcome Science as a tab

Post-Discharge amp Transition of Care

Reporting on changes within 30 days of discharge from hospital via follow-up callschart review Interval events Physician follow-up visits Lifestyle changes Lab assessments Medication managementadherence Rehab amp Functional outcomes Falls

MOSAIC Website

wwwMichigangovstroke

Adrienne Nickles MPHnicklesamichigangov

Thank You

  • Michigan and MOSAIC Data Review
  • Overview
  • Age-adjusted Stroke Hospitalization Rates Michigan 2000-2015
  • Slide Number 4
  • Age-adjusted Stroke Mortality Rates Michigan 2000-2014
  • Slide Number 6
  • Slide Number 7
  • Slide Number 8
  • Slide Number 9
  • Slide Number 10
  • Slide Number 11
  • MOSAIC 2015-2020
  • Pre-hospital Care
  • EMSMOSAIC Data Linkage
  • Slide Number 15
  • GWTG Special Initiatives Tab
  • Slide Number 17
  • MOSAIC Participating Hospitals
  • Hospital Infrastructure
  • Case Demographics MOSAIC Registry
  • Who receives data reports on your stroke quality of care
  • 1) In the most recent calendar year have you run additional analyses (beyond what was required for reporting) on your hospitalrsquos own stroke data 2)How frequently have you run and used the analyses generated
  • What is the main reason you do not run your own additional analyses (Select one best answer)
  • In the most recent calendar year what reports did you run
  • How do you use these analyses reports
  • If you run additional analysis what action items QI efforts did you plan as a result of these reports
  • Hospital Arrival Mode Door-to Needle and Pre-Notification Reports 2016
  • Percent of Cases Who Arrived via EMSMOSAIC 2009-2016
  • Table 1 Arrival Mode among Stroke Cases by Demographics MOSAIC 2016
  • Table 2 Door-to-Needle Times by Arrival Mode among Stroke Cases MOSAIC 2016
  • Table 3 Pre-Notification among Stroke Cases Who Arrived Via EMS by Demographics MOSAIC 2016
  • MOSAIC Transitions of Care Project
  • Slide Number 33
  • MOSAIC Website
  • Adrienne Nickles MPHnicklesamichigangov
CVD
Year White Male Black Male White Female Black Female
2000 4276 5424 3033 4161
2001 4066 5524 2813 4091
2002 3928 5468 2767 4114
2003 3734 518 2638 3887
2004 3448 5079 2432 3643
2005 3366 4983 2375 3545
2006 3276 4994 2313 3477
2007 3236 4845 2223 327
2008 3158 4694 2238 3327
change 234 79 237 164
Heart Disease
Year White Male Black Male White Female Black Female
2000 3393 4298 227 3206
2001 3232 4445 2124 3166
2002 3118 4317 2197 3157
2003 2986 4184 1957 3001
2004 2777 3983 1783 2838
2005 2704 4009 1776 2679
2006 2644 3981 1739 2642
2007 2619 3972 1679 2532
2008 2566 3819 1687 2606
Stroke
Year White Male Black Male White Female Black Female
2000 61 768 561 703 176
2001 575 752 539 681 138
2002 573 806 528 66 15
2003 516 662 498 629 147
2004 463 743 476 562
2005 449 663 429 585
2006 434 63 411 556
2007 415 631 392 494
2008 402 606 392 509
2009 375 616 372 464
2010 372 565 366 513
2011 373 548 366 44
2012 348 587 349 477
2013 347 506 34 462
2014 369 506 352 482
Coronary Heart Disease
Year White Male Black Male White Female Black Female
2000 2625 329 1608 243
2001 2478 3356 1508 2314
2002 2404 3154 1419 2313
2003 2221 3093 1328 209
2004 2067 2956 119 1983
2005 1989 2885 117 1853
2006 1922 2903 1139 1825
2007 1921 2771 1074 1645
2008 1824 2592 1071 1722
Heart Failure
Year White Male Black Male White Female Black Female
2000 255 206 245 17
2001 267 225 225 167
2002 242 238 227 203
2003 256 217 222 189
2004 243 167 214 206
2005 24 218 217 172
2006 255 246 229 202
2007 23 225 208 196
2008 25 216 226 185
Not sure what this data is from previously HD Stroke
Year White Female Black Female White Female Black Female
2000 227 3206 561 703
2001 2124 3166 539 681
2002 2197 3157 528 66
2003 1957 3001 498 629
2004 1783 2838 476 562
2005 1776 2679 429 585
2006 1739 2642 411 556
2007
2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2009 2009 2009 2009
2010 2010 2010 2010
2011 2011 2011 2011
2012 2012 2012 2012
2013 2013 2013 2013
2014 2014 2014 2014
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
CVD
Year US Michigan 0-34 35-64 65-84 85+
2000 3397 3694 43 140 16141 86689
2001 3265 3524 508 1348 15291 82889
2002 3174 3421 45 1338 14891 79536
2003 3061 3258 54 1324 14033 75185
2004 2885 3034 41 1242 13209 69088
2005 2773 2972 48 1283 1291 66011
2006 2898 48 1207 12246 6786
2007 2825 5 1206 1182 66153
2008 2791 43 1175 11619 66406
Heart Disease
Year US Michigan 0-34 35-64 65-84 85+
2000 2576 2851 345 1158 1247 64879
2001 2478 2719 416 112 11794 61938
2002 2408 2631 35 1103 11529 58746
2003 2323 2517 45 110 10827 56172
2004 217 2337 313 1048 10086 51609
2005 2111 2308 38 1078 9937 49828
2006 226 384 1019 9413 51918
2007 2216 42 1008 9174 50961
2008 2192 36 982 904 51209
Stroke
Year US Michigan HP 2010 0-34 35-64 65-84 85+
2000 609 603 50 068 174 2589 15841
2001 579 577 50 0638 157 2522 1504
2002 562 571 50 072 169 2397 1528
2003 535 527 50 0737 157 2249 13741
2004 50 496 50 0652 138 220 12629
2005 466 464 50 0553 145 2063 11398
2006 444 50 0734 127 196 11256
2007 425 064 1368 1832 10718
2008 419 047 134 1804 10646
79 27 243 289
Coronary Heart Disease
Year US Michigan HP 2010 0-34 35-64 65-84 85+
2000 1868 2118 162 0613 874 7701 4670
2001 1778 2006 162 0898 818 9012 44369
2002 1709 192 162 0889 799 8759 41061
2003 1628 179 162 0793 785 8018 38358
2004 1502 1656 162 0865 757 7421 34644
2005 1444 1611 162 097 773 7245 32617
2006 1564 162 088 727 6856 33503
2007 1516 117 709 6585 32727
2008 1472 102 657 6403 32504
168 11 283
Heart Failure
Year US Michigan 35-64 65-84 85+
2000 203 245 3047 936 8287
2001 202 237 2596 88 8285
2002 194 233 2648 878 8057
2003 194 233 3176 902 7722
2004 189 224 2709 863 7586
2005 189 224 2955 878 7388
2006 24 2979 884 8354
2007 219 274 828 7483
2008 233 013 333 85 8102
Heart Disease Stroke
Michigan White Michigan Black US White US Black Michigan White Michigan Black US White US Black
1990 334 4315 317 3915 1990 638 733 629 917
1991 3289 4108 3088 3865 1991 626 781 607 894
1992 3126 3987 3011 3777 1992 609 694 598 86
1993 3234 429 3046 3843 1993 614 77 609 866
1994 3134 4156 295 3661 1994 634 875 609 869
1995 3048 4131 2912 3672 1995 638 925 615 879
1996 2997 380 2842 354 1996 617 804 61 852
1997 2851 3683 2764 345 1997 604 77 598 816
1998 2884 3586 2681 3406 1998 598 729 576 803
1999 2781 3692 2634 3367 1999 609 812 598 824
2000 2757 3663 2536 3265 2000 586 737 587 824
2001 261 3695 2435 3169 2001 56 718 558 788
2002 2522 3659 2367 3084 2002 553 729 542 763
2003 2409 350 2282 3002 2003 511 655 514 743
2004 222 3311 2133 2806 2004 477 633 48 699
2005 219 3227 2005 442 616
2006 2144 320 2006 426 589
2007 2007
2008 2008
CVD CHD HD HF Stroke
2000 3694 2118 2851 245 603
2001 3524 2006 2719 237 577
2002 3421 192 2631 233 571
2003 3258 179 2517 233 527
2004 3034 1656 2337 224 496
2005 2972 1611 2308 224 464
2006 2898 1564 226 24 444
2007 2825 1516 2216 219 425
2008 2791 1472 2192 233 419
2000 2000 2000
2001 2001 2001
2002 2002 2002
2003 2003 2003
2004 2004 2004
2005 2005 2005
2006 2006 2006
2007 2007 2007
2008 2008 2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2000 2000 2000 2000 2000
2001 2001 2001 2001 2001
2002 2002 2002 2002 2002
2003 2003 2003 2003 2003
2004 2004 2004 2004 2004
2005 2005 2005 2005 2005
2006 2006 2006 2006 2006
2007 2007 2007 2007 2007
2008 2008 2008 2008 2008
Page 23: Michigan and MOSAIC Data Review...Michigan and MOSAIC Data Review 2017 ANNUAL WORKSHOP 4/26/2017. Adrienne Nickles, MPH. Michigan’s Ongoing Stroke Registry to Accelerate the Improvement

Overall_Rates

CVD
CHD
HD
HF
Stroke
Year
Rate per 10000
3694
2118
2851
245
603
3524
2006
2719
237
577
3421
192
2631
233
571
3258
179
2517
233
527
3034
1656
2337
224
496
2972
1611
2308
224
464
2898
1564
226
24
444
2825
1516
2216
219
425
2791
1472
2192
233
419

CVD_Age

0-34
35-64
65-84
85+
Year
Age-Adjusted Rate per 100000
43
140
16141
86689
508
1348
15291
82889
45
1338
14891
79536
54
1324
14033
75185
41
1242
13209
69088
48
1283
1291
66011
48
1207
12246
6786
5
1206
1182
66153
43
1175
11619
66406

HD_Age

0-34
35-64
65-84
85+
Year
Age-Adjusted Rate per 100000
345
1158
1247
64879
416
112
11794
61938
35
1103
11529
58746
45
110
10827
56172
313
1048
10086
51609
38
1078
9937
49828
384
1019
9413
51918
42
1008
9174
50961
36
982
904
51209

CHD_Age

0-34
35-64
65-84
85+
Year
Age-Adjusted Rate per 100000
0613
874
7701
4670
0898
818
9012
44369
0889
799
8759
41061
0793
785
8018
38358
0865
757
7421
34644
097
773
7245
32617
088
727
6856
33503
117
709
6585
32727
102
657
6403
32504

Stroke_Age

0-34
35-64
65-84
85+
Year
Age-Adjusted Rate per 100000
068
174
2589
15841
0638
157
2522
1504
072
169
2397
1528
0737
157
2249
13741
0652
138
220
12629
0553
145
2063
11398
0734
127
196
11256
064
1368
1832
10718
047
134
1804
10646

HF_Age

35-64
65-84
85+
Year
Age-Adjusted Rate per 100000
3047
936
8287
2596
88
8285
2648
878
8057
3176
902
7722
2709
863
7586
2955
878
7388
2979
884
8354
274
828
7483
333
85
8102

total

CVD_RG

White Male
Black Male
White Female
Black Female
Year
Age-Adjusted Rate per 100000
4276
5424
3033
4161
4066
5524
2813
4091
3928
5468
2767
4114
3734
518
2638
3887
3448
5079
2432
3643
3366
4983
2375
3545
3276
4994
2313
3477
3236
4845
2223
327
3158
4694
2238
3327

Stroke_RG

White Male
Black Male
White Female
Black Female
Year
Age-Adjusted Rate per 100000
61
768
561
703
575
752
539
681
573
806
528
66
516
662
498
629
463
743
476
562
449
663
429
585
434
63
411
556
415
631
392
494
402
606
392
509
375
616
372
464
372
565
366
513
373
548
366
44
348
587
349
477
347
506
34
462
369
506
352
482

HD_RG

White Male
Black Male
White Female
Black Female
Year
Age-Adjusted Rate per 100000
3393
4298
227
3206
3232
4445
2124
3166
3118
4317
2197
3157
2986
4184
1957
3001
2777
3983
1783
2838
2704
4009
1776
2679
2644
3981
1739
2642
2619
3972
1679
2532
2566
3819
1687
2606

CHD_RG

White Male
Black Male
White Female
Black Female
Year
Age-Adjusted Rate per 100000
2625
329
1608
243
2478
3356
1508
2314
2404
3154
1419
2313
2221
3093
1328
209
2067
2956
119
1983
1989
2885
117
1853
1922
2903
1139
1825
1921
2771
1074
1645
1824
2592
1071
1722

HF_RG

White Male
Black Male
White Female
Black Female
Year
Age-Adjusted Rate per 100000
255
206
245
17
267
225
225
167
242
238
227
203
256
217
222
189
243
167
214
206
24
218
217
172
255
246
229
202
23
225
208
196
25
216
226
185

race_gender

Sheet3

Local Health Department data can be found at wwwmichigangovbrfsSource CDC BRFSS

RISK FACTORMI

2011

MI

2013

MI

2014

MI

2015US 2015

2015 NATIONAL RANKING

Current Smoking 233 214 212 207 175 11

Blood Pressure Ever Told High 342 346 NA 331 309 18

Cholesterol Ever Told High 418 406 NA 382 364 12

Overweight (BMIgt25) 342 347 349 351 355 32tied

Obese (BMIgt30) 313 315 307 312 298 16

No Leisure Time Physical Activity 236 244 255 255 262 27

Diabetes 100 104 104 107 100 18tied

Prevalence of CVD Risk Factors Michigan Adults 1990-2015Compared to 2015 National Prevalence

233214 212 207

175

10

15

20

25

30

MI 2011 MI 2013 MI 2014 MI 2015 US 2015

Current Smoking

342 346331

309

20

25

30

35

40

MI 2011 MI 2013 MI 2014 MI 2015 US 2015

Blood Pressure Ever told high

342 347 349 351 355

20

25

30

35

40

MI 2011 MI 2013 MI 2014 MI 2015 US 2015

Overweight (BMIgt25)

313 315 307 312298

20

25

30

35

40

MI 2011 MI 2013 MI 2014 MI 2015 US 2015

Obese (BMIgt30)

418406

382364

30

35

40

45

50

MI 2011 MI 2013 MI 2014 MI 2015 US 2015

Cholesterol Ever told high

10 104 104 10710

0

3

6

9

12

15

MI 2011 MI 2013 MI 2014 MI 2015 US 2015

Diabetes

236 244255 255 262

10

15

20

25

30

MI 2011 MI 2013 MI 2014 MI 2015 US 2015

No Leisure Time Physical Activity

11 1216 18

2732tied

05

101520253035404550

CurrentSmoking

CholesterolEver told high

Obese(BMIgt30)

BloodPressure Ever

told high

Diabetes No LeisureTime Physical

Activity

Overweight(BMIgt25)

2015 NATIONAL RANKING(1st is worst)

18tied

MOSAIC 2015-2020 Focus of Grant Developing Stroke Systems of

Care Community Awareness EMS In-hospital QI Transition of Care Post-Discharge

12

Pre-hospital Care

A V A I L A B L E D A T A

13

EMSMOSAIC Data Linkage

-The MOSAIC Team continues to link data from the Michigan EMS Information System (MiEMSIS) to MOSAIC Data- Reports have been created for and reviewed by the

Tri-County Area MCA and Detroit East MCA- This work will expand to other MCA regions that

serve hospitals participating in MOSAIC

GWTG Special Initiatives Tab

-A free tab that can be enabled in GWTG-The purpose of the tab is to collect data concerning patient hand-off from EMS

MOSAIC Participating Hospitals

Aspirus Keweenaw Hospital (Laurium)

Aspirus Grand View HospitalAspirus Iron River HospitalAspirus Ontonagon HospitalBixby Medical CenterBronson Methodist HospitalCovenant Health CareDetroit Receiving HospitalGenesys Regional Medical CenterHenry Ford Hospital Herrick Medical CenterHuron Valley-Sinai HospitalLakeland Regional Medical Center McLaren Bay Regional Medical CenterMcLaren Greater Medical Center

McLaren Macomb HospitalMcLaren Northern MI HospitalMcLaren Oakland Medical CenterMcLaren Port Huron HospitalMcLaren Regional Medical CenterMercy Health Saint Maryrsquos HospitalMetro Health HospitalMunson Medical Center

ProMedica Monroe Regional HospitalSparrow HospitalSt Joseph Mercy - Ann ArborSt Joseph Mercy ChelseaSt Joseph Mercy Livingston HospitalSt Mary MercySt Mary of Michigan HospitalU of M Hospital

Hospital Infrastructure19

Among all participating hospitals the average number of

Licensed beds was 374 (range 25 to 1059 beds)

Inpatient discharges was 17076 (range 1064 to 48916 patients)

Acute stroke discharges (primary diagnosis only) was 417 (range 34 to 982 patients)

Case Demographics MOSAIC Registry

VariablesN() or statistics(Total N=68906)

Age at admission (years)Median 710Range 180 - 1060Mean (SE) 697(01)

GenderMale 32886 (477)Female 36015 (523)

RaceAfrican American 9900 (197)AIAN 132 (03)Asian 320 (06)More than one race 44 (01)Unknown 3679 (73)White 36190 (720)Missing 70

EthnicityHispanic or Latino 804 (16)Others 49531 (984)

VariablesN() or statistics(Total N=68906)

Health insuranceMedicaid 2284 (45)MedicaidPrivate 211 (04)Medicare 16863 (336)Medicare Medicaid 2313 (46)

MedicareMedicaidPrivate125 (02)

MedicarePrivate 13640 (272)ND 268(05)No insurance 2123 (42)Private 12356 (246)

Arrival modeEMS 21052 (429)Private

transportationother19313 (393)

Transfer from another hospital

7733(157)

ND or unknown 1021 (21)Missing 1216

Who receives data reports on your stroke quality of care

21

7055

70

10085

65

40

Hos

pita

lC

EO

up

per

man

agem

ent

Hos

pita

lB

oard

Chi

efN

ursi

ngO

ffice

r(C

NO

)

Str

oke

Tea

m

Phy

sici

anS

trok

eC

ham

pion

Chi

ef o

fM

edic

ine

Oth

er

Data Use

1) In the most recent calendar year have you run additional analyses (beyond what was required for reporting) on your hospitalrsquos own stroke data

2)How frequently have you run and used the analyses generated

22

Yes (N=16) 80

No (N=4) 20Weekly (N=2) 125

Monthly (N=8) 500

Less than monthly but more

than 1-2 times(N=6) 375

Data Use

What is the main reason you do not run your own additional analyses (Select one best answer)

23

Not sure how to run analyses

25

Not sure what analyses are needed would be helpful 25

Other 50

Data Use

In the most recent calendar year what reports did you run

24

813 688

Pre-programmedautomated reports in thedata collection tool (eg GWTG)

Additional reports beyond pre-programmed reports from the tool

Data Use

How do you use these analyses reports

25

813 688375

Inform quality improvement (QI) efforts andor plan

ldquoaction itemsrdquo

Report to management administration on our

progress

Other

Data Use

If you run additional analysis what action items QI efforts did you plan as a result of these reports

26

o Discharge education intensive statin use

o Door to tPA time and dysphagia

o Review data between spoke amp hub hospitals regarding transfers IV-tPA administration Mechanical thrombectomy and SAH

o QI efforts were addressed in the department involving calling Stroke Alert on call for cases with FAST symptoms

o ED Medical Director works with team to fix fallouts and problematic areas We have seen improvement

o Process changes (ie fallout emails to RN manager) physician querieso Increased documentation of NIHSS ownership from individual units regarding stroke quality

improvement goalso Daily dysphagia screening determination of whowhat team responsible for documenting initial NIHSS

looking at patients beyond 2h LKW arrival

Hospital Arrival Mode Door-to Needle and Pre-Notification

Reports 2016

Percent of Cases Who Arrived via EMSMOSAIC 2009-2016

Table 1 Arrival Mode among Stroke Cases by Demographics MOSAIC 2016

Demographics N=3496 550 N=2938 450Stroke Type Ischemic 2558 542 2164 458 Hemorrhagic 560 728 209 272 TIA 378 478 413 522Age Group lt 50 Years 233 433 305 567 50-79 Years 1982 497 2008 503 ge 80 Years 1379 688 625 312Sex Female 1933 576 1422 424 Male 1661 523 1516 477Race Black 659 530 584 470 White 2824 557 2248 443 Other Missing 111 512 106 488

MOSAIC AggregateArrival Mode

EMS Private Mode

Table 2 Door-to-Needle Times by Arrival Mode among Stroke Cases MOSAIC 2016

Time Elements (in Minutes)Number of

Patients Mean (Minutes) Median

(Minutes)Range

(Minutes)Door-to-Image 4901 575 400 00-2700 Arrived via EMS 2767 463 270 00-2700 Arrived via Private Transportation 2134 720 570 00-2620

Door-to-Image (among t-PA treated) 492 155 130 00-970 Arrived via EMS 370 125 110 00-840 Arrived via Private Transportation 122 243 215 20-970Image-to Needle 492 500 450 70-2090 Arrived via EMS 370 503 460 70-2090 Arrived via Private Transportation 122 483 420 90-1770Door-to Needle 492 655 570 200-2180 Arrived via EMS 370 629 560 200-2180 Arrived via Private Transportation 122 726 650 290-2060Included ischemic or hemorrhagic cases with times that were less or equal to 270 minutes (45 hours)Transferred cases were excluded

MOSAIC Aggregate

Table 3 Pre-Notification among Stroke Cases Who Arrived Via EMS by Demographics MOSAIC 2016

Demographics N=2015 584 N=1437 416Stroke Type Ischemic 1523 622 924 378 Hemorrhagic 306 566 235 434 TIA 142 381 231 619Age Group lt 50 Years 133 607 86 393 50-79 Years 1105 585 784 415 ge 80 Years 777 578 567 422Sex Female 1075 578 786 422 Male 940 591 651 409Race Black 307 517 287 483 White 1657 602 1097 398 Other 51 490 53 510

All HospitalsPre-Notification

Yes No

MOSAIC Transitions of Care Project

Post-discharge data collection tool is being implemented into Outcome Science as a tab

Post-Discharge amp Transition of Care

Reporting on changes within 30 days of discharge from hospital via follow-up callschart review Interval events Physician follow-up visits Lifestyle changes Lab assessments Medication managementadherence Rehab amp Functional outcomes Falls

MOSAIC Website

wwwMichigangovstroke

Adrienne Nickles MPHnicklesamichigangov

Thank You

  • Michigan and MOSAIC Data Review
  • Overview
  • Age-adjusted Stroke Hospitalization Rates Michigan 2000-2015
  • Slide Number 4
  • Age-adjusted Stroke Mortality Rates Michigan 2000-2014
  • Slide Number 6
  • Slide Number 7
  • Slide Number 8
  • Slide Number 9
  • Slide Number 10
  • Slide Number 11
  • MOSAIC 2015-2020
  • Pre-hospital Care
  • EMSMOSAIC Data Linkage
  • Slide Number 15
  • GWTG Special Initiatives Tab
  • Slide Number 17
  • MOSAIC Participating Hospitals
  • Hospital Infrastructure
  • Case Demographics MOSAIC Registry
  • Who receives data reports on your stroke quality of care
  • 1) In the most recent calendar year have you run additional analyses (beyond what was required for reporting) on your hospitalrsquos own stroke data 2)How frequently have you run and used the analyses generated
  • What is the main reason you do not run your own additional analyses (Select one best answer)
  • In the most recent calendar year what reports did you run
  • How do you use these analyses reports
  • If you run additional analysis what action items QI efforts did you plan as a result of these reports
  • Hospital Arrival Mode Door-to Needle and Pre-Notification Reports 2016
  • Percent of Cases Who Arrived via EMSMOSAIC 2009-2016
  • Table 1 Arrival Mode among Stroke Cases by Demographics MOSAIC 2016
  • Table 2 Door-to-Needle Times by Arrival Mode among Stroke Cases MOSAIC 2016
  • Table 3 Pre-Notification among Stroke Cases Who Arrived Via EMS by Demographics MOSAIC 2016
  • MOSAIC Transitions of Care Project
  • Slide Number 33
  • MOSAIC Website
  • Adrienne Nickles MPHnicklesamichigangov
CVD
Year White Male Black Male White Female Black Female
2000 4276 5424 3033 4161
2001 4066 5524 2813 4091
2002 3928 5468 2767 4114
2003 3734 518 2638 3887
2004 3448 5079 2432 3643
2005 3366 4983 2375 3545
2006 3276 4994 2313 3477
2007 3236 4845 2223 327
2008 3158 4694 2238 3327
change 234 79 237 164
Heart Disease
Year White Male Black Male White Female Black Female
2000 3393 4298 227 3206
2001 3232 4445 2124 3166
2002 3118 4317 2197 3157
2003 2986 4184 1957 3001
2004 2777 3983 1783 2838
2005 2704 4009 1776 2679
2006 2644 3981 1739 2642
2007 2619 3972 1679 2532
2008 2566 3819 1687 2606
Stroke
Year White Male Black Male White Female Black Female
2000 61 768 561 703 176
2001 575 752 539 681 138
2002 573 806 528 66 15
2003 516 662 498 629 147
2004 463 743 476 562
2005 449 663 429 585
2006 434 63 411 556
2007 415 631 392 494
2008 402 606 392 509
2009 375 616 372 464
2010 372 565 366 513
2011 373 548 366 44
2012 348 587 349 477
2013 347 506 34 462
2014 369 506 352 482
Coronary Heart Disease
Year White Male Black Male White Female Black Female
2000 2625 329 1608 243
2001 2478 3356 1508 2314
2002 2404 3154 1419 2313
2003 2221 3093 1328 209
2004 2067 2956 119 1983
2005 1989 2885 117 1853
2006 1922 2903 1139 1825
2007 1921 2771 1074 1645
2008 1824 2592 1071 1722
Heart Failure
Year White Male Black Male White Female Black Female
2000 255 206 245 17
2001 267 225 225 167
2002 242 238 227 203
2003 256 217 222 189
2004 243 167 214 206
2005 24 218 217 172
2006 255 246 229 202
2007 23 225 208 196
2008 25 216 226 185
Not sure what this data is from previously HD Stroke
Year White Female Black Female White Female Black Female
2000 227 3206 561 703
2001 2124 3166 539 681
2002 2197 3157 528 66
2003 1957 3001 498 629
2004 1783 2838 476 562
2005 1776 2679 429 585
2006 1739 2642 411 556
2007
2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2009 2009 2009 2009
2010 2010 2010 2010
2011 2011 2011 2011
2012 2012 2012 2012
2013 2013 2013 2013
2014 2014 2014 2014
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
CVD
Year US Michigan 0-34 35-64 65-84 85+
2000 3397 3694 43 140 16141 86689
2001 3265 3524 508 1348 15291 82889
2002 3174 3421 45 1338 14891 79536
2003 3061 3258 54 1324 14033 75185
2004 2885 3034 41 1242 13209 69088
2005 2773 2972 48 1283 1291 66011
2006 2898 48 1207 12246 6786
2007 2825 5 1206 1182 66153
2008 2791 43 1175 11619 66406
Heart Disease
Year US Michigan 0-34 35-64 65-84 85+
2000 2576 2851 345 1158 1247 64879
2001 2478 2719 416 112 11794 61938
2002 2408 2631 35 1103 11529 58746
2003 2323 2517 45 110 10827 56172
2004 217 2337 313 1048 10086 51609
2005 2111 2308 38 1078 9937 49828
2006 226 384 1019 9413 51918
2007 2216 42 1008 9174 50961
2008 2192 36 982 904 51209
Stroke
Year US Michigan HP 2010 0-34 35-64 65-84 85+
2000 609 603 50 068 174 2589 15841
2001 579 577 50 0638 157 2522 1504
2002 562 571 50 072 169 2397 1528
2003 535 527 50 0737 157 2249 13741
2004 50 496 50 0652 138 220 12629
2005 466 464 50 0553 145 2063 11398
2006 444 50 0734 127 196 11256
2007 425 064 1368 1832 10718
2008 419 047 134 1804 10646
79 27 243 289
Coronary Heart Disease
Year US Michigan HP 2010 0-34 35-64 65-84 85+
2000 1868 2118 162 0613 874 7701 4670
2001 1778 2006 162 0898 818 9012 44369
2002 1709 192 162 0889 799 8759 41061
2003 1628 179 162 0793 785 8018 38358
2004 1502 1656 162 0865 757 7421 34644
2005 1444 1611 162 097 773 7245 32617
2006 1564 162 088 727 6856 33503
2007 1516 117 709 6585 32727
2008 1472 102 657 6403 32504
168 11 283
Heart Failure
Year US Michigan 35-64 65-84 85+
2000 203 245 3047 936 8287
2001 202 237 2596 88 8285
2002 194 233 2648 878 8057
2003 194 233 3176 902 7722
2004 189 224 2709 863 7586
2005 189 224 2955 878 7388
2006 24 2979 884 8354
2007 219 274 828 7483
2008 233 013 333 85 8102
Heart Disease Stroke
Michigan White Michigan Black US White US Black Michigan White Michigan Black US White US Black
1990 334 4315 317 3915 1990 638 733 629 917
1991 3289 4108 3088 3865 1991 626 781 607 894
1992 3126 3987 3011 3777 1992 609 694 598 86
1993 3234 429 3046 3843 1993 614 77 609 866
1994 3134 4156 295 3661 1994 634 875 609 869
1995 3048 4131 2912 3672 1995 638 925 615 879
1996 2997 380 2842 354 1996 617 804 61 852
1997 2851 3683 2764 345 1997 604 77 598 816
1998 2884 3586 2681 3406 1998 598 729 576 803
1999 2781 3692 2634 3367 1999 609 812 598 824
2000 2757 3663 2536 3265 2000 586 737 587 824
2001 261 3695 2435 3169 2001 56 718 558 788
2002 2522 3659 2367 3084 2002 553 729 542 763
2003 2409 350 2282 3002 2003 511 655 514 743
2004 222 3311 2133 2806 2004 477 633 48 699
2005 219 3227 2005 442 616
2006 2144 320 2006 426 589
2007 2007
2008 2008
CVD CHD HD HF Stroke
2000 3694 2118 2851 245 603
2001 3524 2006 2719 237 577
2002 3421 192 2631 233 571
2003 3258 179 2517 233 527
2004 3034 1656 2337 224 496
2005 2972 1611 2308 224 464
2006 2898 1564 226 24 444
2007 2825 1516 2216 219 425
2008 2791 1472 2192 233 419
2000 2000 2000
2001 2001 2001
2002 2002 2002
2003 2003 2003
2004 2004 2004
2005 2005 2005
2006 2006 2006
2007 2007 2007
2008 2008 2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2000 2000 2000 2000 2000
2001 2001 2001 2001 2001
2002 2002 2002 2002 2002
2003 2003 2003 2003 2003
2004 2004 2004 2004 2004
2005 2005 2005 2005 2005
2006 2006 2006 2006 2006
2007 2007 2007 2007 2007
2008 2008 2008 2008 2008
Page 24: Michigan and MOSAIC Data Review...Michigan and MOSAIC Data Review 2017 ANNUAL WORKSHOP 4/26/2017. Adrienne Nickles, MPH. Michigan’s Ongoing Stroke Registry to Accelerate the Improvement

CVD_Age

0-34
35-64
65-84
85+
Year
Age-Adjusted Rate per 100000
43
140
16141
86689
508
1348
15291
82889
45
1338
14891
79536
54
1324
14033
75185
41
1242
13209
69088
48
1283
1291
66011
48
1207
12246
6786
5
1206
1182
66153
43
1175
11619
66406

HD_Age

0-34
35-64
65-84
85+
Year
Age-Adjusted Rate per 100000
345
1158
1247
64879
416
112
11794
61938
35
1103
11529
58746
45
110
10827
56172
313
1048
10086
51609
38
1078
9937
49828
384
1019
9413
51918
42
1008
9174
50961
36
982
904
51209

CHD_Age

0-34
35-64
65-84
85+
Year
Age-Adjusted Rate per 100000
0613
874
7701
4670
0898
818
9012
44369
0889
799
8759
41061
0793
785
8018
38358
0865
757
7421
34644
097
773
7245
32617
088
727
6856
33503
117
709
6585
32727
102
657
6403
32504

Stroke_Age

0-34
35-64
65-84
85+
Year
Age-Adjusted Rate per 100000
068
174
2589
15841
0638
157
2522
1504
072
169
2397
1528
0737
157
2249
13741
0652
138
220
12629
0553
145
2063
11398
0734
127
196
11256
064
1368
1832
10718
047
134
1804
10646

HF_Age

35-64
65-84
85+
Year
Age-Adjusted Rate per 100000
3047
936
8287
2596
88
8285
2648
878
8057
3176
902
7722
2709
863
7586
2955
878
7388
2979
884
8354
274
828
7483
333
85
8102

total

CVD_RG

White Male
Black Male
White Female
Black Female
Year
Age-Adjusted Rate per 100000
4276
5424
3033
4161
4066
5524
2813
4091
3928
5468
2767
4114
3734
518
2638
3887
3448
5079
2432
3643
3366
4983
2375
3545
3276
4994
2313
3477
3236
4845
2223
327
3158
4694
2238
3327

Stroke_RG

White Male
Black Male
White Female
Black Female
Year
Age-Adjusted Rate per 100000
61
768
561
703
575
752
539
681
573
806
528
66
516
662
498
629
463
743
476
562
449
663
429
585
434
63
411
556
415
631
392
494
402
606
392
509
375
616
372
464
372
565
366
513
373
548
366
44
348
587
349
477
347
506
34
462
369
506
352
482

HD_RG

White Male
Black Male
White Female
Black Female
Year
Age-Adjusted Rate per 100000
3393
4298
227
3206
3232
4445
2124
3166
3118
4317
2197
3157
2986
4184
1957
3001
2777
3983
1783
2838
2704
4009
1776
2679
2644
3981
1739
2642
2619
3972
1679
2532
2566
3819
1687
2606

CHD_RG

White Male
Black Male
White Female
Black Female
Year
Age-Adjusted Rate per 100000
2625
329
1608
243
2478
3356
1508
2314
2404
3154
1419
2313
2221
3093
1328
209
2067
2956
119
1983
1989
2885
117
1853
1922
2903
1139
1825
1921
2771
1074
1645
1824
2592
1071
1722

HF_RG

White Male
Black Male
White Female
Black Female
Year
Age-Adjusted Rate per 100000
255
206
245
17
267
225
225
167
242
238
227
203
256
217
222
189
243
167
214
206
24
218
217
172
255
246
229
202
23
225
208
196
25
216
226
185

race_gender

Sheet3

Local Health Department data can be found at wwwmichigangovbrfsSource CDC BRFSS

RISK FACTORMI

2011

MI

2013

MI

2014

MI

2015US 2015

2015 NATIONAL RANKING

Current Smoking 233 214 212 207 175 11

Blood Pressure Ever Told High 342 346 NA 331 309 18

Cholesterol Ever Told High 418 406 NA 382 364 12

Overweight (BMIgt25) 342 347 349 351 355 32tied

Obese (BMIgt30) 313 315 307 312 298 16

No Leisure Time Physical Activity 236 244 255 255 262 27

Diabetes 100 104 104 107 100 18tied

Prevalence of CVD Risk Factors Michigan Adults 1990-2015Compared to 2015 National Prevalence

233214 212 207

175

10

15

20

25

30

MI 2011 MI 2013 MI 2014 MI 2015 US 2015

Current Smoking

342 346331

309

20

25

30

35

40

MI 2011 MI 2013 MI 2014 MI 2015 US 2015

Blood Pressure Ever told high

342 347 349 351 355

20

25

30

35

40

MI 2011 MI 2013 MI 2014 MI 2015 US 2015

Overweight (BMIgt25)

313 315 307 312298

20

25

30

35

40

MI 2011 MI 2013 MI 2014 MI 2015 US 2015

Obese (BMIgt30)

418406

382364

30

35

40

45

50

MI 2011 MI 2013 MI 2014 MI 2015 US 2015

Cholesterol Ever told high

10 104 104 10710

0

3

6

9

12

15

MI 2011 MI 2013 MI 2014 MI 2015 US 2015

Diabetes

236 244255 255 262

10

15

20

25

30

MI 2011 MI 2013 MI 2014 MI 2015 US 2015

No Leisure Time Physical Activity

11 1216 18

2732tied

05

101520253035404550

CurrentSmoking

CholesterolEver told high

Obese(BMIgt30)

BloodPressure Ever

told high

Diabetes No LeisureTime Physical

Activity

Overweight(BMIgt25)

2015 NATIONAL RANKING(1st is worst)

18tied

MOSAIC 2015-2020 Focus of Grant Developing Stroke Systems of

Care Community Awareness EMS In-hospital QI Transition of Care Post-Discharge

12

Pre-hospital Care

A V A I L A B L E D A T A

13

EMSMOSAIC Data Linkage

-The MOSAIC Team continues to link data from the Michigan EMS Information System (MiEMSIS) to MOSAIC Data- Reports have been created for and reviewed by the

Tri-County Area MCA and Detroit East MCA- This work will expand to other MCA regions that

serve hospitals participating in MOSAIC

GWTG Special Initiatives Tab

-A free tab that can be enabled in GWTG-The purpose of the tab is to collect data concerning patient hand-off from EMS

MOSAIC Participating Hospitals

Aspirus Keweenaw Hospital (Laurium)

Aspirus Grand View HospitalAspirus Iron River HospitalAspirus Ontonagon HospitalBixby Medical CenterBronson Methodist HospitalCovenant Health CareDetroit Receiving HospitalGenesys Regional Medical CenterHenry Ford Hospital Herrick Medical CenterHuron Valley-Sinai HospitalLakeland Regional Medical Center McLaren Bay Regional Medical CenterMcLaren Greater Medical Center

McLaren Macomb HospitalMcLaren Northern MI HospitalMcLaren Oakland Medical CenterMcLaren Port Huron HospitalMcLaren Regional Medical CenterMercy Health Saint Maryrsquos HospitalMetro Health HospitalMunson Medical Center

ProMedica Monroe Regional HospitalSparrow HospitalSt Joseph Mercy - Ann ArborSt Joseph Mercy ChelseaSt Joseph Mercy Livingston HospitalSt Mary MercySt Mary of Michigan HospitalU of M Hospital

Hospital Infrastructure19

Among all participating hospitals the average number of

Licensed beds was 374 (range 25 to 1059 beds)

Inpatient discharges was 17076 (range 1064 to 48916 patients)

Acute stroke discharges (primary diagnosis only) was 417 (range 34 to 982 patients)

Case Demographics MOSAIC Registry

VariablesN() or statistics(Total N=68906)

Age at admission (years)Median 710Range 180 - 1060Mean (SE) 697(01)

GenderMale 32886 (477)Female 36015 (523)

RaceAfrican American 9900 (197)AIAN 132 (03)Asian 320 (06)More than one race 44 (01)Unknown 3679 (73)White 36190 (720)Missing 70

EthnicityHispanic or Latino 804 (16)Others 49531 (984)

VariablesN() or statistics(Total N=68906)

Health insuranceMedicaid 2284 (45)MedicaidPrivate 211 (04)Medicare 16863 (336)Medicare Medicaid 2313 (46)

MedicareMedicaidPrivate125 (02)

MedicarePrivate 13640 (272)ND 268(05)No insurance 2123 (42)Private 12356 (246)

Arrival modeEMS 21052 (429)Private

transportationother19313 (393)

Transfer from another hospital

7733(157)

ND or unknown 1021 (21)Missing 1216

Who receives data reports on your stroke quality of care

21

7055

70

10085

65

40

Hos

pita

lC

EO

up

per

man

agem

ent

Hos

pita

lB

oard

Chi

efN

ursi

ngO

ffice

r(C

NO

)

Str

oke

Tea

m

Phy

sici

anS

trok

eC

ham

pion

Chi

ef o

fM

edic

ine

Oth

er

Data Use

1) In the most recent calendar year have you run additional analyses (beyond what was required for reporting) on your hospitalrsquos own stroke data

2)How frequently have you run and used the analyses generated

22

Yes (N=16) 80

No (N=4) 20Weekly (N=2) 125

Monthly (N=8) 500

Less than monthly but more

than 1-2 times(N=6) 375

Data Use

What is the main reason you do not run your own additional analyses (Select one best answer)

23

Not sure how to run analyses

25

Not sure what analyses are needed would be helpful 25

Other 50

Data Use

In the most recent calendar year what reports did you run

24

813 688

Pre-programmedautomated reports in thedata collection tool (eg GWTG)

Additional reports beyond pre-programmed reports from the tool

Data Use

How do you use these analyses reports

25

813 688375

Inform quality improvement (QI) efforts andor plan

ldquoaction itemsrdquo

Report to management administration on our

progress

Other

Data Use

If you run additional analysis what action items QI efforts did you plan as a result of these reports

26

o Discharge education intensive statin use

o Door to tPA time and dysphagia

o Review data between spoke amp hub hospitals regarding transfers IV-tPA administration Mechanical thrombectomy and SAH

o QI efforts were addressed in the department involving calling Stroke Alert on call for cases with FAST symptoms

o ED Medical Director works with team to fix fallouts and problematic areas We have seen improvement

o Process changes (ie fallout emails to RN manager) physician querieso Increased documentation of NIHSS ownership from individual units regarding stroke quality

improvement goalso Daily dysphagia screening determination of whowhat team responsible for documenting initial NIHSS

looking at patients beyond 2h LKW arrival

Hospital Arrival Mode Door-to Needle and Pre-Notification

Reports 2016

Percent of Cases Who Arrived via EMSMOSAIC 2009-2016

Table 1 Arrival Mode among Stroke Cases by Demographics MOSAIC 2016

Demographics N=3496 550 N=2938 450Stroke Type Ischemic 2558 542 2164 458 Hemorrhagic 560 728 209 272 TIA 378 478 413 522Age Group lt 50 Years 233 433 305 567 50-79 Years 1982 497 2008 503 ge 80 Years 1379 688 625 312Sex Female 1933 576 1422 424 Male 1661 523 1516 477Race Black 659 530 584 470 White 2824 557 2248 443 Other Missing 111 512 106 488

MOSAIC AggregateArrival Mode

EMS Private Mode

Table 2 Door-to-Needle Times by Arrival Mode among Stroke Cases MOSAIC 2016

Time Elements (in Minutes)Number of

Patients Mean (Minutes) Median

(Minutes)Range

(Minutes)Door-to-Image 4901 575 400 00-2700 Arrived via EMS 2767 463 270 00-2700 Arrived via Private Transportation 2134 720 570 00-2620

Door-to-Image (among t-PA treated) 492 155 130 00-970 Arrived via EMS 370 125 110 00-840 Arrived via Private Transportation 122 243 215 20-970Image-to Needle 492 500 450 70-2090 Arrived via EMS 370 503 460 70-2090 Arrived via Private Transportation 122 483 420 90-1770Door-to Needle 492 655 570 200-2180 Arrived via EMS 370 629 560 200-2180 Arrived via Private Transportation 122 726 650 290-2060Included ischemic or hemorrhagic cases with times that were less or equal to 270 minutes (45 hours)Transferred cases were excluded

MOSAIC Aggregate

Table 3 Pre-Notification among Stroke Cases Who Arrived Via EMS by Demographics MOSAIC 2016

Demographics N=2015 584 N=1437 416Stroke Type Ischemic 1523 622 924 378 Hemorrhagic 306 566 235 434 TIA 142 381 231 619Age Group lt 50 Years 133 607 86 393 50-79 Years 1105 585 784 415 ge 80 Years 777 578 567 422Sex Female 1075 578 786 422 Male 940 591 651 409Race Black 307 517 287 483 White 1657 602 1097 398 Other 51 490 53 510

All HospitalsPre-Notification

Yes No

MOSAIC Transitions of Care Project

Post-discharge data collection tool is being implemented into Outcome Science as a tab

Post-Discharge amp Transition of Care

Reporting on changes within 30 days of discharge from hospital via follow-up callschart review Interval events Physician follow-up visits Lifestyle changes Lab assessments Medication managementadherence Rehab amp Functional outcomes Falls

MOSAIC Website

wwwMichigangovstroke

Adrienne Nickles MPHnicklesamichigangov

Thank You

  • Michigan and MOSAIC Data Review
  • Overview
  • Age-adjusted Stroke Hospitalization Rates Michigan 2000-2015
  • Slide Number 4
  • Age-adjusted Stroke Mortality Rates Michigan 2000-2014
  • Slide Number 6
  • Slide Number 7
  • Slide Number 8
  • Slide Number 9
  • Slide Number 10
  • Slide Number 11
  • MOSAIC 2015-2020
  • Pre-hospital Care
  • EMSMOSAIC Data Linkage
  • Slide Number 15
  • GWTG Special Initiatives Tab
  • Slide Number 17
  • MOSAIC Participating Hospitals
  • Hospital Infrastructure
  • Case Demographics MOSAIC Registry
  • Who receives data reports on your stroke quality of care
  • 1) In the most recent calendar year have you run additional analyses (beyond what was required for reporting) on your hospitalrsquos own stroke data 2)How frequently have you run and used the analyses generated
  • What is the main reason you do not run your own additional analyses (Select one best answer)
  • In the most recent calendar year what reports did you run
  • How do you use these analyses reports
  • If you run additional analysis what action items QI efforts did you plan as a result of these reports
  • Hospital Arrival Mode Door-to Needle and Pre-Notification Reports 2016
  • Percent of Cases Who Arrived via EMSMOSAIC 2009-2016
  • Table 1 Arrival Mode among Stroke Cases by Demographics MOSAIC 2016
  • Table 2 Door-to-Needle Times by Arrival Mode among Stroke Cases MOSAIC 2016
  • Table 3 Pre-Notification among Stroke Cases Who Arrived Via EMS by Demographics MOSAIC 2016
  • MOSAIC Transitions of Care Project
  • Slide Number 33
  • MOSAIC Website
  • Adrienne Nickles MPHnicklesamichigangov
CVD
Year White Male Black Male White Female Black Female
2000 4276 5424 3033 4161
2001 4066 5524 2813 4091
2002 3928 5468 2767 4114
2003 3734 518 2638 3887
2004 3448 5079 2432 3643
2005 3366 4983 2375 3545
2006 3276 4994 2313 3477
2007 3236 4845 2223 327
2008 3158 4694 2238 3327
change 234 79 237 164
Heart Disease
Year White Male Black Male White Female Black Female
2000 3393 4298 227 3206
2001 3232 4445 2124 3166
2002 3118 4317 2197 3157
2003 2986 4184 1957 3001
2004 2777 3983 1783 2838
2005 2704 4009 1776 2679
2006 2644 3981 1739 2642
2007 2619 3972 1679 2532
2008 2566 3819 1687 2606
Stroke
Year White Male Black Male White Female Black Female
2000 61 768 561 703 176
2001 575 752 539 681 138
2002 573 806 528 66 15
2003 516 662 498 629 147
2004 463 743 476 562
2005 449 663 429 585
2006 434 63 411 556
2007 415 631 392 494
2008 402 606 392 509
2009 375 616 372 464
2010 372 565 366 513
2011 373 548 366 44
2012 348 587 349 477
2013 347 506 34 462
2014 369 506 352 482
Coronary Heart Disease
Year White Male Black Male White Female Black Female
2000 2625 329 1608 243
2001 2478 3356 1508 2314
2002 2404 3154 1419 2313
2003 2221 3093 1328 209
2004 2067 2956 119 1983
2005 1989 2885 117 1853
2006 1922 2903 1139 1825
2007 1921 2771 1074 1645
2008 1824 2592 1071 1722
Heart Failure
Year White Male Black Male White Female Black Female
2000 255 206 245 17
2001 267 225 225 167
2002 242 238 227 203
2003 256 217 222 189
2004 243 167 214 206
2005 24 218 217 172
2006 255 246 229 202
2007 23 225 208 196
2008 25 216 226 185
Not sure what this data is from previously HD Stroke
Year White Female Black Female White Female Black Female
2000 227 3206 561 703
2001 2124 3166 539 681
2002 2197 3157 528 66
2003 1957 3001 498 629
2004 1783 2838 476 562
2005 1776 2679 429 585
2006 1739 2642 411 556
2007
2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2009 2009 2009 2009
2010 2010 2010 2010
2011 2011 2011 2011
2012 2012 2012 2012
2013 2013 2013 2013
2014 2014 2014 2014
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
CVD
Year US Michigan 0-34 35-64 65-84 85+
2000 3397 3694 43 140 16141 86689
2001 3265 3524 508 1348 15291 82889
2002 3174 3421 45 1338 14891 79536
2003 3061 3258 54 1324 14033 75185
2004 2885 3034 41 1242 13209 69088
2005 2773 2972 48 1283 1291 66011
2006 2898 48 1207 12246 6786
2007 2825 5 1206 1182 66153
2008 2791 43 1175 11619 66406
Heart Disease
Year US Michigan 0-34 35-64 65-84 85+
2000 2576 2851 345 1158 1247 64879
2001 2478 2719 416 112 11794 61938
2002 2408 2631 35 1103 11529 58746
2003 2323 2517 45 110 10827 56172
2004 217 2337 313 1048 10086 51609
2005 2111 2308 38 1078 9937 49828
2006 226 384 1019 9413 51918
2007 2216 42 1008 9174 50961
2008 2192 36 982 904 51209
Stroke
Year US Michigan HP 2010 0-34 35-64 65-84 85+
2000 609 603 50 068 174 2589 15841
2001 579 577 50 0638 157 2522 1504
2002 562 571 50 072 169 2397 1528
2003 535 527 50 0737 157 2249 13741
2004 50 496 50 0652 138 220 12629
2005 466 464 50 0553 145 2063 11398
2006 444 50 0734 127 196 11256
2007 425 064 1368 1832 10718
2008 419 047 134 1804 10646
79 27 243 289
Coronary Heart Disease
Year US Michigan HP 2010 0-34 35-64 65-84 85+
2000 1868 2118 162 0613 874 7701 4670
2001 1778 2006 162 0898 818 9012 44369
2002 1709 192 162 0889 799 8759 41061
2003 1628 179 162 0793 785 8018 38358
2004 1502 1656 162 0865 757 7421 34644
2005 1444 1611 162 097 773 7245 32617
2006 1564 162 088 727 6856 33503
2007 1516 117 709 6585 32727
2008 1472 102 657 6403 32504
168 11 283
Heart Failure
Year US Michigan 35-64 65-84 85+
2000 203 245 3047 936 8287
2001 202 237 2596 88 8285
2002 194 233 2648 878 8057
2003 194 233 3176 902 7722
2004 189 224 2709 863 7586
2005 189 224 2955 878 7388
2006 24 2979 884 8354
2007 219 274 828 7483
2008 233 013 333 85 8102
Heart Disease Stroke
Michigan White Michigan Black US White US Black Michigan White Michigan Black US White US Black
1990 334 4315 317 3915 1990 638 733 629 917
1991 3289 4108 3088 3865 1991 626 781 607 894
1992 3126 3987 3011 3777 1992 609 694 598 86
1993 3234 429 3046 3843 1993 614 77 609 866
1994 3134 4156 295 3661 1994 634 875 609 869
1995 3048 4131 2912 3672 1995 638 925 615 879
1996 2997 380 2842 354 1996 617 804 61 852
1997 2851 3683 2764 345 1997 604 77 598 816
1998 2884 3586 2681 3406 1998 598 729 576 803
1999 2781 3692 2634 3367 1999 609 812 598 824
2000 2757 3663 2536 3265 2000 586 737 587 824
2001 261 3695 2435 3169 2001 56 718 558 788
2002 2522 3659 2367 3084 2002 553 729 542 763
2003 2409 350 2282 3002 2003 511 655 514 743
2004 222 3311 2133 2806 2004 477 633 48 699
2005 219 3227 2005 442 616
2006 2144 320 2006 426 589
2007 2007
2008 2008
CVD CHD HD HF Stroke
2000 3694 2118 2851 245 603
2001 3524 2006 2719 237 577
2002 3421 192 2631 233 571
2003 3258 179 2517 233 527
2004 3034 1656 2337 224 496
2005 2972 1611 2308 224 464
2006 2898 1564 226 24 444
2007 2825 1516 2216 219 425
2008 2791 1472 2192 233 419
2000 2000 2000
2001 2001 2001
2002 2002 2002
2003 2003 2003
2004 2004 2004
2005 2005 2005
2006 2006 2006
2007 2007 2007
2008 2008 2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
Page 25: Michigan and MOSAIC Data Review...Michigan and MOSAIC Data Review 2017 ANNUAL WORKSHOP 4/26/2017. Adrienne Nickles, MPH. Michigan’s Ongoing Stroke Registry to Accelerate the Improvement

HD_Age

0-34
35-64
65-84
85+
Year
Age-Adjusted Rate per 100000
345
1158
1247
64879
416
112
11794
61938
35
1103
11529
58746
45
110
10827
56172
313
1048
10086
51609
38
1078
9937
49828
384
1019
9413
51918
42
1008
9174
50961
36
982
904
51209

CHD_Age

0-34
35-64
65-84
85+
Year
Age-Adjusted Rate per 100000
0613
874
7701
4670
0898
818
9012
44369
0889
799
8759
41061
0793
785
8018
38358
0865
757
7421
34644
097
773
7245
32617
088
727
6856
33503
117
709
6585
32727
102
657
6403
32504

Stroke_Age

0-34
35-64
65-84
85+
Year
Age-Adjusted Rate per 100000
068
174
2589
15841
0638
157
2522
1504
072
169
2397
1528
0737
157
2249
13741
0652
138
220
12629
0553
145
2063
11398
0734
127
196
11256
064
1368
1832
10718
047
134
1804
10646

HF_Age

35-64
65-84
85+
Year
Age-Adjusted Rate per 100000
3047
936
8287
2596
88
8285
2648
878
8057
3176
902
7722
2709
863
7586
2955
878
7388
2979
884
8354
274
828
7483
333
85
8102

total

CVD_RG

White Male
Black Male
White Female
Black Female
Year
Age-Adjusted Rate per 100000
4276
5424
3033
4161
4066
5524
2813
4091
3928
5468
2767
4114
3734
518
2638
3887
3448
5079
2432
3643
3366
4983
2375
3545
3276
4994
2313
3477
3236
4845
2223
327
3158
4694
2238
3327

Stroke_RG

White Male
Black Male
White Female
Black Female
Year
Age-Adjusted Rate per 100000
61
768
561
703
575
752
539
681
573
806
528
66
516
662
498
629
463
743
476
562
449
663
429
585
434
63
411
556
415
631
392
494
402
606
392
509
375
616
372
464
372
565
366
513
373
548
366
44
348
587
349
477
347
506
34
462
369
506
352
482

HD_RG

White Male
Black Male
White Female
Black Female
Year
Age-Adjusted Rate per 100000
3393
4298
227
3206
3232
4445
2124
3166
3118
4317
2197
3157
2986
4184
1957
3001
2777
3983
1783
2838
2704
4009
1776
2679
2644
3981
1739
2642
2619
3972
1679
2532
2566
3819
1687
2606

CHD_RG

White Male
Black Male
White Female
Black Female
Year
Age-Adjusted Rate per 100000
2625
329
1608
243
2478
3356
1508
2314
2404
3154
1419
2313
2221
3093
1328
209
2067
2956
119
1983
1989
2885
117
1853
1922
2903
1139
1825
1921
2771
1074
1645
1824
2592
1071
1722

HF_RG

White Male
Black Male
White Female
Black Female
Year
Age-Adjusted Rate per 100000
255
206
245
17
267
225
225
167
242
238
227
203
256
217
222
189
243
167
214
206
24
218
217
172
255
246
229
202
23
225
208
196
25
216
226
185

race_gender

Sheet3

Local Health Department data can be found at wwwmichigangovbrfsSource CDC BRFSS

RISK FACTORMI

2011

MI

2013

MI

2014

MI

2015US 2015

2015 NATIONAL RANKING

Current Smoking 233 214 212 207 175 11

Blood Pressure Ever Told High 342 346 NA 331 309 18

Cholesterol Ever Told High 418 406 NA 382 364 12

Overweight (BMIgt25) 342 347 349 351 355 32tied

Obese (BMIgt30) 313 315 307 312 298 16

No Leisure Time Physical Activity 236 244 255 255 262 27

Diabetes 100 104 104 107 100 18tied

Prevalence of CVD Risk Factors Michigan Adults 1990-2015Compared to 2015 National Prevalence

233214 212 207

175

10

15

20

25

30

MI 2011 MI 2013 MI 2014 MI 2015 US 2015

Current Smoking

342 346331

309

20

25

30

35

40

MI 2011 MI 2013 MI 2014 MI 2015 US 2015

Blood Pressure Ever told high

342 347 349 351 355

20

25

30

35

40

MI 2011 MI 2013 MI 2014 MI 2015 US 2015

Overweight (BMIgt25)

313 315 307 312298

20

25

30

35

40

MI 2011 MI 2013 MI 2014 MI 2015 US 2015

Obese (BMIgt30)

418406

382364

30

35

40

45

50

MI 2011 MI 2013 MI 2014 MI 2015 US 2015

Cholesterol Ever told high

10 104 104 10710

0

3

6

9

12

15

MI 2011 MI 2013 MI 2014 MI 2015 US 2015

Diabetes

236 244255 255 262

10

15

20

25

30

MI 2011 MI 2013 MI 2014 MI 2015 US 2015

No Leisure Time Physical Activity

11 1216 18

2732tied

05

101520253035404550

CurrentSmoking

CholesterolEver told high

Obese(BMIgt30)

BloodPressure Ever

told high

Diabetes No LeisureTime Physical

Activity

Overweight(BMIgt25)

2015 NATIONAL RANKING(1st is worst)

18tied

MOSAIC 2015-2020 Focus of Grant Developing Stroke Systems of

Care Community Awareness EMS In-hospital QI Transition of Care Post-Discharge

12

Pre-hospital Care

A V A I L A B L E D A T A

13

EMSMOSAIC Data Linkage

-The MOSAIC Team continues to link data from the Michigan EMS Information System (MiEMSIS) to MOSAIC Data- Reports have been created for and reviewed by the

Tri-County Area MCA and Detroit East MCA- This work will expand to other MCA regions that

serve hospitals participating in MOSAIC

GWTG Special Initiatives Tab

-A free tab that can be enabled in GWTG-The purpose of the tab is to collect data concerning patient hand-off from EMS

MOSAIC Participating Hospitals

Aspirus Keweenaw Hospital (Laurium)

Aspirus Grand View HospitalAspirus Iron River HospitalAspirus Ontonagon HospitalBixby Medical CenterBronson Methodist HospitalCovenant Health CareDetroit Receiving HospitalGenesys Regional Medical CenterHenry Ford Hospital Herrick Medical CenterHuron Valley-Sinai HospitalLakeland Regional Medical Center McLaren Bay Regional Medical CenterMcLaren Greater Medical Center

McLaren Macomb HospitalMcLaren Northern MI HospitalMcLaren Oakland Medical CenterMcLaren Port Huron HospitalMcLaren Regional Medical CenterMercy Health Saint Maryrsquos HospitalMetro Health HospitalMunson Medical Center

ProMedica Monroe Regional HospitalSparrow HospitalSt Joseph Mercy - Ann ArborSt Joseph Mercy ChelseaSt Joseph Mercy Livingston HospitalSt Mary MercySt Mary of Michigan HospitalU of M Hospital

Hospital Infrastructure19

Among all participating hospitals the average number of

Licensed beds was 374 (range 25 to 1059 beds)

Inpatient discharges was 17076 (range 1064 to 48916 patients)

Acute stroke discharges (primary diagnosis only) was 417 (range 34 to 982 patients)

Case Demographics MOSAIC Registry

VariablesN() or statistics(Total N=68906)

Age at admission (years)Median 710Range 180 - 1060Mean (SE) 697(01)

GenderMale 32886 (477)Female 36015 (523)

RaceAfrican American 9900 (197)AIAN 132 (03)Asian 320 (06)More than one race 44 (01)Unknown 3679 (73)White 36190 (720)Missing 70

EthnicityHispanic or Latino 804 (16)Others 49531 (984)

VariablesN() or statistics(Total N=68906)

Health insuranceMedicaid 2284 (45)MedicaidPrivate 211 (04)Medicare 16863 (336)Medicare Medicaid 2313 (46)

MedicareMedicaidPrivate125 (02)

MedicarePrivate 13640 (272)ND 268(05)No insurance 2123 (42)Private 12356 (246)

Arrival modeEMS 21052 (429)Private

transportationother19313 (393)

Transfer from another hospital

7733(157)

ND or unknown 1021 (21)Missing 1216

Who receives data reports on your stroke quality of care

21

7055

70

10085

65

40

Hos

pita

lC

EO

up

per

man

agem

ent

Hos

pita

lB

oard

Chi

efN

ursi

ngO

ffice

r(C

NO

)

Str

oke

Tea

m

Phy

sici

anS

trok

eC

ham

pion

Chi

ef o

fM

edic

ine

Oth

er

Data Use

1) In the most recent calendar year have you run additional analyses (beyond what was required for reporting) on your hospitalrsquos own stroke data

2)How frequently have you run and used the analyses generated

22

Yes (N=16) 80

No (N=4) 20Weekly (N=2) 125

Monthly (N=8) 500

Less than monthly but more

than 1-2 times(N=6) 375

Data Use

What is the main reason you do not run your own additional analyses (Select one best answer)

23

Not sure how to run analyses

25

Not sure what analyses are needed would be helpful 25

Other 50

Data Use

In the most recent calendar year what reports did you run

24

813 688

Pre-programmedautomated reports in thedata collection tool (eg GWTG)

Additional reports beyond pre-programmed reports from the tool

Data Use

How do you use these analyses reports

25

813 688375

Inform quality improvement (QI) efforts andor plan

ldquoaction itemsrdquo

Report to management administration on our

progress

Other

Data Use

If you run additional analysis what action items QI efforts did you plan as a result of these reports

26

o Discharge education intensive statin use

o Door to tPA time and dysphagia

o Review data between spoke amp hub hospitals regarding transfers IV-tPA administration Mechanical thrombectomy and SAH

o QI efforts were addressed in the department involving calling Stroke Alert on call for cases with FAST symptoms

o ED Medical Director works with team to fix fallouts and problematic areas We have seen improvement

o Process changes (ie fallout emails to RN manager) physician querieso Increased documentation of NIHSS ownership from individual units regarding stroke quality

improvement goalso Daily dysphagia screening determination of whowhat team responsible for documenting initial NIHSS

looking at patients beyond 2h LKW arrival

Hospital Arrival Mode Door-to Needle and Pre-Notification

Reports 2016

Percent of Cases Who Arrived via EMSMOSAIC 2009-2016

Table 1 Arrival Mode among Stroke Cases by Demographics MOSAIC 2016

Demographics N=3496 550 N=2938 450Stroke Type Ischemic 2558 542 2164 458 Hemorrhagic 560 728 209 272 TIA 378 478 413 522Age Group lt 50 Years 233 433 305 567 50-79 Years 1982 497 2008 503 ge 80 Years 1379 688 625 312Sex Female 1933 576 1422 424 Male 1661 523 1516 477Race Black 659 530 584 470 White 2824 557 2248 443 Other Missing 111 512 106 488

MOSAIC AggregateArrival Mode

EMS Private Mode

Table 2 Door-to-Needle Times by Arrival Mode among Stroke Cases MOSAIC 2016

Time Elements (in Minutes)Number of

Patients Mean (Minutes) Median

(Minutes)Range

(Minutes)Door-to-Image 4901 575 400 00-2700 Arrived via EMS 2767 463 270 00-2700 Arrived via Private Transportation 2134 720 570 00-2620

Door-to-Image (among t-PA treated) 492 155 130 00-970 Arrived via EMS 370 125 110 00-840 Arrived via Private Transportation 122 243 215 20-970Image-to Needle 492 500 450 70-2090 Arrived via EMS 370 503 460 70-2090 Arrived via Private Transportation 122 483 420 90-1770Door-to Needle 492 655 570 200-2180 Arrived via EMS 370 629 560 200-2180 Arrived via Private Transportation 122 726 650 290-2060Included ischemic or hemorrhagic cases with times that were less or equal to 270 minutes (45 hours)Transferred cases were excluded

MOSAIC Aggregate

Table 3 Pre-Notification among Stroke Cases Who Arrived Via EMS by Demographics MOSAIC 2016

Demographics N=2015 584 N=1437 416Stroke Type Ischemic 1523 622 924 378 Hemorrhagic 306 566 235 434 TIA 142 381 231 619Age Group lt 50 Years 133 607 86 393 50-79 Years 1105 585 784 415 ge 80 Years 777 578 567 422Sex Female 1075 578 786 422 Male 940 591 651 409Race Black 307 517 287 483 White 1657 602 1097 398 Other 51 490 53 510

All HospitalsPre-Notification

Yes No

MOSAIC Transitions of Care Project

Post-discharge data collection tool is being implemented into Outcome Science as a tab

Post-Discharge amp Transition of Care

Reporting on changes within 30 days of discharge from hospital via follow-up callschart review Interval events Physician follow-up visits Lifestyle changes Lab assessments Medication managementadherence Rehab amp Functional outcomes Falls

MOSAIC Website

wwwMichigangovstroke

Adrienne Nickles MPHnicklesamichigangov

Thank You

  • Michigan and MOSAIC Data Review
  • Overview
  • Age-adjusted Stroke Hospitalization Rates Michigan 2000-2015
  • Slide Number 4
  • Age-adjusted Stroke Mortality Rates Michigan 2000-2014
  • Slide Number 6
  • Slide Number 7
  • Slide Number 8
  • Slide Number 9
  • Slide Number 10
  • Slide Number 11
  • MOSAIC 2015-2020
  • Pre-hospital Care
  • EMSMOSAIC Data Linkage
  • Slide Number 15
  • GWTG Special Initiatives Tab
  • Slide Number 17
  • MOSAIC Participating Hospitals
  • Hospital Infrastructure
  • Case Demographics MOSAIC Registry
  • Who receives data reports on your stroke quality of care
  • 1) In the most recent calendar year have you run additional analyses (beyond what was required for reporting) on your hospitalrsquos own stroke data 2)How frequently have you run and used the analyses generated
  • What is the main reason you do not run your own additional analyses (Select one best answer)
  • In the most recent calendar year what reports did you run
  • How do you use these analyses reports
  • If you run additional analysis what action items QI efforts did you plan as a result of these reports
  • Hospital Arrival Mode Door-to Needle and Pre-Notification Reports 2016
  • Percent of Cases Who Arrived via EMSMOSAIC 2009-2016
  • Table 1 Arrival Mode among Stroke Cases by Demographics MOSAIC 2016
  • Table 2 Door-to-Needle Times by Arrival Mode among Stroke Cases MOSAIC 2016
  • Table 3 Pre-Notification among Stroke Cases Who Arrived Via EMS by Demographics MOSAIC 2016
  • MOSAIC Transitions of Care Project
  • Slide Number 33
  • MOSAIC Website
  • Adrienne Nickles MPHnicklesamichigangov
CVD
Year White Male Black Male White Female Black Female
2000 4276 5424 3033 4161
2001 4066 5524 2813 4091
2002 3928 5468 2767 4114
2003 3734 518 2638 3887
2004 3448 5079 2432 3643
2005 3366 4983 2375 3545
2006 3276 4994 2313 3477
2007 3236 4845 2223 327
2008 3158 4694 2238 3327
change 234 79 237 164
Heart Disease
Year White Male Black Male White Female Black Female
2000 3393 4298 227 3206
2001 3232 4445 2124 3166
2002 3118 4317 2197 3157
2003 2986 4184 1957 3001
2004 2777 3983 1783 2838
2005 2704 4009 1776 2679
2006 2644 3981 1739 2642
2007 2619 3972 1679 2532
2008 2566 3819 1687 2606
Stroke
Year White Male Black Male White Female Black Female
2000 61 768 561 703 176
2001 575 752 539 681 138
2002 573 806 528 66 15
2003 516 662 498 629 147
2004 463 743 476 562
2005 449 663 429 585
2006 434 63 411 556
2007 415 631 392 494
2008 402 606 392 509
2009 375 616 372 464
2010 372 565 366 513
2011 373 548 366 44
2012 348 587 349 477
2013 347 506 34 462
2014 369 506 352 482
Coronary Heart Disease
Year White Male Black Male White Female Black Female
2000 2625 329 1608 243
2001 2478 3356 1508 2314
2002 2404 3154 1419 2313
2003 2221 3093 1328 209
2004 2067 2956 119 1983
2005 1989 2885 117 1853
2006 1922 2903 1139 1825
2007 1921 2771 1074 1645
2008 1824 2592 1071 1722
Heart Failure
Year White Male Black Male White Female Black Female
2000 255 206 245 17
2001 267 225 225 167
2002 242 238 227 203
2003 256 217 222 189
2004 243 167 214 206
2005 24 218 217 172
2006 255 246 229 202
2007 23 225 208 196
2008 25 216 226 185
Not sure what this data is from previously HD Stroke
Year White Female Black Female White Female Black Female
2000 227 3206 561 703
2001 2124 3166 539 681
2002 2197 3157 528 66
2003 1957 3001 498 629
2004 1783 2838 476 562
2005 1776 2679 429 585
2006 1739 2642 411 556
2007
2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2009 2009 2009 2009
2010 2010 2010 2010
2011 2011 2011 2011
2012 2012 2012 2012
2013 2013 2013 2013
2014 2014 2014 2014
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
CVD
Year US Michigan 0-34 35-64 65-84 85+
2000 3397 3694 43 140 16141 86689
2001 3265 3524 508 1348 15291 82889
2002 3174 3421 45 1338 14891 79536
2003 3061 3258 54 1324 14033 75185
2004 2885 3034 41 1242 13209 69088
2005 2773 2972 48 1283 1291 66011
2006 2898 48 1207 12246 6786
2007 2825 5 1206 1182 66153
2008 2791 43 1175 11619 66406
Heart Disease
Year US Michigan 0-34 35-64 65-84 85+
2000 2576 2851 345 1158 1247 64879
2001 2478 2719 416 112 11794 61938
2002 2408 2631 35 1103 11529 58746
2003 2323 2517 45 110 10827 56172
2004 217 2337 313 1048 10086 51609
2005 2111 2308 38 1078 9937 49828
2006 226 384 1019 9413 51918
2007 2216 42 1008 9174 50961
2008 2192 36 982 904 51209
Stroke
Year US Michigan HP 2010 0-34 35-64 65-84 85+
2000 609 603 50 068 174 2589 15841
2001 579 577 50 0638 157 2522 1504
2002 562 571 50 072 169 2397 1528
2003 535 527 50 0737 157 2249 13741
2004 50 496 50 0652 138 220 12629
2005 466 464 50 0553 145 2063 11398
2006 444 50 0734 127 196 11256
2007 425 064 1368 1832 10718
2008 419 047 134 1804 10646
79 27 243 289
Coronary Heart Disease
Year US Michigan HP 2010 0-34 35-64 65-84 85+
2000 1868 2118 162 0613 874 7701 4670
2001 1778 2006 162 0898 818 9012 44369
2002 1709 192 162 0889 799 8759 41061
2003 1628 179 162 0793 785 8018 38358
2004 1502 1656 162 0865 757 7421 34644
2005 1444 1611 162 097 773 7245 32617
2006 1564 162 088 727 6856 33503
2007 1516 117 709 6585 32727
2008 1472 102 657 6403 32504
168 11 283
Heart Failure
Year US Michigan 35-64 65-84 85+
2000 203 245 3047 936 8287
2001 202 237 2596 88 8285
2002 194 233 2648 878 8057
2003 194 233 3176 902 7722
2004 189 224 2709 863 7586
2005 189 224 2955 878 7388
2006 24 2979 884 8354
2007 219 274 828 7483
2008 233 013 333 85 8102
Heart Disease Stroke
Michigan White Michigan Black US White US Black Michigan White Michigan Black US White US Black
1990 334 4315 317 3915 1990 638 733 629 917
1991 3289 4108 3088 3865 1991 626 781 607 894
1992 3126 3987 3011 3777 1992 609 694 598 86
1993 3234 429 3046 3843 1993 614 77 609 866
1994 3134 4156 295 3661 1994 634 875 609 869
1995 3048 4131 2912 3672 1995 638 925 615 879
1996 2997 380 2842 354 1996 617 804 61 852
1997 2851 3683 2764 345 1997 604 77 598 816
1998 2884 3586 2681 3406 1998 598 729 576 803
1999 2781 3692 2634 3367 1999 609 812 598 824
2000 2757 3663 2536 3265 2000 586 737 587 824
2001 261 3695 2435 3169 2001 56 718 558 788
2002 2522 3659 2367 3084 2002 553 729 542 763
2003 2409 350 2282 3002 2003 511 655 514 743
2004 222 3311 2133 2806 2004 477 633 48 699
2005 219 3227 2005 442 616
2006 2144 320 2006 426 589
2007 2007
2008 2008
CVD CHD HD HF Stroke
2000 3694 2118 2851 245 603
2001 3524 2006 2719 237 577
2002 3421 192 2631 233 571
2003 3258 179 2517 233 527
2004 3034 1656 2337 224 496
2005 2972 1611 2308 224 464
2006 2898 1564 226 24 444
2007 2825 1516 2216 219 425
2008 2791 1472 2192 233 419
2000 2000 2000
2001 2001 2001
2002 2002 2002
2003 2003 2003
2004 2004 2004
2005 2005 2005
2006 2006 2006
2007 2007 2007
2008 2008 2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
Page 26: Michigan and MOSAIC Data Review...Michigan and MOSAIC Data Review 2017 ANNUAL WORKSHOP 4/26/2017. Adrienne Nickles, MPH. Michigan’s Ongoing Stroke Registry to Accelerate the Improvement

CHD_Age

0-34
35-64
65-84
85+
Year
Age-Adjusted Rate per 100000
0613
874
7701
4670
0898
818
9012
44369
0889
799
8759
41061
0793
785
8018
38358
0865
757
7421
34644
097
773
7245
32617
088
727
6856
33503
117
709
6585
32727
102
657
6403
32504

Stroke_Age

0-34
35-64
65-84
85+
Year
Age-Adjusted Rate per 100000
068
174
2589
15841
0638
157
2522
1504
072
169
2397
1528
0737
157
2249
13741
0652
138
220
12629
0553
145
2063
11398
0734
127
196
11256
064
1368
1832
10718
047
134
1804
10646

HF_Age

35-64
65-84
85+
Year
Age-Adjusted Rate per 100000
3047
936
8287
2596
88
8285
2648
878
8057
3176
902
7722
2709
863
7586
2955
878
7388
2979
884
8354
274
828
7483
333
85
8102

total

CVD_RG

White Male
Black Male
White Female
Black Female
Year
Age-Adjusted Rate per 100000
4276
5424
3033
4161
4066
5524
2813
4091
3928
5468
2767
4114
3734
518
2638
3887
3448
5079
2432
3643
3366
4983
2375
3545
3276
4994
2313
3477
3236
4845
2223
327
3158
4694
2238
3327

Stroke_RG

White Male
Black Male
White Female
Black Female
Year
Age-Adjusted Rate per 100000
61
768
561
703
575
752
539
681
573
806
528
66
516
662
498
629
463
743
476
562
449
663
429
585
434
63
411
556
415
631
392
494
402
606
392
509
375
616
372
464
372
565
366
513
373
548
366
44
348
587
349
477
347
506
34
462
369
506
352
482

HD_RG

White Male
Black Male
White Female
Black Female
Year
Age-Adjusted Rate per 100000
3393
4298
227
3206
3232
4445
2124
3166
3118
4317
2197
3157
2986
4184
1957
3001
2777
3983
1783
2838
2704
4009
1776
2679
2644
3981
1739
2642
2619
3972
1679
2532
2566
3819
1687
2606

CHD_RG

White Male
Black Male
White Female
Black Female
Year
Age-Adjusted Rate per 100000
2625
329
1608
243
2478
3356
1508
2314
2404
3154
1419
2313
2221
3093
1328
209
2067
2956
119
1983
1989
2885
117
1853
1922
2903
1139
1825
1921
2771
1074
1645
1824
2592
1071
1722

HF_RG

White Male
Black Male
White Female
Black Female
Year
Age-Adjusted Rate per 100000
255
206
245
17
267
225
225
167
242
238
227
203
256
217
222
189
243
167
214
206
24
218
217
172
255
246
229
202
23
225
208
196
25
216
226
185

race_gender

Sheet3

Local Health Department data can be found at wwwmichigangovbrfsSource CDC BRFSS

RISK FACTORMI

2011

MI

2013

MI

2014

MI

2015US 2015

2015 NATIONAL RANKING

Current Smoking 233 214 212 207 175 11

Blood Pressure Ever Told High 342 346 NA 331 309 18

Cholesterol Ever Told High 418 406 NA 382 364 12

Overweight (BMIgt25) 342 347 349 351 355 32tied

Obese (BMIgt30) 313 315 307 312 298 16

No Leisure Time Physical Activity 236 244 255 255 262 27

Diabetes 100 104 104 107 100 18tied

Prevalence of CVD Risk Factors Michigan Adults 1990-2015Compared to 2015 National Prevalence

233214 212 207

175

10

15

20

25

30

MI 2011 MI 2013 MI 2014 MI 2015 US 2015

Current Smoking

342 346331

309

20

25

30

35

40

MI 2011 MI 2013 MI 2014 MI 2015 US 2015

Blood Pressure Ever told high

342 347 349 351 355

20

25

30

35

40

MI 2011 MI 2013 MI 2014 MI 2015 US 2015

Overweight (BMIgt25)

313 315 307 312298

20

25

30

35

40

MI 2011 MI 2013 MI 2014 MI 2015 US 2015

Obese (BMIgt30)

418406

382364

30

35

40

45

50

MI 2011 MI 2013 MI 2014 MI 2015 US 2015

Cholesterol Ever told high

10 104 104 10710

0

3

6

9

12

15

MI 2011 MI 2013 MI 2014 MI 2015 US 2015

Diabetes

236 244255 255 262

10

15

20

25

30

MI 2011 MI 2013 MI 2014 MI 2015 US 2015

No Leisure Time Physical Activity

11 1216 18

2732tied

05

101520253035404550

CurrentSmoking

CholesterolEver told high

Obese(BMIgt30)

BloodPressure Ever

told high

Diabetes No LeisureTime Physical

Activity

Overweight(BMIgt25)

2015 NATIONAL RANKING(1st is worst)

18tied

MOSAIC 2015-2020 Focus of Grant Developing Stroke Systems of

Care Community Awareness EMS In-hospital QI Transition of Care Post-Discharge

12

Pre-hospital Care

A V A I L A B L E D A T A

13

EMSMOSAIC Data Linkage

-The MOSAIC Team continues to link data from the Michigan EMS Information System (MiEMSIS) to MOSAIC Data- Reports have been created for and reviewed by the

Tri-County Area MCA and Detroit East MCA- This work will expand to other MCA regions that

serve hospitals participating in MOSAIC

GWTG Special Initiatives Tab

-A free tab that can be enabled in GWTG-The purpose of the tab is to collect data concerning patient hand-off from EMS

MOSAIC Participating Hospitals

Aspirus Keweenaw Hospital (Laurium)

Aspirus Grand View HospitalAspirus Iron River HospitalAspirus Ontonagon HospitalBixby Medical CenterBronson Methodist HospitalCovenant Health CareDetroit Receiving HospitalGenesys Regional Medical CenterHenry Ford Hospital Herrick Medical CenterHuron Valley-Sinai HospitalLakeland Regional Medical Center McLaren Bay Regional Medical CenterMcLaren Greater Medical Center

McLaren Macomb HospitalMcLaren Northern MI HospitalMcLaren Oakland Medical CenterMcLaren Port Huron HospitalMcLaren Regional Medical CenterMercy Health Saint Maryrsquos HospitalMetro Health HospitalMunson Medical Center

ProMedica Monroe Regional HospitalSparrow HospitalSt Joseph Mercy - Ann ArborSt Joseph Mercy ChelseaSt Joseph Mercy Livingston HospitalSt Mary MercySt Mary of Michigan HospitalU of M Hospital

Hospital Infrastructure19

Among all participating hospitals the average number of

Licensed beds was 374 (range 25 to 1059 beds)

Inpatient discharges was 17076 (range 1064 to 48916 patients)

Acute stroke discharges (primary diagnosis only) was 417 (range 34 to 982 patients)

Case Demographics MOSAIC Registry

VariablesN() or statistics(Total N=68906)

Age at admission (years)Median 710Range 180 - 1060Mean (SE) 697(01)

GenderMale 32886 (477)Female 36015 (523)

RaceAfrican American 9900 (197)AIAN 132 (03)Asian 320 (06)More than one race 44 (01)Unknown 3679 (73)White 36190 (720)Missing 70

EthnicityHispanic or Latino 804 (16)Others 49531 (984)

VariablesN() or statistics(Total N=68906)

Health insuranceMedicaid 2284 (45)MedicaidPrivate 211 (04)Medicare 16863 (336)Medicare Medicaid 2313 (46)

MedicareMedicaidPrivate125 (02)

MedicarePrivate 13640 (272)ND 268(05)No insurance 2123 (42)Private 12356 (246)

Arrival modeEMS 21052 (429)Private

transportationother19313 (393)

Transfer from another hospital

7733(157)

ND or unknown 1021 (21)Missing 1216

Who receives data reports on your stroke quality of care

21

7055

70

10085

65

40

Hos

pita

lC

EO

up

per

man

agem

ent

Hos

pita

lB

oard

Chi

efN

ursi

ngO

ffice

r(C

NO

)

Str

oke

Tea

m

Phy

sici

anS

trok

eC

ham

pion

Chi

ef o

fM

edic

ine

Oth

er

Data Use

1) In the most recent calendar year have you run additional analyses (beyond what was required for reporting) on your hospitalrsquos own stroke data

2)How frequently have you run and used the analyses generated

22

Yes (N=16) 80

No (N=4) 20Weekly (N=2) 125

Monthly (N=8) 500

Less than monthly but more

than 1-2 times(N=6) 375

Data Use

What is the main reason you do not run your own additional analyses (Select one best answer)

23

Not sure how to run analyses

25

Not sure what analyses are needed would be helpful 25

Other 50

Data Use

In the most recent calendar year what reports did you run

24

813 688

Pre-programmedautomated reports in thedata collection tool (eg GWTG)

Additional reports beyond pre-programmed reports from the tool

Data Use

How do you use these analyses reports

25

813 688375

Inform quality improvement (QI) efforts andor plan

ldquoaction itemsrdquo

Report to management administration on our

progress

Other

Data Use

If you run additional analysis what action items QI efforts did you plan as a result of these reports

26

o Discharge education intensive statin use

o Door to tPA time and dysphagia

o Review data between spoke amp hub hospitals regarding transfers IV-tPA administration Mechanical thrombectomy and SAH

o QI efforts were addressed in the department involving calling Stroke Alert on call for cases with FAST symptoms

o ED Medical Director works with team to fix fallouts and problematic areas We have seen improvement

o Process changes (ie fallout emails to RN manager) physician querieso Increased documentation of NIHSS ownership from individual units regarding stroke quality

improvement goalso Daily dysphagia screening determination of whowhat team responsible for documenting initial NIHSS

looking at patients beyond 2h LKW arrival

Hospital Arrival Mode Door-to Needle and Pre-Notification

Reports 2016

Percent of Cases Who Arrived via EMSMOSAIC 2009-2016

Table 1 Arrival Mode among Stroke Cases by Demographics MOSAIC 2016

Demographics N=3496 550 N=2938 450Stroke Type Ischemic 2558 542 2164 458 Hemorrhagic 560 728 209 272 TIA 378 478 413 522Age Group lt 50 Years 233 433 305 567 50-79 Years 1982 497 2008 503 ge 80 Years 1379 688 625 312Sex Female 1933 576 1422 424 Male 1661 523 1516 477Race Black 659 530 584 470 White 2824 557 2248 443 Other Missing 111 512 106 488

MOSAIC AggregateArrival Mode

EMS Private Mode

Table 2 Door-to-Needle Times by Arrival Mode among Stroke Cases MOSAIC 2016

Time Elements (in Minutes)Number of

Patients Mean (Minutes) Median

(Minutes)Range

(Minutes)Door-to-Image 4901 575 400 00-2700 Arrived via EMS 2767 463 270 00-2700 Arrived via Private Transportation 2134 720 570 00-2620

Door-to-Image (among t-PA treated) 492 155 130 00-970 Arrived via EMS 370 125 110 00-840 Arrived via Private Transportation 122 243 215 20-970Image-to Needle 492 500 450 70-2090 Arrived via EMS 370 503 460 70-2090 Arrived via Private Transportation 122 483 420 90-1770Door-to Needle 492 655 570 200-2180 Arrived via EMS 370 629 560 200-2180 Arrived via Private Transportation 122 726 650 290-2060Included ischemic or hemorrhagic cases with times that were less or equal to 270 minutes (45 hours)Transferred cases were excluded

MOSAIC Aggregate

Table 3 Pre-Notification among Stroke Cases Who Arrived Via EMS by Demographics MOSAIC 2016

Demographics N=2015 584 N=1437 416Stroke Type Ischemic 1523 622 924 378 Hemorrhagic 306 566 235 434 TIA 142 381 231 619Age Group lt 50 Years 133 607 86 393 50-79 Years 1105 585 784 415 ge 80 Years 777 578 567 422Sex Female 1075 578 786 422 Male 940 591 651 409Race Black 307 517 287 483 White 1657 602 1097 398 Other 51 490 53 510

All HospitalsPre-Notification

Yes No

MOSAIC Transitions of Care Project

Post-discharge data collection tool is being implemented into Outcome Science as a tab

Post-Discharge amp Transition of Care

Reporting on changes within 30 days of discharge from hospital via follow-up callschart review Interval events Physician follow-up visits Lifestyle changes Lab assessments Medication managementadherence Rehab amp Functional outcomes Falls

MOSAIC Website

wwwMichigangovstroke

Adrienne Nickles MPHnicklesamichigangov

Thank You

  • Michigan and MOSAIC Data Review
  • Overview
  • Age-adjusted Stroke Hospitalization Rates Michigan 2000-2015
  • Slide Number 4
  • Age-adjusted Stroke Mortality Rates Michigan 2000-2014
  • Slide Number 6
  • Slide Number 7
  • Slide Number 8
  • Slide Number 9
  • Slide Number 10
  • Slide Number 11
  • MOSAIC 2015-2020
  • Pre-hospital Care
  • EMSMOSAIC Data Linkage
  • Slide Number 15
  • GWTG Special Initiatives Tab
  • Slide Number 17
  • MOSAIC Participating Hospitals
  • Hospital Infrastructure
  • Case Demographics MOSAIC Registry
  • Who receives data reports on your stroke quality of care
  • 1) In the most recent calendar year have you run additional analyses (beyond what was required for reporting) on your hospitalrsquos own stroke data 2)How frequently have you run and used the analyses generated
  • What is the main reason you do not run your own additional analyses (Select one best answer)
  • In the most recent calendar year what reports did you run
  • How do you use these analyses reports
  • If you run additional analysis what action items QI efforts did you plan as a result of these reports
  • Hospital Arrival Mode Door-to Needle and Pre-Notification Reports 2016
  • Percent of Cases Who Arrived via EMSMOSAIC 2009-2016
  • Table 1 Arrival Mode among Stroke Cases by Demographics MOSAIC 2016
  • Table 2 Door-to-Needle Times by Arrival Mode among Stroke Cases MOSAIC 2016
  • Table 3 Pre-Notification among Stroke Cases Who Arrived Via EMS by Demographics MOSAIC 2016
  • MOSAIC Transitions of Care Project
  • Slide Number 33
  • MOSAIC Website
  • Adrienne Nickles MPHnicklesamichigangov
CVD
Year White Male Black Male White Female Black Female
2000 4276 5424 3033 4161
2001 4066 5524 2813 4091
2002 3928 5468 2767 4114
2003 3734 518 2638 3887
2004 3448 5079 2432 3643
2005 3366 4983 2375 3545
2006 3276 4994 2313 3477
2007 3236 4845 2223 327
2008 3158 4694 2238 3327
change 234 79 237 164
Heart Disease
Year White Male Black Male White Female Black Female
2000 3393 4298 227 3206
2001 3232 4445 2124 3166
2002 3118 4317 2197 3157
2003 2986 4184 1957 3001
2004 2777 3983 1783 2838
2005 2704 4009 1776 2679
2006 2644 3981 1739 2642
2007 2619 3972 1679 2532
2008 2566 3819 1687 2606
Stroke
Year White Male Black Male White Female Black Female
2000 61 768 561 703 176
2001 575 752 539 681 138
2002 573 806 528 66 15
2003 516 662 498 629 147
2004 463 743 476 562
2005 449 663 429 585
2006 434 63 411 556
2007 415 631 392 494
2008 402 606 392 509
2009 375 616 372 464
2010 372 565 366 513
2011 373 548 366 44
2012 348 587 349 477
2013 347 506 34 462
2014 369 506 352 482
Coronary Heart Disease
Year White Male Black Male White Female Black Female
2000 2625 329 1608 243
2001 2478 3356 1508 2314
2002 2404 3154 1419 2313
2003 2221 3093 1328 209
2004 2067 2956 119 1983
2005 1989 2885 117 1853
2006 1922 2903 1139 1825
2007 1921 2771 1074 1645
2008 1824 2592 1071 1722
Heart Failure
Year White Male Black Male White Female Black Female
2000 255 206 245 17
2001 267 225 225 167
2002 242 238 227 203
2003 256 217 222 189
2004 243 167 214 206
2005 24 218 217 172
2006 255 246 229 202
2007 23 225 208 196
2008 25 216 226 185
Not sure what this data is from previously HD Stroke
Year White Female Black Female White Female Black Female
2000 227 3206 561 703
2001 2124 3166 539 681
2002 2197 3157 528 66
2003 1957 3001 498 629
2004 1783 2838 476 562
2005 1776 2679 429 585
2006 1739 2642 411 556
2007
2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2009 2009 2009 2009
2010 2010 2010 2010
2011 2011 2011 2011
2012 2012 2012 2012
2013 2013 2013 2013
2014 2014 2014 2014
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
CVD
Year US Michigan 0-34 35-64 65-84 85+
2000 3397 3694 43 140 16141 86689
2001 3265 3524 508 1348 15291 82889
2002 3174 3421 45 1338 14891 79536
2003 3061 3258 54 1324 14033 75185
2004 2885 3034 41 1242 13209 69088
2005 2773 2972 48 1283 1291 66011
2006 2898 48 1207 12246 6786
2007 2825 5 1206 1182 66153
2008 2791 43 1175 11619 66406
Heart Disease
Year US Michigan 0-34 35-64 65-84 85+
2000 2576 2851 345 1158 1247 64879
2001 2478 2719 416 112 11794 61938
2002 2408 2631 35 1103 11529 58746
2003 2323 2517 45 110 10827 56172
2004 217 2337 313 1048 10086 51609
2005 2111 2308 38 1078 9937 49828
2006 226 384 1019 9413 51918
2007 2216 42 1008 9174 50961
2008 2192 36 982 904 51209
Stroke
Year US Michigan HP 2010 0-34 35-64 65-84 85+
2000 609 603 50 068 174 2589 15841
2001 579 577 50 0638 157 2522 1504
2002 562 571 50 072 169 2397 1528
2003 535 527 50 0737 157 2249 13741
2004 50 496 50 0652 138 220 12629
2005 466 464 50 0553 145 2063 11398
2006 444 50 0734 127 196 11256
2007 425 064 1368 1832 10718
2008 419 047 134 1804 10646
79 27 243 289
Coronary Heart Disease
Year US Michigan HP 2010 0-34 35-64 65-84 85+
2000 1868 2118 162 0613 874 7701 4670
2001 1778 2006 162 0898 818 9012 44369
2002 1709 192 162 0889 799 8759 41061
2003 1628 179 162 0793 785 8018 38358
2004 1502 1656 162 0865 757 7421 34644
2005 1444 1611 162 097 773 7245 32617
2006 1564 162 088 727 6856 33503
2007 1516 117 709 6585 32727
2008 1472 102 657 6403 32504
168 11 283
Heart Failure
Year US Michigan 35-64 65-84 85+
2000 203 245 3047 936 8287
2001 202 237 2596 88 8285
2002 194 233 2648 878 8057
2003 194 233 3176 902 7722
2004 189 224 2709 863 7586
2005 189 224 2955 878 7388
2006 24 2979 884 8354
2007 219 274 828 7483
2008 233 013 333 85 8102
Heart Disease Stroke
Michigan White Michigan Black US White US Black Michigan White Michigan Black US White US Black
1990 334 4315 317 3915 1990 638 733 629 917
1991 3289 4108 3088 3865 1991 626 781 607 894
1992 3126 3987 3011 3777 1992 609 694 598 86
1993 3234 429 3046 3843 1993 614 77 609 866
1994 3134 4156 295 3661 1994 634 875 609 869
1995 3048 4131 2912 3672 1995 638 925 615 879
1996 2997 380 2842 354 1996 617 804 61 852
1997 2851 3683 2764 345 1997 604 77 598 816
1998 2884 3586 2681 3406 1998 598 729 576 803
1999 2781 3692 2634 3367 1999 609 812 598 824
2000 2757 3663 2536 3265 2000 586 737 587 824
2001 261 3695 2435 3169 2001 56 718 558 788
2002 2522 3659 2367 3084 2002 553 729 542 763
2003 2409 350 2282 3002 2003 511 655 514 743
2004 222 3311 2133 2806 2004 477 633 48 699
2005 219 3227 2005 442 616
2006 2144 320 2006 426 589
2007 2007
2008 2008
CVD CHD HD HF Stroke
2000 3694 2118 2851 245 603
2001 3524 2006 2719 237 577
2002 3421 192 2631 233 571
2003 3258 179 2517 233 527
2004 3034 1656 2337 224 496
2005 2972 1611 2308 224 464
2006 2898 1564 226 24 444
2007 2825 1516 2216 219 425
2008 2791 1472 2192 233 419
2000 2000 2000
2001 2001 2001
2002 2002 2002
2003 2003 2003
2004 2004 2004
2005 2005 2005
2006 2006 2006
2007 2007 2007
2008 2008 2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
Page 27: Michigan and MOSAIC Data Review...Michigan and MOSAIC Data Review 2017 ANNUAL WORKSHOP 4/26/2017. Adrienne Nickles, MPH. Michigan’s Ongoing Stroke Registry to Accelerate the Improvement

Stroke_Age

0-34
35-64
65-84
85+
Year
Age-Adjusted Rate per 100000
068
174
2589
15841
0638
157
2522
1504
072
169
2397
1528
0737
157
2249
13741
0652
138
220
12629
0553
145
2063
11398
0734
127
196
11256
064
1368
1832
10718
047
134
1804
10646

HF_Age

35-64
65-84
85+
Year
Age-Adjusted Rate per 100000
3047
936
8287
2596
88
8285
2648
878
8057
3176
902
7722
2709
863
7586
2955
878
7388
2979
884
8354
274
828
7483
333
85
8102

total

CVD_RG

White Male
Black Male
White Female
Black Female
Year
Age-Adjusted Rate per 100000
4276
5424
3033
4161
4066
5524
2813
4091
3928
5468
2767
4114
3734
518
2638
3887
3448
5079
2432
3643
3366
4983
2375
3545
3276
4994
2313
3477
3236
4845
2223
327
3158
4694
2238
3327

Stroke_RG

White Male
Black Male
White Female
Black Female
Year
Age-Adjusted Rate per 100000
61
768
561
703
575
752
539
681
573
806
528
66
516
662
498
629
463
743
476
562
449
663
429
585
434
63
411
556
415
631
392
494
402
606
392
509
375
616
372
464
372
565
366
513
373
548
366
44
348
587
349
477
347
506
34
462
369
506
352
482

HD_RG

White Male
Black Male
White Female
Black Female
Year
Age-Adjusted Rate per 100000
3393
4298
227
3206
3232
4445
2124
3166
3118
4317
2197
3157
2986
4184
1957
3001
2777
3983
1783
2838
2704
4009
1776
2679
2644
3981
1739
2642
2619
3972
1679
2532
2566
3819
1687
2606

CHD_RG

White Male
Black Male
White Female
Black Female
Year
Age-Adjusted Rate per 100000
2625
329
1608
243
2478
3356
1508
2314
2404
3154
1419
2313
2221
3093
1328
209
2067
2956
119
1983
1989
2885
117
1853
1922
2903
1139
1825
1921
2771
1074
1645
1824
2592
1071
1722

HF_RG

White Male
Black Male
White Female
Black Female
Year
Age-Adjusted Rate per 100000
255
206
245
17
267
225
225
167
242
238
227
203
256
217
222
189
243
167
214
206
24
218
217
172
255
246
229
202
23
225
208
196
25
216
226
185

race_gender

Sheet3

Local Health Department data can be found at wwwmichigangovbrfsSource CDC BRFSS

RISK FACTORMI

2011

MI

2013

MI

2014

MI

2015US 2015

2015 NATIONAL RANKING

Current Smoking 233 214 212 207 175 11

Blood Pressure Ever Told High 342 346 NA 331 309 18

Cholesterol Ever Told High 418 406 NA 382 364 12

Overweight (BMIgt25) 342 347 349 351 355 32tied

Obese (BMIgt30) 313 315 307 312 298 16

No Leisure Time Physical Activity 236 244 255 255 262 27

Diabetes 100 104 104 107 100 18tied

Prevalence of CVD Risk Factors Michigan Adults 1990-2015Compared to 2015 National Prevalence

233214 212 207

175

10

15

20

25

30

MI 2011 MI 2013 MI 2014 MI 2015 US 2015

Current Smoking

342 346331

309

20

25

30

35

40

MI 2011 MI 2013 MI 2014 MI 2015 US 2015

Blood Pressure Ever told high

342 347 349 351 355

20

25

30

35

40

MI 2011 MI 2013 MI 2014 MI 2015 US 2015

Overweight (BMIgt25)

313 315 307 312298

20

25

30

35

40

MI 2011 MI 2013 MI 2014 MI 2015 US 2015

Obese (BMIgt30)

418406

382364

30

35

40

45

50

MI 2011 MI 2013 MI 2014 MI 2015 US 2015

Cholesterol Ever told high

10 104 104 10710

0

3

6

9

12

15

MI 2011 MI 2013 MI 2014 MI 2015 US 2015

Diabetes

236 244255 255 262

10

15

20

25

30

MI 2011 MI 2013 MI 2014 MI 2015 US 2015

No Leisure Time Physical Activity

11 1216 18

2732tied

05

101520253035404550

CurrentSmoking

CholesterolEver told high

Obese(BMIgt30)

BloodPressure Ever

told high

Diabetes No LeisureTime Physical

Activity

Overweight(BMIgt25)

2015 NATIONAL RANKING(1st is worst)

18tied

MOSAIC 2015-2020 Focus of Grant Developing Stroke Systems of

Care Community Awareness EMS In-hospital QI Transition of Care Post-Discharge

12

Pre-hospital Care

A V A I L A B L E D A T A

13

EMSMOSAIC Data Linkage

-The MOSAIC Team continues to link data from the Michigan EMS Information System (MiEMSIS) to MOSAIC Data- Reports have been created for and reviewed by the

Tri-County Area MCA and Detroit East MCA- This work will expand to other MCA regions that

serve hospitals participating in MOSAIC

GWTG Special Initiatives Tab

-A free tab that can be enabled in GWTG-The purpose of the tab is to collect data concerning patient hand-off from EMS

MOSAIC Participating Hospitals

Aspirus Keweenaw Hospital (Laurium)

Aspirus Grand View HospitalAspirus Iron River HospitalAspirus Ontonagon HospitalBixby Medical CenterBronson Methodist HospitalCovenant Health CareDetroit Receiving HospitalGenesys Regional Medical CenterHenry Ford Hospital Herrick Medical CenterHuron Valley-Sinai HospitalLakeland Regional Medical Center McLaren Bay Regional Medical CenterMcLaren Greater Medical Center

McLaren Macomb HospitalMcLaren Northern MI HospitalMcLaren Oakland Medical CenterMcLaren Port Huron HospitalMcLaren Regional Medical CenterMercy Health Saint Maryrsquos HospitalMetro Health HospitalMunson Medical Center

ProMedica Monroe Regional HospitalSparrow HospitalSt Joseph Mercy - Ann ArborSt Joseph Mercy ChelseaSt Joseph Mercy Livingston HospitalSt Mary MercySt Mary of Michigan HospitalU of M Hospital

Hospital Infrastructure19

Among all participating hospitals the average number of

Licensed beds was 374 (range 25 to 1059 beds)

Inpatient discharges was 17076 (range 1064 to 48916 patients)

Acute stroke discharges (primary diagnosis only) was 417 (range 34 to 982 patients)

Case Demographics MOSAIC Registry

VariablesN() or statistics(Total N=68906)

Age at admission (years)Median 710Range 180 - 1060Mean (SE) 697(01)

GenderMale 32886 (477)Female 36015 (523)

RaceAfrican American 9900 (197)AIAN 132 (03)Asian 320 (06)More than one race 44 (01)Unknown 3679 (73)White 36190 (720)Missing 70

EthnicityHispanic or Latino 804 (16)Others 49531 (984)

VariablesN() or statistics(Total N=68906)

Health insuranceMedicaid 2284 (45)MedicaidPrivate 211 (04)Medicare 16863 (336)Medicare Medicaid 2313 (46)

MedicareMedicaidPrivate125 (02)

MedicarePrivate 13640 (272)ND 268(05)No insurance 2123 (42)Private 12356 (246)

Arrival modeEMS 21052 (429)Private

transportationother19313 (393)

Transfer from another hospital

7733(157)

ND or unknown 1021 (21)Missing 1216

Who receives data reports on your stroke quality of care

21

7055

70

10085

65

40

Hos

pita

lC

EO

up

per

man

agem

ent

Hos

pita

lB

oard

Chi

efN

ursi

ngO

ffice

r(C

NO

)

Str

oke

Tea

m

Phy

sici

anS

trok

eC

ham

pion

Chi

ef o

fM

edic

ine

Oth

er

Data Use

1) In the most recent calendar year have you run additional analyses (beyond what was required for reporting) on your hospitalrsquos own stroke data

2)How frequently have you run and used the analyses generated

22

Yes (N=16) 80

No (N=4) 20Weekly (N=2) 125

Monthly (N=8) 500

Less than monthly but more

than 1-2 times(N=6) 375

Data Use

What is the main reason you do not run your own additional analyses (Select one best answer)

23

Not sure how to run analyses

25

Not sure what analyses are needed would be helpful 25

Other 50

Data Use

In the most recent calendar year what reports did you run

24

813 688

Pre-programmedautomated reports in thedata collection tool (eg GWTG)

Additional reports beyond pre-programmed reports from the tool

Data Use

How do you use these analyses reports

25

813 688375

Inform quality improvement (QI) efforts andor plan

ldquoaction itemsrdquo

Report to management administration on our

progress

Other

Data Use

If you run additional analysis what action items QI efforts did you plan as a result of these reports

26

o Discharge education intensive statin use

o Door to tPA time and dysphagia

o Review data between spoke amp hub hospitals regarding transfers IV-tPA administration Mechanical thrombectomy and SAH

o QI efforts were addressed in the department involving calling Stroke Alert on call for cases with FAST symptoms

o ED Medical Director works with team to fix fallouts and problematic areas We have seen improvement

o Process changes (ie fallout emails to RN manager) physician querieso Increased documentation of NIHSS ownership from individual units regarding stroke quality

improvement goalso Daily dysphagia screening determination of whowhat team responsible for documenting initial NIHSS

looking at patients beyond 2h LKW arrival

Hospital Arrival Mode Door-to Needle and Pre-Notification

Reports 2016

Percent of Cases Who Arrived via EMSMOSAIC 2009-2016

Table 1 Arrival Mode among Stroke Cases by Demographics MOSAIC 2016

Demographics N=3496 550 N=2938 450Stroke Type Ischemic 2558 542 2164 458 Hemorrhagic 560 728 209 272 TIA 378 478 413 522Age Group lt 50 Years 233 433 305 567 50-79 Years 1982 497 2008 503 ge 80 Years 1379 688 625 312Sex Female 1933 576 1422 424 Male 1661 523 1516 477Race Black 659 530 584 470 White 2824 557 2248 443 Other Missing 111 512 106 488

MOSAIC AggregateArrival Mode

EMS Private Mode

Table 2 Door-to-Needle Times by Arrival Mode among Stroke Cases MOSAIC 2016

Time Elements (in Minutes)Number of

Patients Mean (Minutes) Median

(Minutes)Range

(Minutes)Door-to-Image 4901 575 400 00-2700 Arrived via EMS 2767 463 270 00-2700 Arrived via Private Transportation 2134 720 570 00-2620

Door-to-Image (among t-PA treated) 492 155 130 00-970 Arrived via EMS 370 125 110 00-840 Arrived via Private Transportation 122 243 215 20-970Image-to Needle 492 500 450 70-2090 Arrived via EMS 370 503 460 70-2090 Arrived via Private Transportation 122 483 420 90-1770Door-to Needle 492 655 570 200-2180 Arrived via EMS 370 629 560 200-2180 Arrived via Private Transportation 122 726 650 290-2060Included ischemic or hemorrhagic cases with times that were less or equal to 270 minutes (45 hours)Transferred cases were excluded

MOSAIC Aggregate

Table 3 Pre-Notification among Stroke Cases Who Arrived Via EMS by Demographics MOSAIC 2016

Demographics N=2015 584 N=1437 416Stroke Type Ischemic 1523 622 924 378 Hemorrhagic 306 566 235 434 TIA 142 381 231 619Age Group lt 50 Years 133 607 86 393 50-79 Years 1105 585 784 415 ge 80 Years 777 578 567 422Sex Female 1075 578 786 422 Male 940 591 651 409Race Black 307 517 287 483 White 1657 602 1097 398 Other 51 490 53 510

All HospitalsPre-Notification

Yes No

MOSAIC Transitions of Care Project

Post-discharge data collection tool is being implemented into Outcome Science as a tab

Post-Discharge amp Transition of Care

Reporting on changes within 30 days of discharge from hospital via follow-up callschart review Interval events Physician follow-up visits Lifestyle changes Lab assessments Medication managementadherence Rehab amp Functional outcomes Falls

MOSAIC Website

wwwMichigangovstroke

Adrienne Nickles MPHnicklesamichigangov

Thank You

  • Michigan and MOSAIC Data Review
  • Overview
  • Age-adjusted Stroke Hospitalization Rates Michigan 2000-2015
  • Slide Number 4
  • Age-adjusted Stroke Mortality Rates Michigan 2000-2014
  • Slide Number 6
  • Slide Number 7
  • Slide Number 8
  • Slide Number 9
  • Slide Number 10
  • Slide Number 11
  • MOSAIC 2015-2020
  • Pre-hospital Care
  • EMSMOSAIC Data Linkage
  • Slide Number 15
  • GWTG Special Initiatives Tab
  • Slide Number 17
  • MOSAIC Participating Hospitals
  • Hospital Infrastructure
  • Case Demographics MOSAIC Registry
  • Who receives data reports on your stroke quality of care
  • 1) In the most recent calendar year have you run additional analyses (beyond what was required for reporting) on your hospitalrsquos own stroke data 2)How frequently have you run and used the analyses generated
  • What is the main reason you do not run your own additional analyses (Select one best answer)
  • In the most recent calendar year what reports did you run
  • How do you use these analyses reports
  • If you run additional analysis what action items QI efforts did you plan as a result of these reports
  • Hospital Arrival Mode Door-to Needle and Pre-Notification Reports 2016
  • Percent of Cases Who Arrived via EMSMOSAIC 2009-2016
  • Table 1 Arrival Mode among Stroke Cases by Demographics MOSAIC 2016
  • Table 2 Door-to-Needle Times by Arrival Mode among Stroke Cases MOSAIC 2016
  • Table 3 Pre-Notification among Stroke Cases Who Arrived Via EMS by Demographics MOSAIC 2016
  • MOSAIC Transitions of Care Project
  • Slide Number 33
  • MOSAIC Website
  • Adrienne Nickles MPHnicklesamichigangov
CVD
Year White Male Black Male White Female Black Female
2000 4276 5424 3033 4161
2001 4066 5524 2813 4091
2002 3928 5468 2767 4114
2003 3734 518 2638 3887
2004 3448 5079 2432 3643
2005 3366 4983 2375 3545
2006 3276 4994 2313 3477
2007 3236 4845 2223 327
2008 3158 4694 2238 3327
change 234 79 237 164
Heart Disease
Year White Male Black Male White Female Black Female
2000 3393 4298 227 3206
2001 3232 4445 2124 3166
2002 3118 4317 2197 3157
2003 2986 4184 1957 3001
2004 2777 3983 1783 2838
2005 2704 4009 1776 2679
2006 2644 3981 1739 2642
2007 2619 3972 1679 2532
2008 2566 3819 1687 2606
Stroke
Year White Male Black Male White Female Black Female
2000 61 768 561 703 176
2001 575 752 539 681 138
2002 573 806 528 66 15
2003 516 662 498 629 147
2004 463 743 476 562
2005 449 663 429 585
2006 434 63 411 556
2007 415 631 392 494
2008 402 606 392 509
2009 375 616 372 464
2010 372 565 366 513
2011 373 548 366 44
2012 348 587 349 477
2013 347 506 34 462
2014 369 506 352 482
Coronary Heart Disease
Year White Male Black Male White Female Black Female
2000 2625 329 1608 243
2001 2478 3356 1508 2314
2002 2404 3154 1419 2313
2003 2221 3093 1328 209
2004 2067 2956 119 1983
2005 1989 2885 117 1853
2006 1922 2903 1139 1825
2007 1921 2771 1074 1645
2008 1824 2592 1071 1722
Heart Failure
Year White Male Black Male White Female Black Female
2000 255 206 245 17
2001 267 225 225 167
2002 242 238 227 203
2003 256 217 222 189
2004 243 167 214 206
2005 24 218 217 172
2006 255 246 229 202
2007 23 225 208 196
2008 25 216 226 185
Not sure what this data is from previously HD Stroke
Year White Female Black Female White Female Black Female
2000 227 3206 561 703
2001 2124 3166 539 681
2002 2197 3157 528 66
2003 1957 3001 498 629
2004 1783 2838 476 562
2005 1776 2679 429 585
2006 1739 2642 411 556
2007
2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2009 2009 2009 2009
2010 2010 2010 2010
2011 2011 2011 2011
2012 2012 2012 2012
2013 2013 2013 2013
2014 2014 2014 2014
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
CVD
Year US Michigan 0-34 35-64 65-84 85+
2000 3397 3694 43 140 16141 86689
2001 3265 3524 508 1348 15291 82889
2002 3174 3421 45 1338 14891 79536
2003 3061 3258 54 1324 14033 75185
2004 2885 3034 41 1242 13209 69088
2005 2773 2972 48 1283 1291 66011
2006 2898 48 1207 12246 6786
2007 2825 5 1206 1182 66153
2008 2791 43 1175 11619 66406
Heart Disease
Year US Michigan 0-34 35-64 65-84 85+
2000 2576 2851 345 1158 1247 64879
2001 2478 2719 416 112 11794 61938
2002 2408 2631 35 1103 11529 58746
2003 2323 2517 45 110 10827 56172
2004 217 2337 313 1048 10086 51609
2005 2111 2308 38 1078 9937 49828
2006 226 384 1019 9413 51918
2007 2216 42 1008 9174 50961
2008 2192 36 982 904 51209
Stroke
Year US Michigan HP 2010 0-34 35-64 65-84 85+
2000 609 603 50 068 174 2589 15841
2001 579 577 50 0638 157 2522 1504
2002 562 571 50 072 169 2397 1528
2003 535 527 50 0737 157 2249 13741
2004 50 496 50 0652 138 220 12629
2005 466 464 50 0553 145 2063 11398
2006 444 50 0734 127 196 11256
2007 425 064 1368 1832 10718
2008 419 047 134 1804 10646
79 27 243 289
Coronary Heart Disease
Year US Michigan HP 2010 0-34 35-64 65-84 85+
2000 1868 2118 162 0613 874 7701 4670
2001 1778 2006 162 0898 818 9012 44369
2002 1709 192 162 0889 799 8759 41061
2003 1628 179 162 0793 785 8018 38358
2004 1502 1656 162 0865 757 7421 34644
2005 1444 1611 162 097 773 7245 32617
2006 1564 162 088 727 6856 33503
2007 1516 117 709 6585 32727
2008 1472 102 657 6403 32504
168 11 283
Heart Failure
Year US Michigan 35-64 65-84 85+
2000 203 245 3047 936 8287
2001 202 237 2596 88 8285
2002 194 233 2648 878 8057
2003 194 233 3176 902 7722
2004 189 224 2709 863 7586
2005 189 224 2955 878 7388
2006 24 2979 884 8354
2007 219 274 828 7483
2008 233 013 333 85 8102
Heart Disease Stroke
Michigan White Michigan Black US White US Black Michigan White Michigan Black US White US Black
1990 334 4315 317 3915 1990 638 733 629 917
1991 3289 4108 3088 3865 1991 626 781 607 894
1992 3126 3987 3011 3777 1992 609 694 598 86
1993 3234 429 3046 3843 1993 614 77 609 866
1994 3134 4156 295 3661 1994 634 875 609 869
1995 3048 4131 2912 3672 1995 638 925 615 879
1996 2997 380 2842 354 1996 617 804 61 852
1997 2851 3683 2764 345 1997 604 77 598 816
1998 2884 3586 2681 3406 1998 598 729 576 803
1999 2781 3692 2634 3367 1999 609 812 598 824
2000 2757 3663 2536 3265 2000 586 737 587 824
2001 261 3695 2435 3169 2001 56 718 558 788
2002 2522 3659 2367 3084 2002 553 729 542 763
2003 2409 350 2282 3002 2003 511 655 514 743
2004 222 3311 2133 2806 2004 477 633 48 699
2005 219 3227 2005 442 616
2006 2144 320 2006 426 589
2007 2007
2008 2008
CVD CHD HD HF Stroke
2000 3694 2118 2851 245 603
2001 3524 2006 2719 237 577
2002 3421 192 2631 233 571
2003 3258 179 2517 233 527
2004 3034 1656 2337 224 496
2005 2972 1611 2308 224 464
2006 2898 1564 226 24 444
2007 2825 1516 2216 219 425
2008 2791 1472 2192 233 419
2000 2000 2000
2001 2001 2001
2002 2002 2002
2003 2003 2003
2004 2004 2004
2005 2005 2005
2006 2006 2006
2007 2007 2007
2008 2008 2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
Page 28: Michigan and MOSAIC Data Review...Michigan and MOSAIC Data Review 2017 ANNUAL WORKSHOP 4/26/2017. Adrienne Nickles, MPH. Michigan’s Ongoing Stroke Registry to Accelerate the Improvement

HF_Age

35-64
65-84
85+
Year
Age-Adjusted Rate per 100000
3047
936
8287
2596
88
8285
2648
878
8057
3176
902
7722
2709
863
7586
2955
878
7388
2979
884
8354
274
828
7483
333
85
8102

total

CVD_RG

White Male
Black Male
White Female
Black Female
Year
Age-Adjusted Rate per 100000
4276
5424
3033
4161
4066
5524
2813
4091
3928
5468
2767
4114
3734
518
2638
3887
3448
5079
2432
3643
3366
4983
2375
3545
3276
4994
2313
3477
3236
4845
2223
327
3158
4694
2238
3327

Stroke_RG

White Male
Black Male
White Female
Black Female
Year
Age-Adjusted Rate per 100000
61
768
561
703
575
752
539
681
573
806
528
66
516
662
498
629
463
743
476
562
449
663
429
585
434
63
411
556
415
631
392
494
402
606
392
509
375
616
372
464
372
565
366
513
373
548
366
44
348
587
349
477
347
506
34
462
369
506
352
482

HD_RG

White Male
Black Male
White Female
Black Female
Year
Age-Adjusted Rate per 100000
3393
4298
227
3206
3232
4445
2124
3166
3118
4317
2197
3157
2986
4184
1957
3001
2777
3983
1783
2838
2704
4009
1776
2679
2644
3981
1739
2642
2619
3972
1679
2532
2566
3819
1687
2606

CHD_RG

White Male
Black Male
White Female
Black Female
Year
Age-Adjusted Rate per 100000
2625
329
1608
243
2478
3356
1508
2314
2404
3154
1419
2313
2221
3093
1328
209
2067
2956
119
1983
1989
2885
117
1853
1922
2903
1139
1825
1921
2771
1074
1645
1824
2592
1071
1722

HF_RG

White Male
Black Male
White Female
Black Female
Year
Age-Adjusted Rate per 100000
255
206
245
17
267
225
225
167
242
238
227
203
256
217
222
189
243
167
214
206
24
218
217
172
255
246
229
202
23
225
208
196
25
216
226
185

race_gender

Sheet3

Local Health Department data can be found at wwwmichigangovbrfsSource CDC BRFSS

RISK FACTORMI

2011

MI

2013

MI

2014

MI

2015US 2015

2015 NATIONAL RANKING

Current Smoking 233 214 212 207 175 11

Blood Pressure Ever Told High 342 346 NA 331 309 18

Cholesterol Ever Told High 418 406 NA 382 364 12

Overweight (BMIgt25) 342 347 349 351 355 32tied

Obese (BMIgt30) 313 315 307 312 298 16

No Leisure Time Physical Activity 236 244 255 255 262 27

Diabetes 100 104 104 107 100 18tied

Prevalence of CVD Risk Factors Michigan Adults 1990-2015Compared to 2015 National Prevalence

233214 212 207

175

10

15

20

25

30

MI 2011 MI 2013 MI 2014 MI 2015 US 2015

Current Smoking

342 346331

309

20

25

30

35

40

MI 2011 MI 2013 MI 2014 MI 2015 US 2015

Blood Pressure Ever told high

342 347 349 351 355

20

25

30

35

40

MI 2011 MI 2013 MI 2014 MI 2015 US 2015

Overweight (BMIgt25)

313 315 307 312298

20

25

30

35

40

MI 2011 MI 2013 MI 2014 MI 2015 US 2015

Obese (BMIgt30)

418406

382364

30

35

40

45

50

MI 2011 MI 2013 MI 2014 MI 2015 US 2015

Cholesterol Ever told high

10 104 104 10710

0

3

6

9

12

15

MI 2011 MI 2013 MI 2014 MI 2015 US 2015

Diabetes

236 244255 255 262

10

15

20

25

30

MI 2011 MI 2013 MI 2014 MI 2015 US 2015

No Leisure Time Physical Activity

11 1216 18

2732tied

05

101520253035404550

CurrentSmoking

CholesterolEver told high

Obese(BMIgt30)

BloodPressure Ever

told high

Diabetes No LeisureTime Physical

Activity

Overweight(BMIgt25)

2015 NATIONAL RANKING(1st is worst)

18tied

MOSAIC 2015-2020 Focus of Grant Developing Stroke Systems of

Care Community Awareness EMS In-hospital QI Transition of Care Post-Discharge

12

Pre-hospital Care

A V A I L A B L E D A T A

13

EMSMOSAIC Data Linkage

-The MOSAIC Team continues to link data from the Michigan EMS Information System (MiEMSIS) to MOSAIC Data- Reports have been created for and reviewed by the

Tri-County Area MCA and Detroit East MCA- This work will expand to other MCA regions that

serve hospitals participating in MOSAIC

GWTG Special Initiatives Tab

-A free tab that can be enabled in GWTG-The purpose of the tab is to collect data concerning patient hand-off from EMS

MOSAIC Participating Hospitals

Aspirus Keweenaw Hospital (Laurium)

Aspirus Grand View HospitalAspirus Iron River HospitalAspirus Ontonagon HospitalBixby Medical CenterBronson Methodist HospitalCovenant Health CareDetroit Receiving HospitalGenesys Regional Medical CenterHenry Ford Hospital Herrick Medical CenterHuron Valley-Sinai HospitalLakeland Regional Medical Center McLaren Bay Regional Medical CenterMcLaren Greater Medical Center

McLaren Macomb HospitalMcLaren Northern MI HospitalMcLaren Oakland Medical CenterMcLaren Port Huron HospitalMcLaren Regional Medical CenterMercy Health Saint Maryrsquos HospitalMetro Health HospitalMunson Medical Center

ProMedica Monroe Regional HospitalSparrow HospitalSt Joseph Mercy - Ann ArborSt Joseph Mercy ChelseaSt Joseph Mercy Livingston HospitalSt Mary MercySt Mary of Michigan HospitalU of M Hospital

Hospital Infrastructure19

Among all participating hospitals the average number of

Licensed beds was 374 (range 25 to 1059 beds)

Inpatient discharges was 17076 (range 1064 to 48916 patients)

Acute stroke discharges (primary diagnosis only) was 417 (range 34 to 982 patients)

Case Demographics MOSAIC Registry

VariablesN() or statistics(Total N=68906)

Age at admission (years)Median 710Range 180 - 1060Mean (SE) 697(01)

GenderMale 32886 (477)Female 36015 (523)

RaceAfrican American 9900 (197)AIAN 132 (03)Asian 320 (06)More than one race 44 (01)Unknown 3679 (73)White 36190 (720)Missing 70

EthnicityHispanic or Latino 804 (16)Others 49531 (984)

VariablesN() or statistics(Total N=68906)

Health insuranceMedicaid 2284 (45)MedicaidPrivate 211 (04)Medicare 16863 (336)Medicare Medicaid 2313 (46)

MedicareMedicaidPrivate125 (02)

MedicarePrivate 13640 (272)ND 268(05)No insurance 2123 (42)Private 12356 (246)

Arrival modeEMS 21052 (429)Private

transportationother19313 (393)

Transfer from another hospital

7733(157)

ND or unknown 1021 (21)Missing 1216

Who receives data reports on your stroke quality of care

21

7055

70

10085

65

40

Hos

pita

lC

EO

up

per

man

agem

ent

Hos

pita

lB

oard

Chi

efN

ursi

ngO

ffice

r(C

NO

)

Str

oke

Tea

m

Phy

sici

anS

trok

eC

ham

pion

Chi

ef o

fM

edic

ine

Oth

er

Data Use

1) In the most recent calendar year have you run additional analyses (beyond what was required for reporting) on your hospitalrsquos own stroke data

2)How frequently have you run and used the analyses generated

22

Yes (N=16) 80

No (N=4) 20Weekly (N=2) 125

Monthly (N=8) 500

Less than monthly but more

than 1-2 times(N=6) 375

Data Use

What is the main reason you do not run your own additional analyses (Select one best answer)

23

Not sure how to run analyses

25

Not sure what analyses are needed would be helpful 25

Other 50

Data Use

In the most recent calendar year what reports did you run

24

813 688

Pre-programmedautomated reports in thedata collection tool (eg GWTG)

Additional reports beyond pre-programmed reports from the tool

Data Use

How do you use these analyses reports

25

813 688375

Inform quality improvement (QI) efforts andor plan

ldquoaction itemsrdquo

Report to management administration on our

progress

Other

Data Use

If you run additional analysis what action items QI efforts did you plan as a result of these reports

26

o Discharge education intensive statin use

o Door to tPA time and dysphagia

o Review data between spoke amp hub hospitals regarding transfers IV-tPA administration Mechanical thrombectomy and SAH

o QI efforts were addressed in the department involving calling Stroke Alert on call for cases with FAST symptoms

o ED Medical Director works with team to fix fallouts and problematic areas We have seen improvement

o Process changes (ie fallout emails to RN manager) physician querieso Increased documentation of NIHSS ownership from individual units regarding stroke quality

improvement goalso Daily dysphagia screening determination of whowhat team responsible for documenting initial NIHSS

looking at patients beyond 2h LKW arrival

Hospital Arrival Mode Door-to Needle and Pre-Notification

Reports 2016

Percent of Cases Who Arrived via EMSMOSAIC 2009-2016

Table 1 Arrival Mode among Stroke Cases by Demographics MOSAIC 2016

Demographics N=3496 550 N=2938 450Stroke Type Ischemic 2558 542 2164 458 Hemorrhagic 560 728 209 272 TIA 378 478 413 522Age Group lt 50 Years 233 433 305 567 50-79 Years 1982 497 2008 503 ge 80 Years 1379 688 625 312Sex Female 1933 576 1422 424 Male 1661 523 1516 477Race Black 659 530 584 470 White 2824 557 2248 443 Other Missing 111 512 106 488

MOSAIC AggregateArrival Mode

EMS Private Mode

Table 2 Door-to-Needle Times by Arrival Mode among Stroke Cases MOSAIC 2016

Time Elements (in Minutes)Number of

Patients Mean (Minutes) Median

(Minutes)Range

(Minutes)Door-to-Image 4901 575 400 00-2700 Arrived via EMS 2767 463 270 00-2700 Arrived via Private Transportation 2134 720 570 00-2620

Door-to-Image (among t-PA treated) 492 155 130 00-970 Arrived via EMS 370 125 110 00-840 Arrived via Private Transportation 122 243 215 20-970Image-to Needle 492 500 450 70-2090 Arrived via EMS 370 503 460 70-2090 Arrived via Private Transportation 122 483 420 90-1770Door-to Needle 492 655 570 200-2180 Arrived via EMS 370 629 560 200-2180 Arrived via Private Transportation 122 726 650 290-2060Included ischemic or hemorrhagic cases with times that were less or equal to 270 minutes (45 hours)Transferred cases were excluded

MOSAIC Aggregate

Table 3 Pre-Notification among Stroke Cases Who Arrived Via EMS by Demographics MOSAIC 2016

Demographics N=2015 584 N=1437 416Stroke Type Ischemic 1523 622 924 378 Hemorrhagic 306 566 235 434 TIA 142 381 231 619Age Group lt 50 Years 133 607 86 393 50-79 Years 1105 585 784 415 ge 80 Years 777 578 567 422Sex Female 1075 578 786 422 Male 940 591 651 409Race Black 307 517 287 483 White 1657 602 1097 398 Other 51 490 53 510

All HospitalsPre-Notification

Yes No

MOSAIC Transitions of Care Project

Post-discharge data collection tool is being implemented into Outcome Science as a tab

Post-Discharge amp Transition of Care

Reporting on changes within 30 days of discharge from hospital via follow-up callschart review Interval events Physician follow-up visits Lifestyle changes Lab assessments Medication managementadherence Rehab amp Functional outcomes Falls

MOSAIC Website

wwwMichigangovstroke

Adrienne Nickles MPHnicklesamichigangov

Thank You

  • Michigan and MOSAIC Data Review
  • Overview
  • Age-adjusted Stroke Hospitalization Rates Michigan 2000-2015
  • Slide Number 4
  • Age-adjusted Stroke Mortality Rates Michigan 2000-2014
  • Slide Number 6
  • Slide Number 7
  • Slide Number 8
  • Slide Number 9
  • Slide Number 10
  • Slide Number 11
  • MOSAIC 2015-2020
  • Pre-hospital Care
  • EMSMOSAIC Data Linkage
  • Slide Number 15
  • GWTG Special Initiatives Tab
  • Slide Number 17
  • MOSAIC Participating Hospitals
  • Hospital Infrastructure
  • Case Demographics MOSAIC Registry
  • Who receives data reports on your stroke quality of care
  • 1) In the most recent calendar year have you run additional analyses (beyond what was required for reporting) on your hospitalrsquos own stroke data 2)How frequently have you run and used the analyses generated
  • What is the main reason you do not run your own additional analyses (Select one best answer)
  • In the most recent calendar year what reports did you run
  • How do you use these analyses reports
  • If you run additional analysis what action items QI efforts did you plan as a result of these reports
  • Hospital Arrival Mode Door-to Needle and Pre-Notification Reports 2016
  • Percent of Cases Who Arrived via EMSMOSAIC 2009-2016
  • Table 1 Arrival Mode among Stroke Cases by Demographics MOSAIC 2016
  • Table 2 Door-to-Needle Times by Arrival Mode among Stroke Cases MOSAIC 2016
  • Table 3 Pre-Notification among Stroke Cases Who Arrived Via EMS by Demographics MOSAIC 2016
  • MOSAIC Transitions of Care Project
  • Slide Number 33
  • MOSAIC Website
  • Adrienne Nickles MPHnicklesamichigangov
CVD
Year White Male Black Male White Female Black Female
2000 4276 5424 3033 4161
2001 4066 5524 2813 4091
2002 3928 5468 2767 4114
2003 3734 518 2638 3887
2004 3448 5079 2432 3643
2005 3366 4983 2375 3545
2006 3276 4994 2313 3477
2007 3236 4845 2223 327
2008 3158 4694 2238 3327
change 234 79 237 164
Heart Disease
Year White Male Black Male White Female Black Female
2000 3393 4298 227 3206
2001 3232 4445 2124 3166
2002 3118 4317 2197 3157
2003 2986 4184 1957 3001
2004 2777 3983 1783 2838
2005 2704 4009 1776 2679
2006 2644 3981 1739 2642
2007 2619 3972 1679 2532
2008 2566 3819 1687 2606
Stroke
Year White Male Black Male White Female Black Female
2000 61 768 561 703 176
2001 575 752 539 681 138
2002 573 806 528 66 15
2003 516 662 498 629 147
2004 463 743 476 562
2005 449 663 429 585
2006 434 63 411 556
2007 415 631 392 494
2008 402 606 392 509
2009 375 616 372 464
2010 372 565 366 513
2011 373 548 366 44
2012 348 587 349 477
2013 347 506 34 462
2014 369 506 352 482
Coronary Heart Disease
Year White Male Black Male White Female Black Female
2000 2625 329 1608 243
2001 2478 3356 1508 2314
2002 2404 3154 1419 2313
2003 2221 3093 1328 209
2004 2067 2956 119 1983
2005 1989 2885 117 1853
2006 1922 2903 1139 1825
2007 1921 2771 1074 1645
2008 1824 2592 1071 1722
Heart Failure
Year White Male Black Male White Female Black Female
2000 255 206 245 17
2001 267 225 225 167
2002 242 238 227 203
2003 256 217 222 189
2004 243 167 214 206
2005 24 218 217 172
2006 255 246 229 202
2007 23 225 208 196
2008 25 216 226 185
Not sure what this data is from previously HD Stroke
Year White Female Black Female White Female Black Female
2000 227 3206 561 703
2001 2124 3166 539 681
2002 2197 3157 528 66
2003 1957 3001 498 629
2004 1783 2838 476 562
2005 1776 2679 429 585
2006 1739 2642 411 556
2007
2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2009 2009 2009 2009
2010 2010 2010 2010
2011 2011 2011 2011
2012 2012 2012 2012
2013 2013 2013 2013
2014 2014 2014 2014
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
CVD
Year US Michigan 0-34 35-64 65-84 85+
2000 3397 3694 43 140 16141 86689
2001 3265 3524 508 1348 15291 82889
2002 3174 3421 45 1338 14891 79536
2003 3061 3258 54 1324 14033 75185
2004 2885 3034 41 1242 13209 69088
2005 2773 2972 48 1283 1291 66011
2006 2898 48 1207 12246 6786
2007 2825 5 1206 1182 66153
2008 2791 43 1175 11619 66406
Heart Disease
Year US Michigan 0-34 35-64 65-84 85+
2000 2576 2851 345 1158 1247 64879
2001 2478 2719 416 112 11794 61938
2002 2408 2631 35 1103 11529 58746
2003 2323 2517 45 110 10827 56172
2004 217 2337 313 1048 10086 51609
2005 2111 2308 38 1078 9937 49828
2006 226 384 1019 9413 51918
2007 2216 42 1008 9174 50961
2008 2192 36 982 904 51209
Stroke
Year US Michigan HP 2010 0-34 35-64 65-84 85+
2000 609 603 50 068 174 2589 15841
2001 579 577 50 0638 157 2522 1504
2002 562 571 50 072 169 2397 1528
2003 535 527 50 0737 157 2249 13741
2004 50 496 50 0652 138 220 12629
2005 466 464 50 0553 145 2063 11398
2006 444 50 0734 127 196 11256
2007 425 064 1368 1832 10718
2008 419 047 134 1804 10646
79 27 243 289
Coronary Heart Disease
Year US Michigan HP 2010 0-34 35-64 65-84 85+
2000 1868 2118 162 0613 874 7701 4670
2001 1778 2006 162 0898 818 9012 44369
2002 1709 192 162 0889 799 8759 41061
2003 1628 179 162 0793 785 8018 38358
2004 1502 1656 162 0865 757 7421 34644
2005 1444 1611 162 097 773 7245 32617
2006 1564 162 088 727 6856 33503
2007 1516 117 709 6585 32727
2008 1472 102 657 6403 32504
168 11 283
Heart Failure
Year US Michigan 35-64 65-84 85+
2000 203 245 3047 936 8287
2001 202 237 2596 88 8285
2002 194 233 2648 878 8057
2003 194 233 3176 902 7722
2004 189 224 2709 863 7586
2005 189 224 2955 878 7388
2006 24 2979 884 8354
2007 219 274 828 7483
2008 233 013 333 85 8102
Heart Disease Stroke
Michigan White Michigan Black US White US Black Michigan White Michigan Black US White US Black
1990 334 4315 317 3915 1990 638 733 629 917
1991 3289 4108 3088 3865 1991 626 781 607 894
1992 3126 3987 3011 3777 1992 609 694 598 86
1993 3234 429 3046 3843 1993 614 77 609 866
1994 3134 4156 295 3661 1994 634 875 609 869
1995 3048 4131 2912 3672 1995 638 925 615 879
1996 2997 380 2842 354 1996 617 804 61 852
1997 2851 3683 2764 345 1997 604 77 598 816
1998 2884 3586 2681 3406 1998 598 729 576 803
1999 2781 3692 2634 3367 1999 609 812 598 824
2000 2757 3663 2536 3265 2000 586 737 587 824
2001 261 3695 2435 3169 2001 56 718 558 788
2002 2522 3659 2367 3084 2002 553 729 542 763
2003 2409 350 2282 3002 2003 511 655 514 743
2004 222 3311 2133 2806 2004 477 633 48 699
2005 219 3227 2005 442 616
2006 2144 320 2006 426 589
2007 2007
2008 2008
CVD CHD HD HF Stroke
2000 3694 2118 2851 245 603
2001 3524 2006 2719 237 577
2002 3421 192 2631 233 571
2003 3258 179 2517 233 527
2004 3034 1656 2337 224 496
2005 2972 1611 2308 224 464
2006 2898 1564 226 24 444
2007 2825 1516 2216 219 425
2008 2791 1472 2192 233 419
2000 2000 2000
2001 2001 2001
2002 2002 2002
2003 2003 2003
2004 2004 2004
2005 2005 2005
2006 2006 2006
2007 2007 2007
2008 2008 2008
Page 29: Michigan and MOSAIC Data Review...Michigan and MOSAIC Data Review 2017 ANNUAL WORKSHOP 4/26/2017. Adrienne Nickles, MPH. Michigan’s Ongoing Stroke Registry to Accelerate the Improvement

total

CVD_RG

White Male
Black Male
White Female
Black Female
Year
Age-Adjusted Rate per 100000
4276
5424
3033
4161
4066
5524
2813
4091
3928
5468
2767
4114
3734
518
2638
3887
3448
5079
2432
3643
3366
4983
2375
3545
3276
4994
2313
3477
3236
4845
2223
327
3158
4694
2238
3327

Stroke_RG

White Male
Black Male
White Female
Black Female
Year
Age-Adjusted Rate per 100000
61
768
561
703
575
752
539
681
573
806
528
66
516
662
498
629
463
743
476
562
449
663
429
585
434
63
411
556
415
631
392
494
402
606
392
509
375
616
372
464
372
565
366
513
373
548
366
44
348
587
349
477
347
506
34
462
369
506
352
482

HD_RG

White Male
Black Male
White Female
Black Female
Year
Age-Adjusted Rate per 100000
3393
4298
227
3206
3232
4445
2124
3166
3118
4317
2197
3157
2986
4184
1957
3001
2777
3983
1783
2838
2704
4009
1776
2679
2644
3981
1739
2642
2619
3972
1679
2532
2566
3819
1687
2606

CHD_RG

White Male
Black Male
White Female
Black Female
Year
Age-Adjusted Rate per 100000
2625
329
1608
243
2478
3356
1508
2314
2404
3154
1419
2313
2221
3093
1328
209
2067
2956
119
1983
1989
2885
117
1853
1922
2903
1139
1825
1921
2771
1074
1645
1824
2592
1071
1722

HF_RG

White Male
Black Male
White Female
Black Female
Year
Age-Adjusted Rate per 100000
255
206
245
17
267
225
225
167
242
238
227
203
256
217
222
189
243
167
214
206
24
218
217
172
255
246
229
202
23
225
208
196
25
216
226
185

race_gender

Sheet3

Local Health Department data can be found at wwwmichigangovbrfsSource CDC BRFSS

RISK FACTORMI

2011

MI

2013

MI

2014

MI

2015US 2015

2015 NATIONAL RANKING

Current Smoking 233 214 212 207 175 11

Blood Pressure Ever Told High 342 346 NA 331 309 18

Cholesterol Ever Told High 418 406 NA 382 364 12

Overweight (BMIgt25) 342 347 349 351 355 32tied

Obese (BMIgt30) 313 315 307 312 298 16

No Leisure Time Physical Activity 236 244 255 255 262 27

Diabetes 100 104 104 107 100 18tied

Prevalence of CVD Risk Factors Michigan Adults 1990-2015Compared to 2015 National Prevalence

233214 212 207

175

10

15

20

25

30

MI 2011 MI 2013 MI 2014 MI 2015 US 2015

Current Smoking

342 346331

309

20

25

30

35

40

MI 2011 MI 2013 MI 2014 MI 2015 US 2015

Blood Pressure Ever told high

342 347 349 351 355

20

25

30

35

40

MI 2011 MI 2013 MI 2014 MI 2015 US 2015

Overweight (BMIgt25)

313 315 307 312298

20

25

30

35

40

MI 2011 MI 2013 MI 2014 MI 2015 US 2015

Obese (BMIgt30)

418406

382364

30

35

40

45

50

MI 2011 MI 2013 MI 2014 MI 2015 US 2015

Cholesterol Ever told high

10 104 104 10710

0

3

6

9

12

15

MI 2011 MI 2013 MI 2014 MI 2015 US 2015

Diabetes

236 244255 255 262

10

15

20

25

30

MI 2011 MI 2013 MI 2014 MI 2015 US 2015

No Leisure Time Physical Activity

11 1216 18

2732tied

05

101520253035404550

CurrentSmoking

CholesterolEver told high

Obese(BMIgt30)

BloodPressure Ever

told high

Diabetes No LeisureTime Physical

Activity

Overweight(BMIgt25)

2015 NATIONAL RANKING(1st is worst)

18tied

MOSAIC 2015-2020 Focus of Grant Developing Stroke Systems of

Care Community Awareness EMS In-hospital QI Transition of Care Post-Discharge

12

Pre-hospital Care

A V A I L A B L E D A T A

13

EMSMOSAIC Data Linkage

-The MOSAIC Team continues to link data from the Michigan EMS Information System (MiEMSIS) to MOSAIC Data- Reports have been created for and reviewed by the

Tri-County Area MCA and Detroit East MCA- This work will expand to other MCA regions that

serve hospitals participating in MOSAIC

GWTG Special Initiatives Tab

-A free tab that can be enabled in GWTG-The purpose of the tab is to collect data concerning patient hand-off from EMS

MOSAIC Participating Hospitals

Aspirus Keweenaw Hospital (Laurium)

Aspirus Grand View HospitalAspirus Iron River HospitalAspirus Ontonagon HospitalBixby Medical CenterBronson Methodist HospitalCovenant Health CareDetroit Receiving HospitalGenesys Regional Medical CenterHenry Ford Hospital Herrick Medical CenterHuron Valley-Sinai HospitalLakeland Regional Medical Center McLaren Bay Regional Medical CenterMcLaren Greater Medical Center

McLaren Macomb HospitalMcLaren Northern MI HospitalMcLaren Oakland Medical CenterMcLaren Port Huron HospitalMcLaren Regional Medical CenterMercy Health Saint Maryrsquos HospitalMetro Health HospitalMunson Medical Center

ProMedica Monroe Regional HospitalSparrow HospitalSt Joseph Mercy - Ann ArborSt Joseph Mercy ChelseaSt Joseph Mercy Livingston HospitalSt Mary MercySt Mary of Michigan HospitalU of M Hospital

Hospital Infrastructure19

Among all participating hospitals the average number of

Licensed beds was 374 (range 25 to 1059 beds)

Inpatient discharges was 17076 (range 1064 to 48916 patients)

Acute stroke discharges (primary diagnosis only) was 417 (range 34 to 982 patients)

Case Demographics MOSAIC Registry

VariablesN() or statistics(Total N=68906)

Age at admission (years)Median 710Range 180 - 1060Mean (SE) 697(01)

GenderMale 32886 (477)Female 36015 (523)

RaceAfrican American 9900 (197)AIAN 132 (03)Asian 320 (06)More than one race 44 (01)Unknown 3679 (73)White 36190 (720)Missing 70

EthnicityHispanic or Latino 804 (16)Others 49531 (984)

VariablesN() or statistics(Total N=68906)

Health insuranceMedicaid 2284 (45)MedicaidPrivate 211 (04)Medicare 16863 (336)Medicare Medicaid 2313 (46)

MedicareMedicaidPrivate125 (02)

MedicarePrivate 13640 (272)ND 268(05)No insurance 2123 (42)Private 12356 (246)

Arrival modeEMS 21052 (429)Private

transportationother19313 (393)

Transfer from another hospital

7733(157)

ND or unknown 1021 (21)Missing 1216

Who receives data reports on your stroke quality of care

21

7055

70

10085

65

40

Hos

pita

lC

EO

up

per

man

agem

ent

Hos

pita

lB

oard

Chi

efN

ursi

ngO

ffice

r(C

NO

)

Str

oke

Tea

m

Phy

sici

anS

trok

eC

ham

pion

Chi

ef o

fM

edic

ine

Oth

er

Data Use

1) In the most recent calendar year have you run additional analyses (beyond what was required for reporting) on your hospitalrsquos own stroke data

2)How frequently have you run and used the analyses generated

22

Yes (N=16) 80

No (N=4) 20Weekly (N=2) 125

Monthly (N=8) 500

Less than monthly but more

than 1-2 times(N=6) 375

Data Use

What is the main reason you do not run your own additional analyses (Select one best answer)

23

Not sure how to run analyses

25

Not sure what analyses are needed would be helpful 25

Other 50

Data Use

In the most recent calendar year what reports did you run

24

813 688

Pre-programmedautomated reports in thedata collection tool (eg GWTG)

Additional reports beyond pre-programmed reports from the tool

Data Use

How do you use these analyses reports

25

813 688375

Inform quality improvement (QI) efforts andor plan

ldquoaction itemsrdquo

Report to management administration on our

progress

Other

Data Use

If you run additional analysis what action items QI efforts did you plan as a result of these reports

26

o Discharge education intensive statin use

o Door to tPA time and dysphagia

o Review data between spoke amp hub hospitals regarding transfers IV-tPA administration Mechanical thrombectomy and SAH

o QI efforts were addressed in the department involving calling Stroke Alert on call for cases with FAST symptoms

o ED Medical Director works with team to fix fallouts and problematic areas We have seen improvement

o Process changes (ie fallout emails to RN manager) physician querieso Increased documentation of NIHSS ownership from individual units regarding stroke quality

improvement goalso Daily dysphagia screening determination of whowhat team responsible for documenting initial NIHSS

looking at patients beyond 2h LKW arrival

Hospital Arrival Mode Door-to Needle and Pre-Notification

Reports 2016

Percent of Cases Who Arrived via EMSMOSAIC 2009-2016

Table 1 Arrival Mode among Stroke Cases by Demographics MOSAIC 2016

Demographics N=3496 550 N=2938 450Stroke Type Ischemic 2558 542 2164 458 Hemorrhagic 560 728 209 272 TIA 378 478 413 522Age Group lt 50 Years 233 433 305 567 50-79 Years 1982 497 2008 503 ge 80 Years 1379 688 625 312Sex Female 1933 576 1422 424 Male 1661 523 1516 477Race Black 659 530 584 470 White 2824 557 2248 443 Other Missing 111 512 106 488

MOSAIC AggregateArrival Mode

EMS Private Mode

Table 2 Door-to-Needle Times by Arrival Mode among Stroke Cases MOSAIC 2016

Time Elements (in Minutes)Number of

Patients Mean (Minutes) Median

(Minutes)Range

(Minutes)Door-to-Image 4901 575 400 00-2700 Arrived via EMS 2767 463 270 00-2700 Arrived via Private Transportation 2134 720 570 00-2620

Door-to-Image (among t-PA treated) 492 155 130 00-970 Arrived via EMS 370 125 110 00-840 Arrived via Private Transportation 122 243 215 20-970Image-to Needle 492 500 450 70-2090 Arrived via EMS 370 503 460 70-2090 Arrived via Private Transportation 122 483 420 90-1770Door-to Needle 492 655 570 200-2180 Arrived via EMS 370 629 560 200-2180 Arrived via Private Transportation 122 726 650 290-2060Included ischemic or hemorrhagic cases with times that were less or equal to 270 minutes (45 hours)Transferred cases were excluded

MOSAIC Aggregate

Table 3 Pre-Notification among Stroke Cases Who Arrived Via EMS by Demographics MOSAIC 2016

Demographics N=2015 584 N=1437 416Stroke Type Ischemic 1523 622 924 378 Hemorrhagic 306 566 235 434 TIA 142 381 231 619Age Group lt 50 Years 133 607 86 393 50-79 Years 1105 585 784 415 ge 80 Years 777 578 567 422Sex Female 1075 578 786 422 Male 940 591 651 409Race Black 307 517 287 483 White 1657 602 1097 398 Other 51 490 53 510

All HospitalsPre-Notification

Yes No

MOSAIC Transitions of Care Project

Post-discharge data collection tool is being implemented into Outcome Science as a tab

Post-Discharge amp Transition of Care

Reporting on changes within 30 days of discharge from hospital via follow-up callschart review Interval events Physician follow-up visits Lifestyle changes Lab assessments Medication managementadherence Rehab amp Functional outcomes Falls

MOSAIC Website

wwwMichigangovstroke

Adrienne Nickles MPHnicklesamichigangov

Thank You

  • Michigan and MOSAIC Data Review
  • Overview
  • Age-adjusted Stroke Hospitalization Rates Michigan 2000-2015
  • Slide Number 4
  • Age-adjusted Stroke Mortality Rates Michigan 2000-2014
  • Slide Number 6
  • Slide Number 7
  • Slide Number 8
  • Slide Number 9
  • Slide Number 10
  • Slide Number 11
  • MOSAIC 2015-2020
  • Pre-hospital Care
  • EMSMOSAIC Data Linkage
  • Slide Number 15
  • GWTG Special Initiatives Tab
  • Slide Number 17
  • MOSAIC Participating Hospitals
  • Hospital Infrastructure
  • Case Demographics MOSAIC Registry
  • Who receives data reports on your stroke quality of care
  • 1) In the most recent calendar year have you run additional analyses (beyond what was required for reporting) on your hospitalrsquos own stroke data 2)How frequently have you run and used the analyses generated
  • What is the main reason you do not run your own additional analyses (Select one best answer)
  • In the most recent calendar year what reports did you run
  • How do you use these analyses reports
  • If you run additional analysis what action items QI efforts did you plan as a result of these reports
  • Hospital Arrival Mode Door-to Needle and Pre-Notification Reports 2016
  • Percent of Cases Who Arrived via EMSMOSAIC 2009-2016
  • Table 1 Arrival Mode among Stroke Cases by Demographics MOSAIC 2016
  • Table 2 Door-to-Needle Times by Arrival Mode among Stroke Cases MOSAIC 2016
  • Table 3 Pre-Notification among Stroke Cases Who Arrived Via EMS by Demographics MOSAIC 2016
  • MOSAIC Transitions of Care Project
  • Slide Number 33
  • MOSAIC Website
  • Adrienne Nickles MPHnicklesamichigangov
CVD
Year White Male Black Male White Female Black Female
2000 4276 5424 3033 4161
2001 4066 5524 2813 4091
2002 3928 5468 2767 4114
2003 3734 518 2638 3887
2004 3448 5079 2432 3643
2005 3366 4983 2375 3545
2006 3276 4994 2313 3477
2007 3236 4845 2223 327
2008 3158 4694 2238 3327
change 234 79 237 164
Heart Disease
Year White Male Black Male White Female Black Female
2000 3393 4298 227 3206
2001 3232 4445 2124 3166
2002 3118 4317 2197 3157
2003 2986 4184 1957 3001
2004 2777 3983 1783 2838
2005 2704 4009 1776 2679
2006 2644 3981 1739 2642
2007 2619 3972 1679 2532
2008 2566 3819 1687 2606
Stroke
Year White Male Black Male White Female Black Female
2000 61 768 561 703 176
2001 575 752 539 681 138
2002 573 806 528 66 15
2003 516 662 498 629 147
2004 463 743 476 562
2005 449 663 429 585
2006 434 63 411 556
2007 415 631 392 494
2008 402 606 392 509
2009 375 616 372 464
2010 372 565 366 513
2011 373 548 366 44
2012 348 587 349 477
2013 347 506 34 462
2014 369 506 352 482
Coronary Heart Disease
Year White Male Black Male White Female Black Female
2000 2625 329 1608 243
2001 2478 3356 1508 2314
2002 2404 3154 1419 2313
2003 2221 3093 1328 209
2004 2067 2956 119 1983
2005 1989 2885 117 1853
2006 1922 2903 1139 1825
2007 1921 2771 1074 1645
2008 1824 2592 1071 1722
Heart Failure
Year White Male Black Male White Female Black Female
2000 255 206 245 17
2001 267 225 225 167
2002 242 238 227 203
2003 256 217 222 189
2004 243 167 214 206
2005 24 218 217 172
2006 255 246 229 202
2007 23 225 208 196
2008 25 216 226 185
Not sure what this data is from previously HD Stroke
Year White Female Black Female White Female Black Female
2000 227 3206 561 703
2001 2124 3166 539 681
2002 2197 3157 528 66
2003 1957 3001 498 629
2004 1783 2838 476 562
2005 1776 2679 429 585
2006 1739 2642 411 556
2007
2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2009 2009 2009 2009
2010 2010 2010 2010
2011 2011 2011 2011
2012 2012 2012 2012
2013 2013 2013 2013
2014 2014 2014 2014
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
CVD
Year US Michigan 0-34 35-64 65-84 85+
2000 3397 3694 43 140 16141 86689
2001 3265 3524 508 1348 15291 82889
2002 3174 3421 45 1338 14891 79536
2003 3061 3258 54 1324 14033 75185
2004 2885 3034 41 1242 13209 69088
2005 2773 2972 48 1283 1291 66011
2006 2898 48 1207 12246 6786
2007 2825 5 1206 1182 66153
2008 2791 43 1175 11619 66406
Heart Disease
Year US Michigan 0-34 35-64 65-84 85+
2000 2576 2851 345 1158 1247 64879
2001 2478 2719 416 112 11794 61938
2002 2408 2631 35 1103 11529 58746
2003 2323 2517 45 110 10827 56172
2004 217 2337 313 1048 10086 51609
2005 2111 2308 38 1078 9937 49828
2006 226 384 1019 9413 51918
2007 2216 42 1008 9174 50961
2008 2192 36 982 904 51209
Stroke
Year US Michigan HP 2010 0-34 35-64 65-84 85+
2000 609 603 50 068 174 2589 15841
2001 579 577 50 0638 157 2522 1504
2002 562 571 50 072 169 2397 1528
2003 535 527 50 0737 157 2249 13741
2004 50 496 50 0652 138 220 12629
2005 466 464 50 0553 145 2063 11398
2006 444 50 0734 127 196 11256
2007 425 064 1368 1832 10718
2008 419 047 134 1804 10646
79 27 243 289
Coronary Heart Disease
Year US Michigan HP 2010 0-34 35-64 65-84 85+
2000 1868 2118 162 0613 874 7701 4670
2001 1778 2006 162 0898 818 9012 44369
2002 1709 192 162 0889 799 8759 41061
2003 1628 179 162 0793 785 8018 38358
2004 1502 1656 162 0865 757 7421 34644
2005 1444 1611 162 097 773 7245 32617
2006 1564 162 088 727 6856 33503
2007 1516 117 709 6585 32727
2008 1472 102 657 6403 32504
168 11 283
Heart Failure
Year US Michigan 35-64 65-84 85+
2000 203 245 3047 936 8287
2001 202 237 2596 88 8285
2002 194 233 2648 878 8057
2003 194 233 3176 902 7722
2004 189 224 2709 863 7586
2005 189 224 2955 878 7388
2006 24 2979 884 8354
2007 219 274 828 7483
2008 233 013 333 85 8102
Heart Disease Stroke
Michigan White Michigan Black US White US Black Michigan White Michigan Black US White US Black
1990 334 4315 317 3915 1990 638 733 629 917
1991 3289 4108 3088 3865 1991 626 781 607 894
1992 3126 3987 3011 3777 1992 609 694 598 86
1993 3234 429 3046 3843 1993 614 77 609 866
1994 3134 4156 295 3661 1994 634 875 609 869
1995 3048 4131 2912 3672 1995 638 925 615 879
1996 2997 380 2842 354 1996 617 804 61 852
1997 2851 3683 2764 345 1997 604 77 598 816
1998 2884 3586 2681 3406 1998 598 729 576 803
1999 2781 3692 2634 3367 1999 609 812 598 824
2000 2757 3663 2536 3265 2000 586 737 587 824
2001 261 3695 2435 3169 2001 56 718 558 788
2002 2522 3659 2367 3084 2002 553 729 542 763
2003 2409 350 2282 3002 2003 511 655 514 743
2004 222 3311 2133 2806 2004 477 633 48 699
2005 219 3227 2005 442 616
2006 2144 320 2006 426 589
2007 2007
2008 2008
CVD CHD HD HF Stroke
2000 3694 2118 2851 245 603
2001 3524 2006 2719 237 577
2002 3421 192 2631 233 571
2003 3258 179 2517 233 527
2004 3034 1656 2337 224 496
2005 2972 1611 2308 224 464
2006 2898 1564 226 24 444
2007 2825 1516 2216 219 425
2008 2791 1472 2192 233 419
Page 30: Michigan and MOSAIC Data Review...Michigan and MOSAIC Data Review 2017 ANNUAL WORKSHOP 4/26/2017. Adrienne Nickles, MPH. Michigan’s Ongoing Stroke Registry to Accelerate the Improvement

CVD_RG

White Male
Black Male
White Female
Black Female
Year
Age-Adjusted Rate per 100000
4276
5424
3033
4161
4066
5524
2813
4091
3928
5468
2767
4114
3734
518
2638
3887
3448
5079
2432
3643
3366
4983
2375
3545
3276
4994
2313
3477
3236
4845
2223
327
3158
4694
2238
3327

Stroke_RG

White Male
Black Male
White Female
Black Female
Year
Age-Adjusted Rate per 100000
61
768
561
703
575
752
539
681
573
806
528
66
516
662
498
629
463
743
476
562
449
663
429
585
434
63
411
556
415
631
392
494
402
606
392
509
375
616
372
464
372
565
366
513
373
548
366
44
348
587
349
477
347
506
34
462
369
506
352
482

HD_RG

White Male
Black Male
White Female
Black Female
Year
Age-Adjusted Rate per 100000
3393
4298
227
3206
3232
4445
2124
3166
3118
4317
2197
3157
2986
4184
1957
3001
2777
3983
1783
2838
2704
4009
1776
2679
2644
3981
1739
2642
2619
3972
1679
2532
2566
3819
1687
2606

CHD_RG

White Male
Black Male
White Female
Black Female
Year
Age-Adjusted Rate per 100000
2625
329
1608
243
2478
3356
1508
2314
2404
3154
1419
2313
2221
3093
1328
209
2067
2956
119
1983
1989
2885
117
1853
1922
2903
1139
1825
1921
2771
1074
1645
1824
2592
1071
1722

HF_RG

White Male
Black Male
White Female
Black Female
Year
Age-Adjusted Rate per 100000
255
206
245
17
267
225
225
167
242
238
227
203
256
217
222
189
243
167
214
206
24
218
217
172
255
246
229
202
23
225
208
196
25
216
226
185

race_gender

Sheet3

Local Health Department data can be found at wwwmichigangovbrfsSource CDC BRFSS

RISK FACTORMI

2011

MI

2013

MI

2014

MI

2015US 2015

2015 NATIONAL RANKING

Current Smoking 233 214 212 207 175 11

Blood Pressure Ever Told High 342 346 NA 331 309 18

Cholesterol Ever Told High 418 406 NA 382 364 12

Overweight (BMIgt25) 342 347 349 351 355 32tied

Obese (BMIgt30) 313 315 307 312 298 16

No Leisure Time Physical Activity 236 244 255 255 262 27

Diabetes 100 104 104 107 100 18tied

Prevalence of CVD Risk Factors Michigan Adults 1990-2015Compared to 2015 National Prevalence

233214 212 207

175

10

15

20

25

30

MI 2011 MI 2013 MI 2014 MI 2015 US 2015

Current Smoking

342 346331

309

20

25

30

35

40

MI 2011 MI 2013 MI 2014 MI 2015 US 2015

Blood Pressure Ever told high

342 347 349 351 355

20

25

30

35

40

MI 2011 MI 2013 MI 2014 MI 2015 US 2015

Overweight (BMIgt25)

313 315 307 312298

20

25

30

35

40

MI 2011 MI 2013 MI 2014 MI 2015 US 2015

Obese (BMIgt30)

418406

382364

30

35

40

45

50

MI 2011 MI 2013 MI 2014 MI 2015 US 2015

Cholesterol Ever told high

10 104 104 10710

0

3

6

9

12

15

MI 2011 MI 2013 MI 2014 MI 2015 US 2015

Diabetes

236 244255 255 262

10

15

20

25

30

MI 2011 MI 2013 MI 2014 MI 2015 US 2015

No Leisure Time Physical Activity

11 1216 18

2732tied

05

101520253035404550

CurrentSmoking

CholesterolEver told high

Obese(BMIgt30)

BloodPressure Ever

told high

Diabetes No LeisureTime Physical

Activity

Overweight(BMIgt25)

2015 NATIONAL RANKING(1st is worst)

18tied

MOSAIC 2015-2020 Focus of Grant Developing Stroke Systems of

Care Community Awareness EMS In-hospital QI Transition of Care Post-Discharge

12

Pre-hospital Care

A V A I L A B L E D A T A

13

EMSMOSAIC Data Linkage

-The MOSAIC Team continues to link data from the Michigan EMS Information System (MiEMSIS) to MOSAIC Data- Reports have been created for and reviewed by the

Tri-County Area MCA and Detroit East MCA- This work will expand to other MCA regions that

serve hospitals participating in MOSAIC

GWTG Special Initiatives Tab

-A free tab that can be enabled in GWTG-The purpose of the tab is to collect data concerning patient hand-off from EMS

MOSAIC Participating Hospitals

Aspirus Keweenaw Hospital (Laurium)

Aspirus Grand View HospitalAspirus Iron River HospitalAspirus Ontonagon HospitalBixby Medical CenterBronson Methodist HospitalCovenant Health CareDetroit Receiving HospitalGenesys Regional Medical CenterHenry Ford Hospital Herrick Medical CenterHuron Valley-Sinai HospitalLakeland Regional Medical Center McLaren Bay Regional Medical CenterMcLaren Greater Medical Center

McLaren Macomb HospitalMcLaren Northern MI HospitalMcLaren Oakland Medical CenterMcLaren Port Huron HospitalMcLaren Regional Medical CenterMercy Health Saint Maryrsquos HospitalMetro Health HospitalMunson Medical Center

ProMedica Monroe Regional HospitalSparrow HospitalSt Joseph Mercy - Ann ArborSt Joseph Mercy ChelseaSt Joseph Mercy Livingston HospitalSt Mary MercySt Mary of Michigan HospitalU of M Hospital

Hospital Infrastructure19

Among all participating hospitals the average number of

Licensed beds was 374 (range 25 to 1059 beds)

Inpatient discharges was 17076 (range 1064 to 48916 patients)

Acute stroke discharges (primary diagnosis only) was 417 (range 34 to 982 patients)

Case Demographics MOSAIC Registry

VariablesN() or statistics(Total N=68906)

Age at admission (years)Median 710Range 180 - 1060Mean (SE) 697(01)

GenderMale 32886 (477)Female 36015 (523)

RaceAfrican American 9900 (197)AIAN 132 (03)Asian 320 (06)More than one race 44 (01)Unknown 3679 (73)White 36190 (720)Missing 70

EthnicityHispanic or Latino 804 (16)Others 49531 (984)

VariablesN() or statistics(Total N=68906)

Health insuranceMedicaid 2284 (45)MedicaidPrivate 211 (04)Medicare 16863 (336)Medicare Medicaid 2313 (46)

MedicareMedicaidPrivate125 (02)

MedicarePrivate 13640 (272)ND 268(05)No insurance 2123 (42)Private 12356 (246)

Arrival modeEMS 21052 (429)Private

transportationother19313 (393)

Transfer from another hospital

7733(157)

ND or unknown 1021 (21)Missing 1216

Who receives data reports on your stroke quality of care

21

7055

70

10085

65

40

Hos

pita

lC

EO

up

per

man

agem

ent

Hos

pita

lB

oard

Chi

efN

ursi

ngO

ffice

r(C

NO

)

Str

oke

Tea

m

Phy

sici

anS

trok

eC

ham

pion

Chi

ef o

fM

edic

ine

Oth

er

Data Use

1) In the most recent calendar year have you run additional analyses (beyond what was required for reporting) on your hospitalrsquos own stroke data

2)How frequently have you run and used the analyses generated

22

Yes (N=16) 80

No (N=4) 20Weekly (N=2) 125

Monthly (N=8) 500

Less than monthly but more

than 1-2 times(N=6) 375

Data Use

What is the main reason you do not run your own additional analyses (Select one best answer)

23

Not sure how to run analyses

25

Not sure what analyses are needed would be helpful 25

Other 50

Data Use

In the most recent calendar year what reports did you run

24

813 688

Pre-programmedautomated reports in thedata collection tool (eg GWTG)

Additional reports beyond pre-programmed reports from the tool

Data Use

How do you use these analyses reports

25

813 688375

Inform quality improvement (QI) efforts andor plan

ldquoaction itemsrdquo

Report to management administration on our

progress

Other

Data Use

If you run additional analysis what action items QI efforts did you plan as a result of these reports

26

o Discharge education intensive statin use

o Door to tPA time and dysphagia

o Review data between spoke amp hub hospitals regarding transfers IV-tPA administration Mechanical thrombectomy and SAH

o QI efforts were addressed in the department involving calling Stroke Alert on call for cases with FAST symptoms

o ED Medical Director works with team to fix fallouts and problematic areas We have seen improvement

o Process changes (ie fallout emails to RN manager) physician querieso Increased documentation of NIHSS ownership from individual units regarding stroke quality

improvement goalso Daily dysphagia screening determination of whowhat team responsible for documenting initial NIHSS

looking at patients beyond 2h LKW arrival

Hospital Arrival Mode Door-to Needle and Pre-Notification

Reports 2016

Percent of Cases Who Arrived via EMSMOSAIC 2009-2016

Table 1 Arrival Mode among Stroke Cases by Demographics MOSAIC 2016

Demographics N=3496 550 N=2938 450Stroke Type Ischemic 2558 542 2164 458 Hemorrhagic 560 728 209 272 TIA 378 478 413 522Age Group lt 50 Years 233 433 305 567 50-79 Years 1982 497 2008 503 ge 80 Years 1379 688 625 312Sex Female 1933 576 1422 424 Male 1661 523 1516 477Race Black 659 530 584 470 White 2824 557 2248 443 Other Missing 111 512 106 488

MOSAIC AggregateArrival Mode

EMS Private Mode

Table 2 Door-to-Needle Times by Arrival Mode among Stroke Cases MOSAIC 2016

Time Elements (in Minutes)Number of

Patients Mean (Minutes) Median

(Minutes)Range

(Minutes)Door-to-Image 4901 575 400 00-2700 Arrived via EMS 2767 463 270 00-2700 Arrived via Private Transportation 2134 720 570 00-2620

Door-to-Image (among t-PA treated) 492 155 130 00-970 Arrived via EMS 370 125 110 00-840 Arrived via Private Transportation 122 243 215 20-970Image-to Needle 492 500 450 70-2090 Arrived via EMS 370 503 460 70-2090 Arrived via Private Transportation 122 483 420 90-1770Door-to Needle 492 655 570 200-2180 Arrived via EMS 370 629 560 200-2180 Arrived via Private Transportation 122 726 650 290-2060Included ischemic or hemorrhagic cases with times that were less or equal to 270 minutes (45 hours)Transferred cases were excluded

MOSAIC Aggregate

Table 3 Pre-Notification among Stroke Cases Who Arrived Via EMS by Demographics MOSAIC 2016

Demographics N=2015 584 N=1437 416Stroke Type Ischemic 1523 622 924 378 Hemorrhagic 306 566 235 434 TIA 142 381 231 619Age Group lt 50 Years 133 607 86 393 50-79 Years 1105 585 784 415 ge 80 Years 777 578 567 422Sex Female 1075 578 786 422 Male 940 591 651 409Race Black 307 517 287 483 White 1657 602 1097 398 Other 51 490 53 510

All HospitalsPre-Notification

Yes No

MOSAIC Transitions of Care Project

Post-discharge data collection tool is being implemented into Outcome Science as a tab

Post-Discharge amp Transition of Care

Reporting on changes within 30 days of discharge from hospital via follow-up callschart review Interval events Physician follow-up visits Lifestyle changes Lab assessments Medication managementadherence Rehab amp Functional outcomes Falls

MOSAIC Website

wwwMichigangovstroke

Adrienne Nickles MPHnicklesamichigangov

Thank You

  • Michigan and MOSAIC Data Review
  • Overview
  • Age-adjusted Stroke Hospitalization Rates Michigan 2000-2015
  • Slide Number 4
  • Age-adjusted Stroke Mortality Rates Michigan 2000-2014
  • Slide Number 6
  • Slide Number 7
  • Slide Number 8
  • Slide Number 9
  • Slide Number 10
  • Slide Number 11
  • MOSAIC 2015-2020
  • Pre-hospital Care
  • EMSMOSAIC Data Linkage
  • Slide Number 15
  • GWTG Special Initiatives Tab
  • Slide Number 17
  • MOSAIC Participating Hospitals
  • Hospital Infrastructure
  • Case Demographics MOSAIC Registry
  • Who receives data reports on your stroke quality of care
  • 1) In the most recent calendar year have you run additional analyses (beyond what was required for reporting) on your hospitalrsquos own stroke data 2)How frequently have you run and used the analyses generated
  • What is the main reason you do not run your own additional analyses (Select one best answer)
  • In the most recent calendar year what reports did you run
  • How do you use these analyses reports
  • If you run additional analysis what action items QI efforts did you plan as a result of these reports
  • Hospital Arrival Mode Door-to Needle and Pre-Notification Reports 2016
  • Percent of Cases Who Arrived via EMSMOSAIC 2009-2016
  • Table 1 Arrival Mode among Stroke Cases by Demographics MOSAIC 2016
  • Table 2 Door-to-Needle Times by Arrival Mode among Stroke Cases MOSAIC 2016
  • Table 3 Pre-Notification among Stroke Cases Who Arrived Via EMS by Demographics MOSAIC 2016
  • MOSAIC Transitions of Care Project
  • Slide Number 33
  • MOSAIC Website
  • Adrienne Nickles MPHnicklesamichigangov
CVD
Year White Male Black Male White Female Black Female
2000 4276 5424 3033 4161
2001 4066 5524 2813 4091
2002 3928 5468 2767 4114
2003 3734 518 2638 3887
2004 3448 5079 2432 3643
2005 3366 4983 2375 3545
2006 3276 4994 2313 3477
2007 3236 4845 2223 327
2008 3158 4694 2238 3327
change 234 79 237 164
Heart Disease
Year White Male Black Male White Female Black Female
2000 3393 4298 227 3206
2001 3232 4445 2124 3166
2002 3118 4317 2197 3157
2003 2986 4184 1957 3001
2004 2777 3983 1783 2838
2005 2704 4009 1776 2679
2006 2644 3981 1739 2642
2007 2619 3972 1679 2532
2008 2566 3819 1687 2606
Stroke
Year White Male Black Male White Female Black Female
2000 61 768 561 703 176
2001 575 752 539 681 138
2002 573 806 528 66 15
2003 516 662 498 629 147
2004 463 743 476 562
2005 449 663 429 585
2006 434 63 411 556
2007 415 631 392 494
2008 402 606 392 509
2009 375 616 372 464
2010 372 565 366 513
2011 373 548 366 44
2012 348 587 349 477
2013 347 506 34 462
2014 369 506 352 482
Coronary Heart Disease
Year White Male Black Male White Female Black Female
2000 2625 329 1608 243
2001 2478 3356 1508 2314
2002 2404 3154 1419 2313
2003 2221 3093 1328 209
2004 2067 2956 119 1983
2005 1989 2885 117 1853
2006 1922 2903 1139 1825
2007 1921 2771 1074 1645
2008 1824 2592 1071 1722
Heart Failure
Year White Male Black Male White Female Black Female
2000 255 206 245 17
2001 267 225 225 167
2002 242 238 227 203
2003 256 217 222 189
2004 243 167 214 206
2005 24 218 217 172
2006 255 246 229 202
2007 23 225 208 196
2008 25 216 226 185
Not sure what this data is from previously HD Stroke
Year White Female Black Female White Female Black Female
2000 227 3206 561 703
2001 2124 3166 539 681
2002 2197 3157 528 66
2003 1957 3001 498 629
2004 1783 2838 476 562
2005 1776 2679 429 585
2006 1739 2642 411 556
2007
2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2009 2009 2009 2009
2010 2010 2010 2010
2011 2011 2011 2011
2012 2012 2012 2012
2013 2013 2013 2013
2014 2014 2014 2014
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
Page 31: Michigan and MOSAIC Data Review...Michigan and MOSAIC Data Review 2017 ANNUAL WORKSHOP 4/26/2017. Adrienne Nickles, MPH. Michigan’s Ongoing Stroke Registry to Accelerate the Improvement

Stroke_RG

White Male
Black Male
White Female
Black Female
Year
Age-Adjusted Rate per 100000
61
768
561
703
575
752
539
681
573
806
528
66
516
662
498
629
463
743
476
562
449
663
429
585
434
63
411
556
415
631
392
494
402
606
392
509
375
616
372
464
372
565
366
513
373
548
366
44
348
587
349
477
347
506
34
462
369
506
352
482

HD_RG

White Male
Black Male
White Female
Black Female
Year
Age-Adjusted Rate per 100000
3393
4298
227
3206
3232
4445
2124
3166
3118
4317
2197
3157
2986
4184
1957
3001
2777
3983
1783
2838
2704
4009
1776
2679
2644
3981
1739
2642
2619
3972
1679
2532
2566
3819
1687
2606

CHD_RG

White Male
Black Male
White Female
Black Female
Year
Age-Adjusted Rate per 100000
2625
329
1608
243
2478
3356
1508
2314
2404
3154
1419
2313
2221
3093
1328
209
2067
2956
119
1983
1989
2885
117
1853
1922
2903
1139
1825
1921
2771
1074
1645
1824
2592
1071
1722

HF_RG

White Male
Black Male
White Female
Black Female
Year
Age-Adjusted Rate per 100000
255
206
245
17
267
225
225
167
242
238
227
203
256
217
222
189
243
167
214
206
24
218
217
172
255
246
229
202
23
225
208
196
25
216
226
185

race_gender

Sheet3

Local Health Department data can be found at wwwmichigangovbrfsSource CDC BRFSS

RISK FACTORMI

2011

MI

2013

MI

2014

MI

2015US 2015

2015 NATIONAL RANKING

Current Smoking 233 214 212 207 175 11

Blood Pressure Ever Told High 342 346 NA 331 309 18

Cholesterol Ever Told High 418 406 NA 382 364 12

Overweight (BMIgt25) 342 347 349 351 355 32tied

Obese (BMIgt30) 313 315 307 312 298 16

No Leisure Time Physical Activity 236 244 255 255 262 27

Diabetes 100 104 104 107 100 18tied

Prevalence of CVD Risk Factors Michigan Adults 1990-2015Compared to 2015 National Prevalence

233214 212 207

175

10

15

20

25

30

MI 2011 MI 2013 MI 2014 MI 2015 US 2015

Current Smoking

342 346331

309

20

25

30

35

40

MI 2011 MI 2013 MI 2014 MI 2015 US 2015

Blood Pressure Ever told high

342 347 349 351 355

20

25

30

35

40

MI 2011 MI 2013 MI 2014 MI 2015 US 2015

Overweight (BMIgt25)

313 315 307 312298

20

25

30

35

40

MI 2011 MI 2013 MI 2014 MI 2015 US 2015

Obese (BMIgt30)

418406

382364

30

35

40

45

50

MI 2011 MI 2013 MI 2014 MI 2015 US 2015

Cholesterol Ever told high

10 104 104 10710

0

3

6

9

12

15

MI 2011 MI 2013 MI 2014 MI 2015 US 2015

Diabetes

236 244255 255 262

10

15

20

25

30

MI 2011 MI 2013 MI 2014 MI 2015 US 2015

No Leisure Time Physical Activity

11 1216 18

2732tied

05

101520253035404550

CurrentSmoking

CholesterolEver told high

Obese(BMIgt30)

BloodPressure Ever

told high

Diabetes No LeisureTime Physical

Activity

Overweight(BMIgt25)

2015 NATIONAL RANKING(1st is worst)

18tied

MOSAIC 2015-2020 Focus of Grant Developing Stroke Systems of

Care Community Awareness EMS In-hospital QI Transition of Care Post-Discharge

12

Pre-hospital Care

A V A I L A B L E D A T A

13

EMSMOSAIC Data Linkage

-The MOSAIC Team continues to link data from the Michigan EMS Information System (MiEMSIS) to MOSAIC Data- Reports have been created for and reviewed by the

Tri-County Area MCA and Detroit East MCA- This work will expand to other MCA regions that

serve hospitals participating in MOSAIC

GWTG Special Initiatives Tab

-A free tab that can be enabled in GWTG-The purpose of the tab is to collect data concerning patient hand-off from EMS

MOSAIC Participating Hospitals

Aspirus Keweenaw Hospital (Laurium)

Aspirus Grand View HospitalAspirus Iron River HospitalAspirus Ontonagon HospitalBixby Medical CenterBronson Methodist HospitalCovenant Health CareDetroit Receiving HospitalGenesys Regional Medical CenterHenry Ford Hospital Herrick Medical CenterHuron Valley-Sinai HospitalLakeland Regional Medical Center McLaren Bay Regional Medical CenterMcLaren Greater Medical Center

McLaren Macomb HospitalMcLaren Northern MI HospitalMcLaren Oakland Medical CenterMcLaren Port Huron HospitalMcLaren Regional Medical CenterMercy Health Saint Maryrsquos HospitalMetro Health HospitalMunson Medical Center

ProMedica Monroe Regional HospitalSparrow HospitalSt Joseph Mercy - Ann ArborSt Joseph Mercy ChelseaSt Joseph Mercy Livingston HospitalSt Mary MercySt Mary of Michigan HospitalU of M Hospital

Hospital Infrastructure19

Among all participating hospitals the average number of

Licensed beds was 374 (range 25 to 1059 beds)

Inpatient discharges was 17076 (range 1064 to 48916 patients)

Acute stroke discharges (primary diagnosis only) was 417 (range 34 to 982 patients)

Case Demographics MOSAIC Registry

VariablesN() or statistics(Total N=68906)

Age at admission (years)Median 710Range 180 - 1060Mean (SE) 697(01)

GenderMale 32886 (477)Female 36015 (523)

RaceAfrican American 9900 (197)AIAN 132 (03)Asian 320 (06)More than one race 44 (01)Unknown 3679 (73)White 36190 (720)Missing 70

EthnicityHispanic or Latino 804 (16)Others 49531 (984)

VariablesN() or statistics(Total N=68906)

Health insuranceMedicaid 2284 (45)MedicaidPrivate 211 (04)Medicare 16863 (336)Medicare Medicaid 2313 (46)

MedicareMedicaidPrivate125 (02)

MedicarePrivate 13640 (272)ND 268(05)No insurance 2123 (42)Private 12356 (246)

Arrival modeEMS 21052 (429)Private

transportationother19313 (393)

Transfer from another hospital

7733(157)

ND or unknown 1021 (21)Missing 1216

Who receives data reports on your stroke quality of care

21

7055

70

10085

65

40

Hos

pita

lC

EO

up

per

man

agem

ent

Hos

pita

lB

oard

Chi

efN

ursi

ngO

ffice

r(C

NO

)

Str

oke

Tea

m

Phy

sici

anS

trok

eC

ham

pion

Chi

ef o

fM

edic

ine

Oth

er

Data Use

1) In the most recent calendar year have you run additional analyses (beyond what was required for reporting) on your hospitalrsquos own stroke data

2)How frequently have you run and used the analyses generated

22

Yes (N=16) 80

No (N=4) 20Weekly (N=2) 125

Monthly (N=8) 500

Less than monthly but more

than 1-2 times(N=6) 375

Data Use

What is the main reason you do not run your own additional analyses (Select one best answer)

23

Not sure how to run analyses

25

Not sure what analyses are needed would be helpful 25

Other 50

Data Use

In the most recent calendar year what reports did you run

24

813 688

Pre-programmedautomated reports in thedata collection tool (eg GWTG)

Additional reports beyond pre-programmed reports from the tool

Data Use

How do you use these analyses reports

25

813 688375

Inform quality improvement (QI) efforts andor plan

ldquoaction itemsrdquo

Report to management administration on our

progress

Other

Data Use

If you run additional analysis what action items QI efforts did you plan as a result of these reports

26

o Discharge education intensive statin use

o Door to tPA time and dysphagia

o Review data between spoke amp hub hospitals regarding transfers IV-tPA administration Mechanical thrombectomy and SAH

o QI efforts were addressed in the department involving calling Stroke Alert on call for cases with FAST symptoms

o ED Medical Director works with team to fix fallouts and problematic areas We have seen improvement

o Process changes (ie fallout emails to RN manager) physician querieso Increased documentation of NIHSS ownership from individual units regarding stroke quality

improvement goalso Daily dysphagia screening determination of whowhat team responsible for documenting initial NIHSS

looking at patients beyond 2h LKW arrival

Hospital Arrival Mode Door-to Needle and Pre-Notification

Reports 2016

Percent of Cases Who Arrived via EMSMOSAIC 2009-2016

Table 1 Arrival Mode among Stroke Cases by Demographics MOSAIC 2016

Demographics N=3496 550 N=2938 450Stroke Type Ischemic 2558 542 2164 458 Hemorrhagic 560 728 209 272 TIA 378 478 413 522Age Group lt 50 Years 233 433 305 567 50-79 Years 1982 497 2008 503 ge 80 Years 1379 688 625 312Sex Female 1933 576 1422 424 Male 1661 523 1516 477Race Black 659 530 584 470 White 2824 557 2248 443 Other Missing 111 512 106 488

MOSAIC AggregateArrival Mode

EMS Private Mode

Table 2 Door-to-Needle Times by Arrival Mode among Stroke Cases MOSAIC 2016

Time Elements (in Minutes)Number of

Patients Mean (Minutes) Median

(Minutes)Range

(Minutes)Door-to-Image 4901 575 400 00-2700 Arrived via EMS 2767 463 270 00-2700 Arrived via Private Transportation 2134 720 570 00-2620

Door-to-Image (among t-PA treated) 492 155 130 00-970 Arrived via EMS 370 125 110 00-840 Arrived via Private Transportation 122 243 215 20-970Image-to Needle 492 500 450 70-2090 Arrived via EMS 370 503 460 70-2090 Arrived via Private Transportation 122 483 420 90-1770Door-to Needle 492 655 570 200-2180 Arrived via EMS 370 629 560 200-2180 Arrived via Private Transportation 122 726 650 290-2060Included ischemic or hemorrhagic cases with times that were less or equal to 270 minutes (45 hours)Transferred cases were excluded

MOSAIC Aggregate

Table 3 Pre-Notification among Stroke Cases Who Arrived Via EMS by Demographics MOSAIC 2016

Demographics N=2015 584 N=1437 416Stroke Type Ischemic 1523 622 924 378 Hemorrhagic 306 566 235 434 TIA 142 381 231 619Age Group lt 50 Years 133 607 86 393 50-79 Years 1105 585 784 415 ge 80 Years 777 578 567 422Sex Female 1075 578 786 422 Male 940 591 651 409Race Black 307 517 287 483 White 1657 602 1097 398 Other 51 490 53 510

All HospitalsPre-Notification

Yes No

MOSAIC Transitions of Care Project

Post-discharge data collection tool is being implemented into Outcome Science as a tab

Post-Discharge amp Transition of Care

Reporting on changes within 30 days of discharge from hospital via follow-up callschart review Interval events Physician follow-up visits Lifestyle changes Lab assessments Medication managementadherence Rehab amp Functional outcomes Falls

MOSAIC Website

wwwMichigangovstroke

Adrienne Nickles MPHnicklesamichigangov

Thank You

  • Michigan and MOSAIC Data Review
  • Overview
  • Age-adjusted Stroke Hospitalization Rates Michigan 2000-2015
  • Slide Number 4
  • Age-adjusted Stroke Mortality Rates Michigan 2000-2014
  • Slide Number 6
  • Slide Number 7
  • Slide Number 8
  • Slide Number 9
  • Slide Number 10
  • Slide Number 11
  • MOSAIC 2015-2020
  • Pre-hospital Care
  • EMSMOSAIC Data Linkage
  • Slide Number 15
  • GWTG Special Initiatives Tab
  • Slide Number 17
  • MOSAIC Participating Hospitals
  • Hospital Infrastructure
  • Case Demographics MOSAIC Registry
  • Who receives data reports on your stroke quality of care
  • 1) In the most recent calendar year have you run additional analyses (beyond what was required for reporting) on your hospitalrsquos own stroke data 2)How frequently have you run and used the analyses generated
  • What is the main reason you do not run your own additional analyses (Select one best answer)
  • In the most recent calendar year what reports did you run
  • How do you use these analyses reports
  • If you run additional analysis what action items QI efforts did you plan as a result of these reports
  • Hospital Arrival Mode Door-to Needle and Pre-Notification Reports 2016
  • Percent of Cases Who Arrived via EMSMOSAIC 2009-2016
  • Table 1 Arrival Mode among Stroke Cases by Demographics MOSAIC 2016
  • Table 2 Door-to-Needle Times by Arrival Mode among Stroke Cases MOSAIC 2016
  • Table 3 Pre-Notification among Stroke Cases Who Arrived Via EMS by Demographics MOSAIC 2016
  • MOSAIC Transitions of Care Project
  • Slide Number 33
  • MOSAIC Website
  • Adrienne Nickles MPHnicklesamichigangov
CVD
Year White Male Black Male White Female Black Female
2000 4276 5424 3033 4161
2001 4066 5524 2813 4091
2002 3928 5468 2767 4114
2003 3734 518 2638 3887
2004 3448 5079 2432 3643
2005 3366 4983 2375 3545
2006 3276 4994 2313 3477
2007 3236 4845 2223 327
2008 3158 4694 2238 3327
change 234 79 237 164
Heart Disease
Year White Male Black Male White Female Black Female
2000 3393 4298 227 3206
2001 3232 4445 2124 3166
2002 3118 4317 2197 3157
2003 2986 4184 1957 3001
2004 2777 3983 1783 2838
2005 2704 4009 1776 2679
2006 2644 3981 1739 2642
2007 2619 3972 1679 2532
2008 2566 3819 1687 2606
Stroke
Year White Male Black Male White Female Black Female
2000 61 768 561 703 176
2001 575 752 539 681 138
2002 573 806 528 66 15
2003 516 662 498 629 147
2004 463 743 476 562
2005 449 663 429 585
2006 434 63 411 556
2007 415 631 392 494
2008 402 606 392 509
2009 375 616 372 464
2010 372 565 366 513
2011 373 548 366 44
2012 348 587 349 477
2013 347 506 34 462
2014 369 506 352 482
Coronary Heart Disease
Year White Male Black Male White Female Black Female
2000 2625 329 1608 243
2001 2478 3356 1508 2314
2002 2404 3154 1419 2313
2003 2221 3093 1328 209
2004 2067 2956 119 1983
2005 1989 2885 117 1853
2006 1922 2903 1139 1825
2007 1921 2771 1074 1645
2008 1824 2592 1071 1722
Heart Failure
Year White Male Black Male White Female Black Female
2000 255 206 245 17
2001 267 225 225 167
2002 242 238 227 203
2003 256 217 222 189
2004 243 167 214 206
2005 24 218 217 172
2006 255 246 229 202
2007 23 225 208 196
2008 25 216 226 185
Not sure what this data is from previously HD Stroke
Year White Female Black Female White Female Black Female
2000 227 3206 561 703
2001 2124 3166 539 681
2002 2197 3157 528 66
2003 1957 3001 498 629
2004 1783 2838 476 562
2005 1776 2679 429 585
2006 1739 2642 411 556
2007
2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2009 2009 2009 2009
2010 2010 2010 2010
2011 2011 2011 2011
2012 2012 2012 2012
2013 2013 2013 2013
2014 2014 2014 2014
Page 32: Michigan and MOSAIC Data Review...Michigan and MOSAIC Data Review 2017 ANNUAL WORKSHOP 4/26/2017. Adrienne Nickles, MPH. Michigan’s Ongoing Stroke Registry to Accelerate the Improvement

HD_RG

White Male
Black Male
White Female
Black Female
Year
Age-Adjusted Rate per 100000
3393
4298
227
3206
3232
4445
2124
3166
3118
4317
2197
3157
2986
4184
1957
3001
2777
3983
1783
2838
2704
4009
1776
2679
2644
3981
1739
2642
2619
3972
1679
2532
2566
3819
1687
2606

CHD_RG

White Male
Black Male
White Female
Black Female
Year
Age-Adjusted Rate per 100000
2625
329
1608
243
2478
3356
1508
2314
2404
3154
1419
2313
2221
3093
1328
209
2067
2956
119
1983
1989
2885
117
1853
1922
2903
1139
1825
1921
2771
1074
1645
1824
2592
1071
1722

HF_RG

White Male
Black Male
White Female
Black Female
Year
Age-Adjusted Rate per 100000
255
206
245
17
267
225
225
167
242
238
227
203
256
217
222
189
243
167
214
206
24
218
217
172
255
246
229
202
23
225
208
196
25
216
226
185

race_gender

Sheet3

Local Health Department data can be found at wwwmichigangovbrfsSource CDC BRFSS

RISK FACTORMI

2011

MI

2013

MI

2014

MI

2015US 2015

2015 NATIONAL RANKING

Current Smoking 233 214 212 207 175 11

Blood Pressure Ever Told High 342 346 NA 331 309 18

Cholesterol Ever Told High 418 406 NA 382 364 12

Overweight (BMIgt25) 342 347 349 351 355 32tied

Obese (BMIgt30) 313 315 307 312 298 16

No Leisure Time Physical Activity 236 244 255 255 262 27

Diabetes 100 104 104 107 100 18tied

Prevalence of CVD Risk Factors Michigan Adults 1990-2015Compared to 2015 National Prevalence

233214 212 207

175

10

15

20

25

30

MI 2011 MI 2013 MI 2014 MI 2015 US 2015

Current Smoking

342 346331

309

20

25

30

35

40

MI 2011 MI 2013 MI 2014 MI 2015 US 2015

Blood Pressure Ever told high

342 347 349 351 355

20

25

30

35

40

MI 2011 MI 2013 MI 2014 MI 2015 US 2015

Overweight (BMIgt25)

313 315 307 312298

20

25

30

35

40

MI 2011 MI 2013 MI 2014 MI 2015 US 2015

Obese (BMIgt30)

418406

382364

30

35

40

45

50

MI 2011 MI 2013 MI 2014 MI 2015 US 2015

Cholesterol Ever told high

10 104 104 10710

0

3

6

9

12

15

MI 2011 MI 2013 MI 2014 MI 2015 US 2015

Diabetes

236 244255 255 262

10

15

20

25

30

MI 2011 MI 2013 MI 2014 MI 2015 US 2015

No Leisure Time Physical Activity

11 1216 18

2732tied

05

101520253035404550

CurrentSmoking

CholesterolEver told high

Obese(BMIgt30)

BloodPressure Ever

told high

Diabetes No LeisureTime Physical

Activity

Overweight(BMIgt25)

2015 NATIONAL RANKING(1st is worst)

18tied

MOSAIC 2015-2020 Focus of Grant Developing Stroke Systems of

Care Community Awareness EMS In-hospital QI Transition of Care Post-Discharge

12

Pre-hospital Care

A V A I L A B L E D A T A

13

EMSMOSAIC Data Linkage

-The MOSAIC Team continues to link data from the Michigan EMS Information System (MiEMSIS) to MOSAIC Data- Reports have been created for and reviewed by the

Tri-County Area MCA and Detroit East MCA- This work will expand to other MCA regions that

serve hospitals participating in MOSAIC

GWTG Special Initiatives Tab

-A free tab that can be enabled in GWTG-The purpose of the tab is to collect data concerning patient hand-off from EMS

MOSAIC Participating Hospitals

Aspirus Keweenaw Hospital (Laurium)

Aspirus Grand View HospitalAspirus Iron River HospitalAspirus Ontonagon HospitalBixby Medical CenterBronson Methodist HospitalCovenant Health CareDetroit Receiving HospitalGenesys Regional Medical CenterHenry Ford Hospital Herrick Medical CenterHuron Valley-Sinai HospitalLakeland Regional Medical Center McLaren Bay Regional Medical CenterMcLaren Greater Medical Center

McLaren Macomb HospitalMcLaren Northern MI HospitalMcLaren Oakland Medical CenterMcLaren Port Huron HospitalMcLaren Regional Medical CenterMercy Health Saint Maryrsquos HospitalMetro Health HospitalMunson Medical Center

ProMedica Monroe Regional HospitalSparrow HospitalSt Joseph Mercy - Ann ArborSt Joseph Mercy ChelseaSt Joseph Mercy Livingston HospitalSt Mary MercySt Mary of Michigan HospitalU of M Hospital

Hospital Infrastructure19

Among all participating hospitals the average number of

Licensed beds was 374 (range 25 to 1059 beds)

Inpatient discharges was 17076 (range 1064 to 48916 patients)

Acute stroke discharges (primary diagnosis only) was 417 (range 34 to 982 patients)

Case Demographics MOSAIC Registry

VariablesN() or statistics(Total N=68906)

Age at admission (years)Median 710Range 180 - 1060Mean (SE) 697(01)

GenderMale 32886 (477)Female 36015 (523)

RaceAfrican American 9900 (197)AIAN 132 (03)Asian 320 (06)More than one race 44 (01)Unknown 3679 (73)White 36190 (720)Missing 70

EthnicityHispanic or Latino 804 (16)Others 49531 (984)

VariablesN() or statistics(Total N=68906)

Health insuranceMedicaid 2284 (45)MedicaidPrivate 211 (04)Medicare 16863 (336)Medicare Medicaid 2313 (46)

MedicareMedicaidPrivate125 (02)

MedicarePrivate 13640 (272)ND 268(05)No insurance 2123 (42)Private 12356 (246)

Arrival modeEMS 21052 (429)Private

transportationother19313 (393)

Transfer from another hospital

7733(157)

ND or unknown 1021 (21)Missing 1216

Who receives data reports on your stroke quality of care

21

7055

70

10085

65

40

Hos

pita

lC

EO

up

per

man

agem

ent

Hos

pita

lB

oard

Chi

efN

ursi

ngO

ffice

r(C

NO

)

Str

oke

Tea

m

Phy

sici

anS

trok

eC

ham

pion

Chi

ef o

fM

edic

ine

Oth

er

Data Use

1) In the most recent calendar year have you run additional analyses (beyond what was required for reporting) on your hospitalrsquos own stroke data

2)How frequently have you run and used the analyses generated

22

Yes (N=16) 80

No (N=4) 20Weekly (N=2) 125

Monthly (N=8) 500

Less than monthly but more

than 1-2 times(N=6) 375

Data Use

What is the main reason you do not run your own additional analyses (Select one best answer)

23

Not sure how to run analyses

25

Not sure what analyses are needed would be helpful 25

Other 50

Data Use

In the most recent calendar year what reports did you run

24

813 688

Pre-programmedautomated reports in thedata collection tool (eg GWTG)

Additional reports beyond pre-programmed reports from the tool

Data Use

How do you use these analyses reports

25

813 688375

Inform quality improvement (QI) efforts andor plan

ldquoaction itemsrdquo

Report to management administration on our

progress

Other

Data Use

If you run additional analysis what action items QI efforts did you plan as a result of these reports

26

o Discharge education intensive statin use

o Door to tPA time and dysphagia

o Review data between spoke amp hub hospitals regarding transfers IV-tPA administration Mechanical thrombectomy and SAH

o QI efforts were addressed in the department involving calling Stroke Alert on call for cases with FAST symptoms

o ED Medical Director works with team to fix fallouts and problematic areas We have seen improvement

o Process changes (ie fallout emails to RN manager) physician querieso Increased documentation of NIHSS ownership from individual units regarding stroke quality

improvement goalso Daily dysphagia screening determination of whowhat team responsible for documenting initial NIHSS

looking at patients beyond 2h LKW arrival

Hospital Arrival Mode Door-to Needle and Pre-Notification

Reports 2016

Percent of Cases Who Arrived via EMSMOSAIC 2009-2016

Table 1 Arrival Mode among Stroke Cases by Demographics MOSAIC 2016

Demographics N=3496 550 N=2938 450Stroke Type Ischemic 2558 542 2164 458 Hemorrhagic 560 728 209 272 TIA 378 478 413 522Age Group lt 50 Years 233 433 305 567 50-79 Years 1982 497 2008 503 ge 80 Years 1379 688 625 312Sex Female 1933 576 1422 424 Male 1661 523 1516 477Race Black 659 530 584 470 White 2824 557 2248 443 Other Missing 111 512 106 488

MOSAIC AggregateArrival Mode

EMS Private Mode

Table 2 Door-to-Needle Times by Arrival Mode among Stroke Cases MOSAIC 2016

Time Elements (in Minutes)Number of

Patients Mean (Minutes) Median

(Minutes)Range

(Minutes)Door-to-Image 4901 575 400 00-2700 Arrived via EMS 2767 463 270 00-2700 Arrived via Private Transportation 2134 720 570 00-2620

Door-to-Image (among t-PA treated) 492 155 130 00-970 Arrived via EMS 370 125 110 00-840 Arrived via Private Transportation 122 243 215 20-970Image-to Needle 492 500 450 70-2090 Arrived via EMS 370 503 460 70-2090 Arrived via Private Transportation 122 483 420 90-1770Door-to Needle 492 655 570 200-2180 Arrived via EMS 370 629 560 200-2180 Arrived via Private Transportation 122 726 650 290-2060Included ischemic or hemorrhagic cases with times that were less or equal to 270 minutes (45 hours)Transferred cases were excluded

MOSAIC Aggregate

Table 3 Pre-Notification among Stroke Cases Who Arrived Via EMS by Demographics MOSAIC 2016

Demographics N=2015 584 N=1437 416Stroke Type Ischemic 1523 622 924 378 Hemorrhagic 306 566 235 434 TIA 142 381 231 619Age Group lt 50 Years 133 607 86 393 50-79 Years 1105 585 784 415 ge 80 Years 777 578 567 422Sex Female 1075 578 786 422 Male 940 591 651 409Race Black 307 517 287 483 White 1657 602 1097 398 Other 51 490 53 510

All HospitalsPre-Notification

Yes No

MOSAIC Transitions of Care Project

Post-discharge data collection tool is being implemented into Outcome Science as a tab

Post-Discharge amp Transition of Care

Reporting on changes within 30 days of discharge from hospital via follow-up callschart review Interval events Physician follow-up visits Lifestyle changes Lab assessments Medication managementadherence Rehab amp Functional outcomes Falls

MOSAIC Website

wwwMichigangovstroke

Adrienne Nickles MPHnicklesamichigangov

Thank You

  • Michigan and MOSAIC Data Review
  • Overview
  • Age-adjusted Stroke Hospitalization Rates Michigan 2000-2015
  • Slide Number 4
  • Age-adjusted Stroke Mortality Rates Michigan 2000-2014
  • Slide Number 6
  • Slide Number 7
  • Slide Number 8
  • Slide Number 9
  • Slide Number 10
  • Slide Number 11
  • MOSAIC 2015-2020
  • Pre-hospital Care
  • EMSMOSAIC Data Linkage
  • Slide Number 15
  • GWTG Special Initiatives Tab
  • Slide Number 17
  • MOSAIC Participating Hospitals
  • Hospital Infrastructure
  • Case Demographics MOSAIC Registry
  • Who receives data reports on your stroke quality of care
  • 1) In the most recent calendar year have you run additional analyses (beyond what was required for reporting) on your hospitalrsquos own stroke data 2)How frequently have you run and used the analyses generated
  • What is the main reason you do not run your own additional analyses (Select one best answer)
  • In the most recent calendar year what reports did you run
  • How do you use these analyses reports
  • If you run additional analysis what action items QI efforts did you plan as a result of these reports
  • Hospital Arrival Mode Door-to Needle and Pre-Notification Reports 2016
  • Percent of Cases Who Arrived via EMSMOSAIC 2009-2016
  • Table 1 Arrival Mode among Stroke Cases by Demographics MOSAIC 2016
  • Table 2 Door-to-Needle Times by Arrival Mode among Stroke Cases MOSAIC 2016
  • Table 3 Pre-Notification among Stroke Cases Who Arrived Via EMS by Demographics MOSAIC 2016
  • MOSAIC Transitions of Care Project
  • Slide Number 33
  • MOSAIC Website
  • Adrienne Nickles MPHnicklesamichigangov
CVD
Year White Male Black Male White Female Black Female
2000 4276 5424 3033 4161
2001 4066 5524 2813 4091
2002 3928 5468 2767 4114
2003 3734 518 2638 3887
2004 3448 5079 2432 3643
2005 3366 4983 2375 3545
2006 3276 4994 2313 3477
2007 3236 4845 2223 327
2008 3158 4694 2238 3327
change 234 79 237 164
Heart Disease
Year White Male Black Male White Female Black Female
2000 3393 4298 227 3206
2001 3232 4445 2124 3166
2002 3118 4317 2197 3157
2003 2986 4184 1957 3001
2004 2777 3983 1783 2838
2005 2704 4009 1776 2679
2006 2644 3981 1739 2642
2007 2619 3972 1679 2532
2008 2566 3819 1687 2606
Stroke
Year White Male Black Male White Female Black Female
2000 61 768 561 703 176
2001 575 752 539 681 138
2002 573 806 528 66 15
2003 516 662 498 629 147
2004 463 743 476 562
2005 449 663 429 585
2006 434 63 411 556
2007 415 631 392 494
2008 402 606 392 509
2009 375 616 372 464
2010 372 565 366 513
2011 373 548 366 44
2012 348 587 349 477
2013 347 506 34 462
2014 369 506 352 482
Coronary Heart Disease
Year White Male Black Male White Female Black Female
2000 2625 329 1608 243
2001 2478 3356 1508 2314
2002 2404 3154 1419 2313
2003 2221 3093 1328 209
2004 2067 2956 119 1983
2005 1989 2885 117 1853
2006 1922 2903 1139 1825
2007 1921 2771 1074 1645
2008 1824 2592 1071 1722
Heart Failure
Year White Male Black Male White Female Black Female
2000 255 206 245 17
2001 267 225 225 167
2002 242 238 227 203
2003 256 217 222 189
2004 243 167 214 206
2005 24 218 217 172
2006 255 246 229 202
2007 23 225 208 196
2008 25 216 226 185
Not sure what this data is from previously HD Stroke
Year White Female Black Female White Female Black Female
2000 227 3206 561 703
2001 2124 3166 539 681
2002 2197 3157 528 66
2003 1957 3001 498 629
2004 1783 2838 476 562
2005 1776 2679 429 585
2006 1739 2642 411 556
2007
2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
Page 33: Michigan and MOSAIC Data Review...Michigan and MOSAIC Data Review 2017 ANNUAL WORKSHOP 4/26/2017. Adrienne Nickles, MPH. Michigan’s Ongoing Stroke Registry to Accelerate the Improvement

CHD_RG

White Male
Black Male
White Female
Black Female
Year
Age-Adjusted Rate per 100000
2625
329
1608
243
2478
3356
1508
2314
2404
3154
1419
2313
2221
3093
1328
209
2067
2956
119
1983
1989
2885
117
1853
1922
2903
1139
1825
1921
2771
1074
1645
1824
2592
1071
1722

HF_RG

White Male
Black Male
White Female
Black Female
Year
Age-Adjusted Rate per 100000
255
206
245
17
267
225
225
167
242
238
227
203
256
217
222
189
243
167
214
206
24
218
217
172
255
246
229
202
23
225
208
196
25
216
226
185

race_gender

Sheet3

Local Health Department data can be found at wwwmichigangovbrfsSource CDC BRFSS

RISK FACTORMI

2011

MI

2013

MI

2014

MI

2015US 2015

2015 NATIONAL RANKING

Current Smoking 233 214 212 207 175 11

Blood Pressure Ever Told High 342 346 NA 331 309 18

Cholesterol Ever Told High 418 406 NA 382 364 12

Overweight (BMIgt25) 342 347 349 351 355 32tied

Obese (BMIgt30) 313 315 307 312 298 16

No Leisure Time Physical Activity 236 244 255 255 262 27

Diabetes 100 104 104 107 100 18tied

Prevalence of CVD Risk Factors Michigan Adults 1990-2015Compared to 2015 National Prevalence

233214 212 207

175

10

15

20

25

30

MI 2011 MI 2013 MI 2014 MI 2015 US 2015

Current Smoking

342 346331

309

20

25

30

35

40

MI 2011 MI 2013 MI 2014 MI 2015 US 2015

Blood Pressure Ever told high

342 347 349 351 355

20

25

30

35

40

MI 2011 MI 2013 MI 2014 MI 2015 US 2015

Overweight (BMIgt25)

313 315 307 312298

20

25

30

35

40

MI 2011 MI 2013 MI 2014 MI 2015 US 2015

Obese (BMIgt30)

418406

382364

30

35

40

45

50

MI 2011 MI 2013 MI 2014 MI 2015 US 2015

Cholesterol Ever told high

10 104 104 10710

0

3

6

9

12

15

MI 2011 MI 2013 MI 2014 MI 2015 US 2015

Diabetes

236 244255 255 262

10

15

20

25

30

MI 2011 MI 2013 MI 2014 MI 2015 US 2015

No Leisure Time Physical Activity

11 1216 18

2732tied

05

101520253035404550

CurrentSmoking

CholesterolEver told high

Obese(BMIgt30)

BloodPressure Ever

told high

Diabetes No LeisureTime Physical

Activity

Overweight(BMIgt25)

2015 NATIONAL RANKING(1st is worst)

18tied

MOSAIC 2015-2020 Focus of Grant Developing Stroke Systems of

Care Community Awareness EMS In-hospital QI Transition of Care Post-Discharge

12

Pre-hospital Care

A V A I L A B L E D A T A

13

EMSMOSAIC Data Linkage

-The MOSAIC Team continues to link data from the Michigan EMS Information System (MiEMSIS) to MOSAIC Data- Reports have been created for and reviewed by the

Tri-County Area MCA and Detroit East MCA- This work will expand to other MCA regions that

serve hospitals participating in MOSAIC

GWTG Special Initiatives Tab

-A free tab that can be enabled in GWTG-The purpose of the tab is to collect data concerning patient hand-off from EMS

MOSAIC Participating Hospitals

Aspirus Keweenaw Hospital (Laurium)

Aspirus Grand View HospitalAspirus Iron River HospitalAspirus Ontonagon HospitalBixby Medical CenterBronson Methodist HospitalCovenant Health CareDetroit Receiving HospitalGenesys Regional Medical CenterHenry Ford Hospital Herrick Medical CenterHuron Valley-Sinai HospitalLakeland Regional Medical Center McLaren Bay Regional Medical CenterMcLaren Greater Medical Center

McLaren Macomb HospitalMcLaren Northern MI HospitalMcLaren Oakland Medical CenterMcLaren Port Huron HospitalMcLaren Regional Medical CenterMercy Health Saint Maryrsquos HospitalMetro Health HospitalMunson Medical Center

ProMedica Monroe Regional HospitalSparrow HospitalSt Joseph Mercy - Ann ArborSt Joseph Mercy ChelseaSt Joseph Mercy Livingston HospitalSt Mary MercySt Mary of Michigan HospitalU of M Hospital

Hospital Infrastructure19

Among all participating hospitals the average number of

Licensed beds was 374 (range 25 to 1059 beds)

Inpatient discharges was 17076 (range 1064 to 48916 patients)

Acute stroke discharges (primary diagnosis only) was 417 (range 34 to 982 patients)

Case Demographics MOSAIC Registry

VariablesN() or statistics(Total N=68906)

Age at admission (years)Median 710Range 180 - 1060Mean (SE) 697(01)

GenderMale 32886 (477)Female 36015 (523)

RaceAfrican American 9900 (197)AIAN 132 (03)Asian 320 (06)More than one race 44 (01)Unknown 3679 (73)White 36190 (720)Missing 70

EthnicityHispanic or Latino 804 (16)Others 49531 (984)

VariablesN() or statistics(Total N=68906)

Health insuranceMedicaid 2284 (45)MedicaidPrivate 211 (04)Medicare 16863 (336)Medicare Medicaid 2313 (46)

MedicareMedicaidPrivate125 (02)

MedicarePrivate 13640 (272)ND 268(05)No insurance 2123 (42)Private 12356 (246)

Arrival modeEMS 21052 (429)Private

transportationother19313 (393)

Transfer from another hospital

7733(157)

ND or unknown 1021 (21)Missing 1216

Who receives data reports on your stroke quality of care

21

7055

70

10085

65

40

Hos

pita

lC

EO

up

per

man

agem

ent

Hos

pita

lB

oard

Chi

efN

ursi

ngO

ffice

r(C

NO

)

Str

oke

Tea

m

Phy

sici

anS

trok

eC

ham

pion

Chi

ef o

fM

edic

ine

Oth

er

Data Use

1) In the most recent calendar year have you run additional analyses (beyond what was required for reporting) on your hospitalrsquos own stroke data

2)How frequently have you run and used the analyses generated

22

Yes (N=16) 80

No (N=4) 20Weekly (N=2) 125

Monthly (N=8) 500

Less than monthly but more

than 1-2 times(N=6) 375

Data Use

What is the main reason you do not run your own additional analyses (Select one best answer)

23

Not sure how to run analyses

25

Not sure what analyses are needed would be helpful 25

Other 50

Data Use

In the most recent calendar year what reports did you run

24

813 688

Pre-programmedautomated reports in thedata collection tool (eg GWTG)

Additional reports beyond pre-programmed reports from the tool

Data Use

How do you use these analyses reports

25

813 688375

Inform quality improvement (QI) efforts andor plan

ldquoaction itemsrdquo

Report to management administration on our

progress

Other

Data Use

If you run additional analysis what action items QI efforts did you plan as a result of these reports

26

o Discharge education intensive statin use

o Door to tPA time and dysphagia

o Review data between spoke amp hub hospitals regarding transfers IV-tPA administration Mechanical thrombectomy and SAH

o QI efforts were addressed in the department involving calling Stroke Alert on call for cases with FAST symptoms

o ED Medical Director works with team to fix fallouts and problematic areas We have seen improvement

o Process changes (ie fallout emails to RN manager) physician querieso Increased documentation of NIHSS ownership from individual units regarding stroke quality

improvement goalso Daily dysphagia screening determination of whowhat team responsible for documenting initial NIHSS

looking at patients beyond 2h LKW arrival

Hospital Arrival Mode Door-to Needle and Pre-Notification

Reports 2016

Percent of Cases Who Arrived via EMSMOSAIC 2009-2016

Table 1 Arrival Mode among Stroke Cases by Demographics MOSAIC 2016

Demographics N=3496 550 N=2938 450Stroke Type Ischemic 2558 542 2164 458 Hemorrhagic 560 728 209 272 TIA 378 478 413 522Age Group lt 50 Years 233 433 305 567 50-79 Years 1982 497 2008 503 ge 80 Years 1379 688 625 312Sex Female 1933 576 1422 424 Male 1661 523 1516 477Race Black 659 530 584 470 White 2824 557 2248 443 Other Missing 111 512 106 488

MOSAIC AggregateArrival Mode

EMS Private Mode

Table 2 Door-to-Needle Times by Arrival Mode among Stroke Cases MOSAIC 2016

Time Elements (in Minutes)Number of

Patients Mean (Minutes) Median

(Minutes)Range

(Minutes)Door-to-Image 4901 575 400 00-2700 Arrived via EMS 2767 463 270 00-2700 Arrived via Private Transportation 2134 720 570 00-2620

Door-to-Image (among t-PA treated) 492 155 130 00-970 Arrived via EMS 370 125 110 00-840 Arrived via Private Transportation 122 243 215 20-970Image-to Needle 492 500 450 70-2090 Arrived via EMS 370 503 460 70-2090 Arrived via Private Transportation 122 483 420 90-1770Door-to Needle 492 655 570 200-2180 Arrived via EMS 370 629 560 200-2180 Arrived via Private Transportation 122 726 650 290-2060Included ischemic or hemorrhagic cases with times that were less or equal to 270 minutes (45 hours)Transferred cases were excluded

MOSAIC Aggregate

Table 3 Pre-Notification among Stroke Cases Who Arrived Via EMS by Demographics MOSAIC 2016

Demographics N=2015 584 N=1437 416Stroke Type Ischemic 1523 622 924 378 Hemorrhagic 306 566 235 434 TIA 142 381 231 619Age Group lt 50 Years 133 607 86 393 50-79 Years 1105 585 784 415 ge 80 Years 777 578 567 422Sex Female 1075 578 786 422 Male 940 591 651 409Race Black 307 517 287 483 White 1657 602 1097 398 Other 51 490 53 510

All HospitalsPre-Notification

Yes No

MOSAIC Transitions of Care Project

Post-discharge data collection tool is being implemented into Outcome Science as a tab

Post-Discharge amp Transition of Care

Reporting on changes within 30 days of discharge from hospital via follow-up callschart review Interval events Physician follow-up visits Lifestyle changes Lab assessments Medication managementadherence Rehab amp Functional outcomes Falls

MOSAIC Website

wwwMichigangovstroke

Adrienne Nickles MPHnicklesamichigangov

Thank You

  • Michigan and MOSAIC Data Review
  • Overview
  • Age-adjusted Stroke Hospitalization Rates Michigan 2000-2015
  • Slide Number 4
  • Age-adjusted Stroke Mortality Rates Michigan 2000-2014
  • Slide Number 6
  • Slide Number 7
  • Slide Number 8
  • Slide Number 9
  • Slide Number 10
  • Slide Number 11
  • MOSAIC 2015-2020
  • Pre-hospital Care
  • EMSMOSAIC Data Linkage
  • Slide Number 15
  • GWTG Special Initiatives Tab
  • Slide Number 17
  • MOSAIC Participating Hospitals
  • Hospital Infrastructure
  • Case Demographics MOSAIC Registry
  • Who receives data reports on your stroke quality of care
  • 1) In the most recent calendar year have you run additional analyses (beyond what was required for reporting) on your hospitalrsquos own stroke data 2)How frequently have you run and used the analyses generated
  • What is the main reason you do not run your own additional analyses (Select one best answer)
  • In the most recent calendar year what reports did you run
  • How do you use these analyses reports
  • If you run additional analysis what action items QI efforts did you plan as a result of these reports
  • Hospital Arrival Mode Door-to Needle and Pre-Notification Reports 2016
  • Percent of Cases Who Arrived via EMSMOSAIC 2009-2016
  • Table 1 Arrival Mode among Stroke Cases by Demographics MOSAIC 2016
  • Table 2 Door-to-Needle Times by Arrival Mode among Stroke Cases MOSAIC 2016
  • Table 3 Pre-Notification among Stroke Cases Who Arrived Via EMS by Demographics MOSAIC 2016
  • MOSAIC Transitions of Care Project
  • Slide Number 33
  • MOSAIC Website
  • Adrienne Nickles MPHnicklesamichigangov
CVD
Year White Male Black Male White Female Black Female
2000 4276 5424 3033 4161
2001 4066 5524 2813 4091
2002 3928 5468 2767 4114
2003 3734 518 2638 3887
2004 3448 5079 2432 3643
2005 3366 4983 2375 3545
2006 3276 4994 2313 3477
2007 3236 4845 2223 327
2008 3158 4694 2238 3327
change 234 79 237 164
Heart Disease
Year White Male Black Male White Female Black Female
2000 3393 4298 227 3206
2001 3232 4445 2124 3166
2002 3118 4317 2197 3157
2003 2986 4184 1957 3001
2004 2777 3983 1783 2838
2005 2704 4009 1776 2679
2006 2644 3981 1739 2642
2007 2619 3972 1679 2532
2008 2566 3819 1687 2606
Stroke
Year White Male Black Male White Female Black Female
2000 61 768 561 703 176
2001 575 752 539 681 138
2002 573 806 528 66 15
2003 516 662 498 629 147
2004 463 743 476 562
2005 449 663 429 585
2006 434 63 411 556
2007 415 631 392 494
2008 402 606 392 509
2009 375 616 372 464
2010 372 565 366 513
2011 373 548 366 44
2012 348 587 349 477
2013 347 506 34 462
2014 369 506 352 482
Coronary Heart Disease
Year White Male Black Male White Female Black Female
2000 2625 329 1608 243
2001 2478 3356 1508 2314
2002 2404 3154 1419 2313
2003 2221 3093 1328 209
2004 2067 2956 119 1983
2005 1989 2885 117 1853
2006 1922 2903 1139 1825
2007 1921 2771 1074 1645
2008 1824 2592 1071 1722
Heart Failure
Year White Male Black Male White Female Black Female
2000 255 206 245 17
2001 267 225 225 167
2002 242 238 227 203
2003 256 217 222 189
2004 243 167 214 206
2005 24 218 217 172
2006 255 246 229 202
2007 23 225 208 196
2008 25 216 226 185
Not sure what this data is from previously HD Stroke
Year White Female Black Female White Female Black Female
2000 227 3206 561 703
2001 2124 3166 539 681
2002 2197 3157 528 66
2003 1957 3001 498 629
2004 1783 2838 476 562
2005 1776 2679 429 585
2006 1739 2642 411 556
2007
2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
Page 34: Michigan and MOSAIC Data Review...Michigan and MOSAIC Data Review 2017 ANNUAL WORKSHOP 4/26/2017. Adrienne Nickles, MPH. Michigan’s Ongoing Stroke Registry to Accelerate the Improvement

HF_RG

White Male
Black Male
White Female
Black Female
Year
Age-Adjusted Rate per 100000
255
206
245
17
267
225
225
167
242
238
227
203
256
217
222
189
243
167
214
206
24
218
217
172
255
246
229
202
23
225
208
196
25
216
226
185

race_gender

Sheet3

Local Health Department data can be found at wwwmichigangovbrfsSource CDC BRFSS

RISK FACTORMI

2011

MI

2013

MI

2014

MI

2015US 2015

2015 NATIONAL RANKING

Current Smoking 233 214 212 207 175 11

Blood Pressure Ever Told High 342 346 NA 331 309 18

Cholesterol Ever Told High 418 406 NA 382 364 12

Overweight (BMIgt25) 342 347 349 351 355 32tied

Obese (BMIgt30) 313 315 307 312 298 16

No Leisure Time Physical Activity 236 244 255 255 262 27

Diabetes 100 104 104 107 100 18tied

Prevalence of CVD Risk Factors Michigan Adults 1990-2015Compared to 2015 National Prevalence

233214 212 207

175

10

15

20

25

30

MI 2011 MI 2013 MI 2014 MI 2015 US 2015

Current Smoking

342 346331

309

20

25

30

35

40

MI 2011 MI 2013 MI 2014 MI 2015 US 2015

Blood Pressure Ever told high

342 347 349 351 355

20

25

30

35

40

MI 2011 MI 2013 MI 2014 MI 2015 US 2015

Overweight (BMIgt25)

313 315 307 312298

20

25

30

35

40

MI 2011 MI 2013 MI 2014 MI 2015 US 2015

Obese (BMIgt30)

418406

382364

30

35

40

45

50

MI 2011 MI 2013 MI 2014 MI 2015 US 2015

Cholesterol Ever told high

10 104 104 10710

0

3

6

9

12

15

MI 2011 MI 2013 MI 2014 MI 2015 US 2015

Diabetes

236 244255 255 262

10

15

20

25

30

MI 2011 MI 2013 MI 2014 MI 2015 US 2015

No Leisure Time Physical Activity

11 1216 18

2732tied

05

101520253035404550

CurrentSmoking

CholesterolEver told high

Obese(BMIgt30)

BloodPressure Ever

told high

Diabetes No LeisureTime Physical

Activity

Overweight(BMIgt25)

2015 NATIONAL RANKING(1st is worst)

18tied

MOSAIC 2015-2020 Focus of Grant Developing Stroke Systems of

Care Community Awareness EMS In-hospital QI Transition of Care Post-Discharge

12

Pre-hospital Care

A V A I L A B L E D A T A

13

EMSMOSAIC Data Linkage

-The MOSAIC Team continues to link data from the Michigan EMS Information System (MiEMSIS) to MOSAIC Data- Reports have been created for and reviewed by the

Tri-County Area MCA and Detroit East MCA- This work will expand to other MCA regions that

serve hospitals participating in MOSAIC

GWTG Special Initiatives Tab

-A free tab that can be enabled in GWTG-The purpose of the tab is to collect data concerning patient hand-off from EMS

MOSAIC Participating Hospitals

Aspirus Keweenaw Hospital (Laurium)

Aspirus Grand View HospitalAspirus Iron River HospitalAspirus Ontonagon HospitalBixby Medical CenterBronson Methodist HospitalCovenant Health CareDetroit Receiving HospitalGenesys Regional Medical CenterHenry Ford Hospital Herrick Medical CenterHuron Valley-Sinai HospitalLakeland Regional Medical Center McLaren Bay Regional Medical CenterMcLaren Greater Medical Center

McLaren Macomb HospitalMcLaren Northern MI HospitalMcLaren Oakland Medical CenterMcLaren Port Huron HospitalMcLaren Regional Medical CenterMercy Health Saint Maryrsquos HospitalMetro Health HospitalMunson Medical Center

ProMedica Monroe Regional HospitalSparrow HospitalSt Joseph Mercy - Ann ArborSt Joseph Mercy ChelseaSt Joseph Mercy Livingston HospitalSt Mary MercySt Mary of Michigan HospitalU of M Hospital

Hospital Infrastructure19

Among all participating hospitals the average number of

Licensed beds was 374 (range 25 to 1059 beds)

Inpatient discharges was 17076 (range 1064 to 48916 patients)

Acute stroke discharges (primary diagnosis only) was 417 (range 34 to 982 patients)

Case Demographics MOSAIC Registry

VariablesN() or statistics(Total N=68906)

Age at admission (years)Median 710Range 180 - 1060Mean (SE) 697(01)

GenderMale 32886 (477)Female 36015 (523)

RaceAfrican American 9900 (197)AIAN 132 (03)Asian 320 (06)More than one race 44 (01)Unknown 3679 (73)White 36190 (720)Missing 70

EthnicityHispanic or Latino 804 (16)Others 49531 (984)

VariablesN() or statistics(Total N=68906)

Health insuranceMedicaid 2284 (45)MedicaidPrivate 211 (04)Medicare 16863 (336)Medicare Medicaid 2313 (46)

MedicareMedicaidPrivate125 (02)

MedicarePrivate 13640 (272)ND 268(05)No insurance 2123 (42)Private 12356 (246)

Arrival modeEMS 21052 (429)Private

transportationother19313 (393)

Transfer from another hospital

7733(157)

ND or unknown 1021 (21)Missing 1216

Who receives data reports on your stroke quality of care

21

7055

70

10085

65

40

Hos

pita

lC

EO

up

per

man

agem

ent

Hos

pita

lB

oard

Chi

efN

ursi

ngO

ffice

r(C

NO

)

Str

oke

Tea

m

Phy

sici

anS

trok

eC

ham

pion

Chi

ef o

fM

edic

ine

Oth

er

Data Use

1) In the most recent calendar year have you run additional analyses (beyond what was required for reporting) on your hospitalrsquos own stroke data

2)How frequently have you run and used the analyses generated

22

Yes (N=16) 80

No (N=4) 20Weekly (N=2) 125

Monthly (N=8) 500

Less than monthly but more

than 1-2 times(N=6) 375

Data Use

What is the main reason you do not run your own additional analyses (Select one best answer)

23

Not sure how to run analyses

25

Not sure what analyses are needed would be helpful 25

Other 50

Data Use

In the most recent calendar year what reports did you run

24

813 688

Pre-programmedautomated reports in thedata collection tool (eg GWTG)

Additional reports beyond pre-programmed reports from the tool

Data Use

How do you use these analyses reports

25

813 688375

Inform quality improvement (QI) efforts andor plan

ldquoaction itemsrdquo

Report to management administration on our

progress

Other

Data Use

If you run additional analysis what action items QI efforts did you plan as a result of these reports

26

o Discharge education intensive statin use

o Door to tPA time and dysphagia

o Review data between spoke amp hub hospitals regarding transfers IV-tPA administration Mechanical thrombectomy and SAH

o QI efforts were addressed in the department involving calling Stroke Alert on call for cases with FAST symptoms

o ED Medical Director works with team to fix fallouts and problematic areas We have seen improvement

o Process changes (ie fallout emails to RN manager) physician querieso Increased documentation of NIHSS ownership from individual units regarding stroke quality

improvement goalso Daily dysphagia screening determination of whowhat team responsible for documenting initial NIHSS

looking at patients beyond 2h LKW arrival

Hospital Arrival Mode Door-to Needle and Pre-Notification

Reports 2016

Percent of Cases Who Arrived via EMSMOSAIC 2009-2016

Table 1 Arrival Mode among Stroke Cases by Demographics MOSAIC 2016

Demographics N=3496 550 N=2938 450Stroke Type Ischemic 2558 542 2164 458 Hemorrhagic 560 728 209 272 TIA 378 478 413 522Age Group lt 50 Years 233 433 305 567 50-79 Years 1982 497 2008 503 ge 80 Years 1379 688 625 312Sex Female 1933 576 1422 424 Male 1661 523 1516 477Race Black 659 530 584 470 White 2824 557 2248 443 Other Missing 111 512 106 488

MOSAIC AggregateArrival Mode

EMS Private Mode

Table 2 Door-to-Needle Times by Arrival Mode among Stroke Cases MOSAIC 2016

Time Elements (in Minutes)Number of

Patients Mean (Minutes) Median

(Minutes)Range

(Minutes)Door-to-Image 4901 575 400 00-2700 Arrived via EMS 2767 463 270 00-2700 Arrived via Private Transportation 2134 720 570 00-2620

Door-to-Image (among t-PA treated) 492 155 130 00-970 Arrived via EMS 370 125 110 00-840 Arrived via Private Transportation 122 243 215 20-970Image-to Needle 492 500 450 70-2090 Arrived via EMS 370 503 460 70-2090 Arrived via Private Transportation 122 483 420 90-1770Door-to Needle 492 655 570 200-2180 Arrived via EMS 370 629 560 200-2180 Arrived via Private Transportation 122 726 650 290-2060Included ischemic or hemorrhagic cases with times that were less or equal to 270 minutes (45 hours)Transferred cases were excluded

MOSAIC Aggregate

Table 3 Pre-Notification among Stroke Cases Who Arrived Via EMS by Demographics MOSAIC 2016

Demographics N=2015 584 N=1437 416Stroke Type Ischemic 1523 622 924 378 Hemorrhagic 306 566 235 434 TIA 142 381 231 619Age Group lt 50 Years 133 607 86 393 50-79 Years 1105 585 784 415 ge 80 Years 777 578 567 422Sex Female 1075 578 786 422 Male 940 591 651 409Race Black 307 517 287 483 White 1657 602 1097 398 Other 51 490 53 510

All HospitalsPre-Notification

Yes No

MOSAIC Transitions of Care Project

Post-discharge data collection tool is being implemented into Outcome Science as a tab

Post-Discharge amp Transition of Care

Reporting on changes within 30 days of discharge from hospital via follow-up callschart review Interval events Physician follow-up visits Lifestyle changes Lab assessments Medication managementadherence Rehab amp Functional outcomes Falls

MOSAIC Website

wwwMichigangovstroke

Adrienne Nickles MPHnicklesamichigangov

Thank You

  • Michigan and MOSAIC Data Review
  • Overview
  • Age-adjusted Stroke Hospitalization Rates Michigan 2000-2015
  • Slide Number 4
  • Age-adjusted Stroke Mortality Rates Michigan 2000-2014
  • Slide Number 6
  • Slide Number 7
  • Slide Number 8
  • Slide Number 9
  • Slide Number 10
  • Slide Number 11
  • MOSAIC 2015-2020
  • Pre-hospital Care
  • EMSMOSAIC Data Linkage
  • Slide Number 15
  • GWTG Special Initiatives Tab
  • Slide Number 17
  • MOSAIC Participating Hospitals
  • Hospital Infrastructure
  • Case Demographics MOSAIC Registry
  • Who receives data reports on your stroke quality of care
  • 1) In the most recent calendar year have you run additional analyses (beyond what was required for reporting) on your hospitalrsquos own stroke data 2)How frequently have you run and used the analyses generated
  • What is the main reason you do not run your own additional analyses (Select one best answer)
  • In the most recent calendar year what reports did you run
  • How do you use these analyses reports
  • If you run additional analysis what action items QI efforts did you plan as a result of these reports
  • Hospital Arrival Mode Door-to Needle and Pre-Notification Reports 2016
  • Percent of Cases Who Arrived via EMSMOSAIC 2009-2016
  • Table 1 Arrival Mode among Stroke Cases by Demographics MOSAIC 2016
  • Table 2 Door-to-Needle Times by Arrival Mode among Stroke Cases MOSAIC 2016
  • Table 3 Pre-Notification among Stroke Cases Who Arrived Via EMS by Demographics MOSAIC 2016
  • MOSAIC Transitions of Care Project
  • Slide Number 33
  • MOSAIC Website
  • Adrienne Nickles MPHnicklesamichigangov
CVD
Year White Male Black Male White Female Black Female
2000 4276 5424 3033 4161
2001 4066 5524 2813 4091
2002 3928 5468 2767 4114
2003 3734 518 2638 3887
2004 3448 5079 2432 3643
2005 3366 4983 2375 3545
2006 3276 4994 2313 3477
2007 3236 4845 2223 327
2008 3158 4694 2238 3327
change 234 79 237 164
Heart Disease
Year White Male Black Male White Female Black Female
2000 3393 4298 227 3206
2001 3232 4445 2124 3166
2002 3118 4317 2197 3157
2003 2986 4184 1957 3001
2004 2777 3983 1783 2838
2005 2704 4009 1776 2679
2006 2644 3981 1739 2642
2007 2619 3972 1679 2532
2008 2566 3819 1687 2606
Stroke
Year White Male Black Male White Female Black Female
2000 61 768 561 703 176
2001 575 752 539 681 138
2002 573 806 528 66 15
2003 516 662 498 629 147
2004 463 743 476 562
2005 449 663 429 585
2006 434 63 411 556
2007 415 631 392 494
2008 402 606 392 509
2009 375 616 372 464
2010 372 565 366 513
2011 373 548 366 44
2012 348 587 349 477
2013 347 506 34 462
2014 369 506 352 482
Coronary Heart Disease
Year White Male Black Male White Female Black Female
2000 2625 329 1608 243
2001 2478 3356 1508 2314
2002 2404 3154 1419 2313
2003 2221 3093 1328 209
2004 2067 2956 119 1983
2005 1989 2885 117 1853
2006 1922 2903 1139 1825
2007 1921 2771 1074 1645
2008 1824 2592 1071 1722
Heart Failure
Year White Male Black Male White Female Black Female
2000 255 206 245 17
2001 267 225 225 167
2002 242 238 227 203
2003 256 217 222 189
2004 243 167 214 206
2005 24 218 217 172
2006 255 246 229 202
2007 23 225 208 196
2008 25 216 226 185
Not sure what this data is from previously HD Stroke
Year White Female Black Female White Female Black Female
2000 227 3206 561 703
2001 2124 3166 539 681
2002 2197 3157 528 66
2003 1957 3001 498 629
2004 1783 2838 476 562
2005 1776 2679 429 585
2006 1739 2642 411 556
2007
2008
2000 2000 2000 2000
2001 2001 2001 2001
2002 2002 2002 2002
2003 2003 2003 2003
2004 2004 2004 2004
2005 2005 2005 2005
2006 2006 2006 2006
2007 2007 2007 2007
2008 2008 2008 2008
Page 35: Michigan and MOSAIC Data Review...Michigan and MOSAIC Data Review 2017 ANNUAL WORKSHOP 4/26/2017. Adrienne Nickles, MPH. Michigan’s Ongoing Stroke Registry to Accelerate the Improvement

race_gender

Sheet3

Local Health Department data can be found at wwwmichigangovbrfsSource CDC BRFSS

RISK FACTORMI

2011

MI

2013

MI

2014

MI

2015US 2015

2015 NATIONAL RANKING

Current Smoking 233 214 212 207 175 11

Blood Pressure Ever Told High 342 346 NA 331 309 18

Cholesterol Ever Told High 418 406 NA 382 364 12

Overweight (BMIgt25) 342 347 349 351 355 32tied

Obese (BMIgt30) 313 315 307 312 298 16

No Leisure Time Physical Activity 236 244 255 255 262 27

Diabetes 100 104 104 107 100 18tied

Prevalence of CVD Risk Factors Michigan Adults 1990-2015Compared to 2015 National Prevalence

233214 212 207

175

10

15

20

25

30

MI 2011 MI 2013 MI 2014 MI 2015 US 2015

Current Smoking

342 346331

309

20

25

30

35

40

MI 2011 MI 2013 MI 2014 MI 2015 US 2015

Blood Pressure Ever told high

342 347 349 351 355

20

25

30

35

40

MI 2011 MI 2013 MI 2014 MI 2015 US 2015

Overweight (BMIgt25)

313 315 307 312298

20

25

30

35

40

MI 2011 MI 2013 MI 2014 MI 2015 US 2015

Obese (BMIgt30)

418406

382364

30

35

40

45

50

MI 2011 MI 2013 MI 2014 MI 2015 US 2015

Cholesterol Ever told high

10 104 104 10710

0

3

6

9

12

15

MI 2011 MI 2013 MI 2014 MI 2015 US 2015

Diabetes

236 244255 255 262

10

15

20

25

30

MI 2011 MI 2013 MI 2014 MI 2015 US 2015

No Leisure Time Physical Activity

11 1216 18

2732tied

05

101520253035404550

CurrentSmoking

CholesterolEver told high

Obese(BMIgt30)

BloodPressure Ever

told high

Diabetes No LeisureTime Physical

Activity

Overweight(BMIgt25)

2015 NATIONAL RANKING(1st is worst)

18tied

MOSAIC 2015-2020 Focus of Grant Developing Stroke Systems of

Care Community Awareness EMS In-hospital QI Transition of Care Post-Discharge

12

Pre-hospital Care

A V A I L A B L E D A T A

13

EMSMOSAIC Data Linkage

-The MOSAIC Team continues to link data from the Michigan EMS Information System (MiEMSIS) to MOSAIC Data- Reports have been created for and reviewed by the

Tri-County Area MCA and Detroit East MCA- This work will expand to other MCA regions that

serve hospitals participating in MOSAIC

GWTG Special Initiatives Tab

-A free tab that can be enabled in GWTG-The purpose of the tab is to collect data concerning patient hand-off from EMS

MOSAIC Participating Hospitals

Aspirus Keweenaw Hospital (Laurium)

Aspirus Grand View HospitalAspirus Iron River HospitalAspirus Ontonagon HospitalBixby Medical CenterBronson Methodist HospitalCovenant Health CareDetroit Receiving HospitalGenesys Regional Medical CenterHenry Ford Hospital Herrick Medical CenterHuron Valley-Sinai HospitalLakeland Regional Medical Center McLaren Bay Regional Medical CenterMcLaren Greater Medical Center

McLaren Macomb HospitalMcLaren Northern MI HospitalMcLaren Oakland Medical CenterMcLaren Port Huron HospitalMcLaren Regional Medical CenterMercy Health Saint Maryrsquos HospitalMetro Health HospitalMunson Medical Center

ProMedica Monroe Regional HospitalSparrow HospitalSt Joseph Mercy - Ann ArborSt Joseph Mercy ChelseaSt Joseph Mercy Livingston HospitalSt Mary MercySt Mary of Michigan HospitalU of M Hospital

Hospital Infrastructure19

Among all participating hospitals the average number of

Licensed beds was 374 (range 25 to 1059 beds)

Inpatient discharges was 17076 (range 1064 to 48916 patients)

Acute stroke discharges (primary diagnosis only) was 417 (range 34 to 982 patients)

Case Demographics MOSAIC Registry

VariablesN() or statistics(Total N=68906)

Age at admission (years)Median 710Range 180 - 1060Mean (SE) 697(01)

GenderMale 32886 (477)Female 36015 (523)

RaceAfrican American 9900 (197)AIAN 132 (03)Asian 320 (06)More than one race 44 (01)Unknown 3679 (73)White 36190 (720)Missing 70

EthnicityHispanic or Latino 804 (16)Others 49531 (984)

VariablesN() or statistics(Total N=68906)

Health insuranceMedicaid 2284 (45)MedicaidPrivate 211 (04)Medicare 16863 (336)Medicare Medicaid 2313 (46)

MedicareMedicaidPrivate125 (02)

MedicarePrivate 13640 (272)ND 268(05)No insurance 2123 (42)Private 12356 (246)

Arrival modeEMS 21052 (429)Private

transportationother19313 (393)

Transfer from another hospital

7733(157)

ND or unknown 1021 (21)Missing 1216

Who receives data reports on your stroke quality of care

21

7055

70

10085

65

40

Hos

pita

lC

EO

up

per

man

agem

ent

Hos

pita

lB

oard

Chi

efN

ursi

ngO

ffice

r(C

NO

)

Str

oke

Tea

m

Phy

sici

anS

trok

eC

ham

pion

Chi

ef o

fM

edic

ine

Oth

er

Data Use

1) In the most recent calendar year have you run additional analyses (beyond what was required for reporting) on your hospitalrsquos own stroke data

2)How frequently have you run and used the analyses generated

22

Yes (N=16) 80

No (N=4) 20Weekly (N=2) 125

Monthly (N=8) 500

Less than monthly but more

than 1-2 times(N=6) 375

Data Use

What is the main reason you do not run your own additional analyses (Select one best answer)

23

Not sure how to run analyses

25

Not sure what analyses are needed would be helpful 25

Other 50

Data Use

In the most recent calendar year what reports did you run

24

813 688

Pre-programmedautomated reports in thedata collection tool (eg GWTG)

Additional reports beyond pre-programmed reports from the tool

Data Use

How do you use these analyses reports

25

813 688375

Inform quality improvement (QI) efforts andor plan

ldquoaction itemsrdquo

Report to management administration on our

progress

Other

Data Use

If you run additional analysis what action items QI efforts did you plan as a result of these reports

26

o Discharge education intensive statin use

o Door to tPA time and dysphagia

o Review data between spoke amp hub hospitals regarding transfers IV-tPA administration Mechanical thrombectomy and SAH

o QI efforts were addressed in the department involving calling Stroke Alert on call for cases with FAST symptoms

o ED Medical Director works with team to fix fallouts and problematic areas We have seen improvement

o Process changes (ie fallout emails to RN manager) physician querieso Increased documentation of NIHSS ownership from individual units regarding stroke quality

improvement goalso Daily dysphagia screening determination of whowhat team responsible for documenting initial NIHSS

looking at patients beyond 2h LKW arrival

Hospital Arrival Mode Door-to Needle and Pre-Notification

Reports 2016

Percent of Cases Who Arrived via EMSMOSAIC 2009-2016

Table 1 Arrival Mode among Stroke Cases by Demographics MOSAIC 2016

Demographics N=3496 550 N=2938 450Stroke Type Ischemic 2558 542 2164 458 Hemorrhagic 560 728 209 272 TIA 378 478 413 522Age Group lt 50 Years 233 433 305 567 50-79 Years 1982 497 2008 503 ge 80 Years 1379 688 625 312Sex Female 1933 576 1422 424 Male 1661 523 1516 477Race Black 659 530 584 470 White 2824 557 2248 443 Other Missing 111 512 106 488

MOSAIC AggregateArrival Mode

EMS Private Mode

Table 2 Door-to-Needle Times by Arrival Mode among Stroke Cases MOSAIC 2016

Time Elements (in Minutes)Number of

Patients Mean (Minutes) Median

(Minutes)Range

(Minutes)Door-to-Image 4901 575 400 00-2700 Arrived via EMS 2767 463 270 00-2700 Arrived via Private Transportation 2134 720 570 00-2620

Door-to-Image (among t-PA treated) 492 155 130 00-970 Arrived via EMS 370 125 110 00-840 Arrived via Private Transportation 122 243 215 20-970Image-to Needle 492 500 450 70-2090 Arrived via EMS 370 503 460 70-2090 Arrived via Private Transportation 122 483 420 90-1770Door-to Needle 492 655 570 200-2180 Arrived via EMS 370 629 560 200-2180 Arrived via Private Transportation 122 726 650 290-2060Included ischemic or hemorrhagic cases with times that were less or equal to 270 minutes (45 hours)Transferred cases were excluded

MOSAIC Aggregate

Table 3 Pre-Notification among Stroke Cases Who Arrived Via EMS by Demographics MOSAIC 2016

Demographics N=2015 584 N=1437 416Stroke Type Ischemic 1523 622 924 378 Hemorrhagic 306 566 235 434 TIA 142 381 231 619Age Group lt 50 Years 133 607 86 393 50-79 Years 1105 585 784 415 ge 80 Years 777 578 567 422Sex Female 1075 578 786 422 Male 940 591 651 409Race Black 307 517 287 483 White 1657 602 1097 398 Other 51 490 53 510

All HospitalsPre-Notification

Yes No

MOSAIC Transitions of Care Project

Post-discharge data collection tool is being implemented into Outcome Science as a tab

Post-Discharge amp Transition of Care

Reporting on changes within 30 days of discharge from hospital via follow-up callschart review Interval events Physician follow-up visits Lifestyle changes Lab assessments Medication managementadherence Rehab amp Functional outcomes Falls

MOSAIC Website

wwwMichigangovstroke

Adrienne Nickles MPHnicklesamichigangov

Thank You

  • Michigan and MOSAIC Data Review
  • Overview
  • Age-adjusted Stroke Hospitalization Rates Michigan 2000-2015
  • Slide Number 4
  • Age-adjusted Stroke Mortality Rates Michigan 2000-2014
  • Slide Number 6
  • Slide Number 7
  • Slide Number 8
  • Slide Number 9
  • Slide Number 10
  • Slide Number 11
  • MOSAIC 2015-2020
  • Pre-hospital Care
  • EMSMOSAIC Data Linkage
  • Slide Number 15
  • GWTG Special Initiatives Tab
  • Slide Number 17
  • MOSAIC Participating Hospitals
  • Hospital Infrastructure
  • Case Demographics MOSAIC Registry
  • Who receives data reports on your stroke quality of care
  • 1) In the most recent calendar year have you run additional analyses (beyond what was required for reporting) on your hospitalrsquos own stroke data 2)How frequently have you run and used the analyses generated
  • What is the main reason you do not run your own additional analyses (Select one best answer)
  • In the most recent calendar year what reports did you run
  • How do you use these analyses reports
  • If you run additional analysis what action items QI efforts did you plan as a result of these reports
  • Hospital Arrival Mode Door-to Needle and Pre-Notification Reports 2016
  • Percent of Cases Who Arrived via EMSMOSAIC 2009-2016
  • Table 1 Arrival Mode among Stroke Cases by Demographics MOSAIC 2016
  • Table 2 Door-to-Needle Times by Arrival Mode among Stroke Cases MOSAIC 2016
  • Table 3 Pre-Notification among Stroke Cases Who Arrived Via EMS by Demographics MOSAIC 2016
  • MOSAIC Transitions of Care Project
  • Slide Number 33
  • MOSAIC Website
  • Adrienne Nickles MPHnicklesamichigangov
CVD
Year White Male Black Male White Female Black Female
2000 4276 5424 3033 4161
2001 4066 5524 2813 4091
2002 3928 5468 2767 4114
2003 3734 518 2638 3887
2004 3448 5079 2432 3643
2005 3366 4983 2375 3545
2006 3276 4994 2313 3477
2007 3236 4845 2223 327
2008 3158 4694 2238 3327
change 234 79 237 164
Heart Disease
Year White Male Black Male White Female Black Female
2000 3393 4298 227 3206
2001 3232 4445 2124 3166
2002 3118 4317 2197 3157
2003 2986 4184 1957 3001
2004 2777 3983 1783 2838
2005 2704 4009 1776 2679
2006 2644 3981 1739 2642
2007 2619 3972 1679 2532
2008 2566 3819 1687 2606
Stroke
Year White Male Black Male White Female Black Female
2000 61 768 561 703 176
2001 575 752 539 681 138
2002 573 806 528 66 15
2003 516 662 498 629 147
2004 463 743 476 562
2005 449 663 429 585
2006 434 63 411 556
2007 415 631 392 494
2008 402 606 392 509
2009 375 616 372 464
2010 372 565 366 513
2011 373 548 366 44
2012 348 587 349 477
2013 347 506 34 462
2014 369 506 352 482
Coronary Heart Disease
Year White Male Black Male White Female Black Female
2000 2625 329 1608 243
2001 2478 3356 1508 2314
2002 2404 3154 1419 2313
2003 2221 3093 1328 209
2004 2067 2956 119 1983
2005 1989 2885 117 1853
2006 1922 2903 1139 1825
2007 1921 2771 1074 1645
2008 1824 2592 1071 1722
Heart Failure
Year White Male Black Male White Female Black Female
2000 255 206 245 17
2001 267 225 225 167
2002 242 238 227 203
2003 256 217 222 189
2004 243 167 214 206
2005 24 218 217 172
2006 255 246 229 202
2007 23 225 208 196
2008 25 216 226 185
Not sure what this data is from previously HD Stroke
Year White Female Black Female White Female Black Female
2000 227 3206 561 703
2001 2124 3166 539 681
2002 2197 3157 528 66
2003 1957 3001 498 629
2004 1783 2838 476 562
2005 1776 2679 429 585
2006 1739 2642 411 556
2007
2008
Page 36: Michigan and MOSAIC Data Review...Michigan and MOSAIC Data Review 2017 ANNUAL WORKSHOP 4/26/2017. Adrienne Nickles, MPH. Michigan’s Ongoing Stroke Registry to Accelerate the Improvement

Sheet3

Local Health Department data can be found at wwwmichigangovbrfsSource CDC BRFSS

RISK FACTORMI

2011

MI

2013

MI

2014

MI

2015US 2015

2015 NATIONAL RANKING

Current Smoking 233 214 212 207 175 11

Blood Pressure Ever Told High 342 346 NA 331 309 18

Cholesterol Ever Told High 418 406 NA 382 364 12

Overweight (BMIgt25) 342 347 349 351 355 32tied

Obese (BMIgt30) 313 315 307 312 298 16

No Leisure Time Physical Activity 236 244 255 255 262 27

Diabetes 100 104 104 107 100 18tied

Prevalence of CVD Risk Factors Michigan Adults 1990-2015Compared to 2015 National Prevalence

233214 212 207

175

10

15

20

25

30

MI 2011 MI 2013 MI 2014 MI 2015 US 2015

Current Smoking

342 346331

309

20

25

30

35

40

MI 2011 MI 2013 MI 2014 MI 2015 US 2015

Blood Pressure Ever told high

342 347 349 351 355

20

25

30

35

40

MI 2011 MI 2013 MI 2014 MI 2015 US 2015

Overweight (BMIgt25)

313 315 307 312298

20

25

30

35

40

MI 2011 MI 2013 MI 2014 MI 2015 US 2015

Obese (BMIgt30)

418406

382364

30

35

40

45

50

MI 2011 MI 2013 MI 2014 MI 2015 US 2015

Cholesterol Ever told high

10 104 104 10710

0

3

6

9

12

15

MI 2011 MI 2013 MI 2014 MI 2015 US 2015

Diabetes

236 244255 255 262

10

15

20

25

30

MI 2011 MI 2013 MI 2014 MI 2015 US 2015

No Leisure Time Physical Activity

11 1216 18

2732tied

05

101520253035404550

CurrentSmoking

CholesterolEver told high

Obese(BMIgt30)

BloodPressure Ever

told high

Diabetes No LeisureTime Physical

Activity

Overweight(BMIgt25)

2015 NATIONAL RANKING(1st is worst)

18tied

MOSAIC 2015-2020 Focus of Grant Developing Stroke Systems of

Care Community Awareness EMS In-hospital QI Transition of Care Post-Discharge

12

Pre-hospital Care

A V A I L A B L E D A T A

13

EMSMOSAIC Data Linkage

-The MOSAIC Team continues to link data from the Michigan EMS Information System (MiEMSIS) to MOSAIC Data- Reports have been created for and reviewed by the

Tri-County Area MCA and Detroit East MCA- This work will expand to other MCA regions that

serve hospitals participating in MOSAIC

GWTG Special Initiatives Tab

-A free tab that can be enabled in GWTG-The purpose of the tab is to collect data concerning patient hand-off from EMS

MOSAIC Participating Hospitals

Aspirus Keweenaw Hospital (Laurium)

Aspirus Grand View HospitalAspirus Iron River HospitalAspirus Ontonagon HospitalBixby Medical CenterBronson Methodist HospitalCovenant Health CareDetroit Receiving HospitalGenesys Regional Medical CenterHenry Ford Hospital Herrick Medical CenterHuron Valley-Sinai HospitalLakeland Regional Medical Center McLaren Bay Regional Medical CenterMcLaren Greater Medical Center

McLaren Macomb HospitalMcLaren Northern MI HospitalMcLaren Oakland Medical CenterMcLaren Port Huron HospitalMcLaren Regional Medical CenterMercy Health Saint Maryrsquos HospitalMetro Health HospitalMunson Medical Center

ProMedica Monroe Regional HospitalSparrow HospitalSt Joseph Mercy - Ann ArborSt Joseph Mercy ChelseaSt Joseph Mercy Livingston HospitalSt Mary MercySt Mary of Michigan HospitalU of M Hospital

Hospital Infrastructure19

Among all participating hospitals the average number of

Licensed beds was 374 (range 25 to 1059 beds)

Inpatient discharges was 17076 (range 1064 to 48916 patients)

Acute stroke discharges (primary diagnosis only) was 417 (range 34 to 982 patients)

Case Demographics MOSAIC Registry

VariablesN() or statistics(Total N=68906)

Age at admission (years)Median 710Range 180 - 1060Mean (SE) 697(01)

GenderMale 32886 (477)Female 36015 (523)

RaceAfrican American 9900 (197)AIAN 132 (03)Asian 320 (06)More than one race 44 (01)Unknown 3679 (73)White 36190 (720)Missing 70

EthnicityHispanic or Latino 804 (16)Others 49531 (984)

VariablesN() or statistics(Total N=68906)

Health insuranceMedicaid 2284 (45)MedicaidPrivate 211 (04)Medicare 16863 (336)Medicare Medicaid 2313 (46)

MedicareMedicaidPrivate125 (02)

MedicarePrivate 13640 (272)ND 268(05)No insurance 2123 (42)Private 12356 (246)

Arrival modeEMS 21052 (429)Private

transportationother19313 (393)

Transfer from another hospital

7733(157)

ND or unknown 1021 (21)Missing 1216

Who receives data reports on your stroke quality of care

21

7055

70

10085

65

40

Hos

pita

lC

EO

up

per

man

agem

ent

Hos

pita

lB

oard

Chi

efN

ursi

ngO

ffice

r(C

NO

)

Str

oke

Tea

m

Phy

sici

anS

trok

eC

ham

pion

Chi

ef o

fM

edic

ine

Oth

er

Data Use

1) In the most recent calendar year have you run additional analyses (beyond what was required for reporting) on your hospitalrsquos own stroke data

2)How frequently have you run and used the analyses generated

22

Yes (N=16) 80

No (N=4) 20Weekly (N=2) 125

Monthly (N=8) 500

Less than monthly but more

than 1-2 times(N=6) 375

Data Use

What is the main reason you do not run your own additional analyses (Select one best answer)

23

Not sure how to run analyses

25

Not sure what analyses are needed would be helpful 25

Other 50

Data Use

In the most recent calendar year what reports did you run

24

813 688

Pre-programmedautomated reports in thedata collection tool (eg GWTG)

Additional reports beyond pre-programmed reports from the tool

Data Use

How do you use these analyses reports

25

813 688375

Inform quality improvement (QI) efforts andor plan

ldquoaction itemsrdquo

Report to management administration on our

progress

Other

Data Use

If you run additional analysis what action items QI efforts did you plan as a result of these reports

26

o Discharge education intensive statin use

o Door to tPA time and dysphagia

o Review data between spoke amp hub hospitals regarding transfers IV-tPA administration Mechanical thrombectomy and SAH

o QI efforts were addressed in the department involving calling Stroke Alert on call for cases with FAST symptoms

o ED Medical Director works with team to fix fallouts and problematic areas We have seen improvement

o Process changes (ie fallout emails to RN manager) physician querieso Increased documentation of NIHSS ownership from individual units regarding stroke quality

improvement goalso Daily dysphagia screening determination of whowhat team responsible for documenting initial NIHSS

looking at patients beyond 2h LKW arrival

Hospital Arrival Mode Door-to Needle and Pre-Notification

Reports 2016

Percent of Cases Who Arrived via EMSMOSAIC 2009-2016

Table 1 Arrival Mode among Stroke Cases by Demographics MOSAIC 2016

Demographics N=3496 550 N=2938 450Stroke Type Ischemic 2558 542 2164 458 Hemorrhagic 560 728 209 272 TIA 378 478 413 522Age Group lt 50 Years 233 433 305 567 50-79 Years 1982 497 2008 503 ge 80 Years 1379 688 625 312Sex Female 1933 576 1422 424 Male 1661 523 1516 477Race Black 659 530 584 470 White 2824 557 2248 443 Other Missing 111 512 106 488

MOSAIC AggregateArrival Mode

EMS Private Mode

Table 2 Door-to-Needle Times by Arrival Mode among Stroke Cases MOSAIC 2016

Time Elements (in Minutes)Number of

Patients Mean (Minutes) Median

(Minutes)Range

(Minutes)Door-to-Image 4901 575 400 00-2700 Arrived via EMS 2767 463 270 00-2700 Arrived via Private Transportation 2134 720 570 00-2620

Door-to-Image (among t-PA treated) 492 155 130 00-970 Arrived via EMS 370 125 110 00-840 Arrived via Private Transportation 122 243 215 20-970Image-to Needle 492 500 450 70-2090 Arrived via EMS 370 503 460 70-2090 Arrived via Private Transportation 122 483 420 90-1770Door-to Needle 492 655 570 200-2180 Arrived via EMS 370 629 560 200-2180 Arrived via Private Transportation 122 726 650 290-2060Included ischemic or hemorrhagic cases with times that were less or equal to 270 minutes (45 hours)Transferred cases were excluded

MOSAIC Aggregate

Table 3 Pre-Notification among Stroke Cases Who Arrived Via EMS by Demographics MOSAIC 2016

Demographics N=2015 584 N=1437 416Stroke Type Ischemic 1523 622 924 378 Hemorrhagic 306 566 235 434 TIA 142 381 231 619Age Group lt 50 Years 133 607 86 393 50-79 Years 1105 585 784 415 ge 80 Years 777 578 567 422Sex Female 1075 578 786 422 Male 940 591 651 409Race Black 307 517 287 483 White 1657 602 1097 398 Other 51 490 53 510

All HospitalsPre-Notification

Yes No

MOSAIC Transitions of Care Project

Post-discharge data collection tool is being implemented into Outcome Science as a tab

Post-Discharge amp Transition of Care

Reporting on changes within 30 days of discharge from hospital via follow-up callschart review Interval events Physician follow-up visits Lifestyle changes Lab assessments Medication managementadherence Rehab amp Functional outcomes Falls

MOSAIC Website

wwwMichigangovstroke

Adrienne Nickles MPHnicklesamichigangov

Thank You

  • Michigan and MOSAIC Data Review
  • Overview
  • Age-adjusted Stroke Hospitalization Rates Michigan 2000-2015
  • Slide Number 4
  • Age-adjusted Stroke Mortality Rates Michigan 2000-2014
  • Slide Number 6
  • Slide Number 7
  • Slide Number 8
  • Slide Number 9
  • Slide Number 10
  • Slide Number 11
  • MOSAIC 2015-2020
  • Pre-hospital Care
  • EMSMOSAIC Data Linkage
  • Slide Number 15
  • GWTG Special Initiatives Tab
  • Slide Number 17
  • MOSAIC Participating Hospitals
  • Hospital Infrastructure
  • Case Demographics MOSAIC Registry
  • Who receives data reports on your stroke quality of care
  • 1) In the most recent calendar year have you run additional analyses (beyond what was required for reporting) on your hospitalrsquos own stroke data 2)How frequently have you run and used the analyses generated
  • What is the main reason you do not run your own additional analyses (Select one best answer)
  • In the most recent calendar year what reports did you run
  • How do you use these analyses reports
  • If you run additional analysis what action items QI efforts did you plan as a result of these reports
  • Hospital Arrival Mode Door-to Needle and Pre-Notification Reports 2016
  • Percent of Cases Who Arrived via EMSMOSAIC 2009-2016
  • Table 1 Arrival Mode among Stroke Cases by Demographics MOSAIC 2016
  • Table 2 Door-to-Needle Times by Arrival Mode among Stroke Cases MOSAIC 2016
  • Table 3 Pre-Notification among Stroke Cases Who Arrived Via EMS by Demographics MOSAIC 2016
  • MOSAIC Transitions of Care Project
  • Slide Number 33
  • MOSAIC Website
  • Adrienne Nickles MPHnicklesamichigangov
Page 37: Michigan and MOSAIC Data Review...Michigan and MOSAIC Data Review 2017 ANNUAL WORKSHOP 4/26/2017. Adrienne Nickles, MPH. Michigan’s Ongoing Stroke Registry to Accelerate the Improvement

Local Health Department data can be found at wwwmichigangovbrfsSource CDC BRFSS

RISK FACTORMI

2011

MI

2013

MI

2014

MI

2015US 2015

2015 NATIONAL RANKING

Current Smoking 233 214 212 207 175 11

Blood Pressure Ever Told High 342 346 NA 331 309 18

Cholesterol Ever Told High 418 406 NA 382 364 12

Overweight (BMIgt25) 342 347 349 351 355 32tied

Obese (BMIgt30) 313 315 307 312 298 16

No Leisure Time Physical Activity 236 244 255 255 262 27

Diabetes 100 104 104 107 100 18tied

Prevalence of CVD Risk Factors Michigan Adults 1990-2015Compared to 2015 National Prevalence

233214 212 207

175

10

15

20

25

30

MI 2011 MI 2013 MI 2014 MI 2015 US 2015

Current Smoking

342 346331

309

20

25

30

35

40

MI 2011 MI 2013 MI 2014 MI 2015 US 2015

Blood Pressure Ever told high

342 347 349 351 355

20

25

30

35

40

MI 2011 MI 2013 MI 2014 MI 2015 US 2015

Overweight (BMIgt25)

313 315 307 312298

20

25

30

35

40

MI 2011 MI 2013 MI 2014 MI 2015 US 2015

Obese (BMIgt30)

418406

382364

30

35

40

45

50

MI 2011 MI 2013 MI 2014 MI 2015 US 2015

Cholesterol Ever told high

10 104 104 10710

0

3

6

9

12

15

MI 2011 MI 2013 MI 2014 MI 2015 US 2015

Diabetes

236 244255 255 262

10

15

20

25

30

MI 2011 MI 2013 MI 2014 MI 2015 US 2015

No Leisure Time Physical Activity

11 1216 18

2732tied

05

101520253035404550

CurrentSmoking

CholesterolEver told high

Obese(BMIgt30)

BloodPressure Ever

told high

Diabetes No LeisureTime Physical

Activity

Overweight(BMIgt25)

2015 NATIONAL RANKING(1st is worst)

18tied

MOSAIC 2015-2020 Focus of Grant Developing Stroke Systems of

Care Community Awareness EMS In-hospital QI Transition of Care Post-Discharge

12

Pre-hospital Care

A V A I L A B L E D A T A

13

EMSMOSAIC Data Linkage

-The MOSAIC Team continues to link data from the Michigan EMS Information System (MiEMSIS) to MOSAIC Data- Reports have been created for and reviewed by the

Tri-County Area MCA and Detroit East MCA- This work will expand to other MCA regions that

serve hospitals participating in MOSAIC

GWTG Special Initiatives Tab

-A free tab that can be enabled in GWTG-The purpose of the tab is to collect data concerning patient hand-off from EMS

MOSAIC Participating Hospitals

Aspirus Keweenaw Hospital (Laurium)

Aspirus Grand View HospitalAspirus Iron River HospitalAspirus Ontonagon HospitalBixby Medical CenterBronson Methodist HospitalCovenant Health CareDetroit Receiving HospitalGenesys Regional Medical CenterHenry Ford Hospital Herrick Medical CenterHuron Valley-Sinai HospitalLakeland Regional Medical Center McLaren Bay Regional Medical CenterMcLaren Greater Medical Center

McLaren Macomb HospitalMcLaren Northern MI HospitalMcLaren Oakland Medical CenterMcLaren Port Huron HospitalMcLaren Regional Medical CenterMercy Health Saint Maryrsquos HospitalMetro Health HospitalMunson Medical Center

ProMedica Monroe Regional HospitalSparrow HospitalSt Joseph Mercy - Ann ArborSt Joseph Mercy ChelseaSt Joseph Mercy Livingston HospitalSt Mary MercySt Mary of Michigan HospitalU of M Hospital

Hospital Infrastructure19

Among all participating hospitals the average number of

Licensed beds was 374 (range 25 to 1059 beds)

Inpatient discharges was 17076 (range 1064 to 48916 patients)

Acute stroke discharges (primary diagnosis only) was 417 (range 34 to 982 patients)

Case Demographics MOSAIC Registry

VariablesN() or statistics(Total N=68906)

Age at admission (years)Median 710Range 180 - 1060Mean (SE) 697(01)

GenderMale 32886 (477)Female 36015 (523)

RaceAfrican American 9900 (197)AIAN 132 (03)Asian 320 (06)More than one race 44 (01)Unknown 3679 (73)White 36190 (720)Missing 70

EthnicityHispanic or Latino 804 (16)Others 49531 (984)

VariablesN() or statistics(Total N=68906)

Health insuranceMedicaid 2284 (45)MedicaidPrivate 211 (04)Medicare 16863 (336)Medicare Medicaid 2313 (46)

MedicareMedicaidPrivate125 (02)

MedicarePrivate 13640 (272)ND 268(05)No insurance 2123 (42)Private 12356 (246)

Arrival modeEMS 21052 (429)Private

transportationother19313 (393)

Transfer from another hospital

7733(157)

ND or unknown 1021 (21)Missing 1216

Who receives data reports on your stroke quality of care

21

7055

70

10085

65

40

Hos

pita

lC

EO

up

per

man

agem

ent

Hos

pita

lB

oard

Chi

efN

ursi

ngO

ffice

r(C

NO

)

Str

oke

Tea

m

Phy

sici

anS

trok

eC

ham

pion

Chi

ef o

fM

edic

ine

Oth

er

Data Use

1) In the most recent calendar year have you run additional analyses (beyond what was required for reporting) on your hospitalrsquos own stroke data

2)How frequently have you run and used the analyses generated

22

Yes (N=16) 80

No (N=4) 20Weekly (N=2) 125

Monthly (N=8) 500

Less than monthly but more

than 1-2 times(N=6) 375

Data Use

What is the main reason you do not run your own additional analyses (Select one best answer)

23

Not sure how to run analyses

25

Not sure what analyses are needed would be helpful 25

Other 50

Data Use

In the most recent calendar year what reports did you run

24

813 688

Pre-programmedautomated reports in thedata collection tool (eg GWTG)

Additional reports beyond pre-programmed reports from the tool

Data Use

How do you use these analyses reports

25

813 688375

Inform quality improvement (QI) efforts andor plan

ldquoaction itemsrdquo

Report to management administration on our

progress

Other

Data Use

If you run additional analysis what action items QI efforts did you plan as a result of these reports

26

o Discharge education intensive statin use

o Door to tPA time and dysphagia

o Review data between spoke amp hub hospitals regarding transfers IV-tPA administration Mechanical thrombectomy and SAH

o QI efforts were addressed in the department involving calling Stroke Alert on call for cases with FAST symptoms

o ED Medical Director works with team to fix fallouts and problematic areas We have seen improvement

o Process changes (ie fallout emails to RN manager) physician querieso Increased documentation of NIHSS ownership from individual units regarding stroke quality

improvement goalso Daily dysphagia screening determination of whowhat team responsible for documenting initial NIHSS

looking at patients beyond 2h LKW arrival

Hospital Arrival Mode Door-to Needle and Pre-Notification

Reports 2016

Percent of Cases Who Arrived via EMSMOSAIC 2009-2016

Table 1 Arrival Mode among Stroke Cases by Demographics MOSAIC 2016

Demographics N=3496 550 N=2938 450Stroke Type Ischemic 2558 542 2164 458 Hemorrhagic 560 728 209 272 TIA 378 478 413 522Age Group lt 50 Years 233 433 305 567 50-79 Years 1982 497 2008 503 ge 80 Years 1379 688 625 312Sex Female 1933 576 1422 424 Male 1661 523 1516 477Race Black 659 530 584 470 White 2824 557 2248 443 Other Missing 111 512 106 488

MOSAIC AggregateArrival Mode

EMS Private Mode

Table 2 Door-to-Needle Times by Arrival Mode among Stroke Cases MOSAIC 2016

Time Elements (in Minutes)Number of

Patients Mean (Minutes) Median

(Minutes)Range

(Minutes)Door-to-Image 4901 575 400 00-2700 Arrived via EMS 2767 463 270 00-2700 Arrived via Private Transportation 2134 720 570 00-2620

Door-to-Image (among t-PA treated) 492 155 130 00-970 Arrived via EMS 370 125 110 00-840 Arrived via Private Transportation 122 243 215 20-970Image-to Needle 492 500 450 70-2090 Arrived via EMS 370 503 460 70-2090 Arrived via Private Transportation 122 483 420 90-1770Door-to Needle 492 655 570 200-2180 Arrived via EMS 370 629 560 200-2180 Arrived via Private Transportation 122 726 650 290-2060Included ischemic or hemorrhagic cases with times that were less or equal to 270 minutes (45 hours)Transferred cases were excluded

MOSAIC Aggregate

Table 3 Pre-Notification among Stroke Cases Who Arrived Via EMS by Demographics MOSAIC 2016

Demographics N=2015 584 N=1437 416Stroke Type Ischemic 1523 622 924 378 Hemorrhagic 306 566 235 434 TIA 142 381 231 619Age Group lt 50 Years 133 607 86 393 50-79 Years 1105 585 784 415 ge 80 Years 777 578 567 422Sex Female 1075 578 786 422 Male 940 591 651 409Race Black 307 517 287 483 White 1657 602 1097 398 Other 51 490 53 510

All HospitalsPre-Notification

Yes No

MOSAIC Transitions of Care Project

Post-discharge data collection tool is being implemented into Outcome Science as a tab

Post-Discharge amp Transition of Care

Reporting on changes within 30 days of discharge from hospital via follow-up callschart review Interval events Physician follow-up visits Lifestyle changes Lab assessments Medication managementadherence Rehab amp Functional outcomes Falls

MOSAIC Website

wwwMichigangovstroke

Adrienne Nickles MPHnicklesamichigangov

Thank You

  • Michigan and MOSAIC Data Review
  • Overview
  • Age-adjusted Stroke Hospitalization Rates Michigan 2000-2015
  • Slide Number 4
  • Age-adjusted Stroke Mortality Rates Michigan 2000-2014
  • Slide Number 6
  • Slide Number 7
  • Slide Number 8
  • Slide Number 9
  • Slide Number 10
  • Slide Number 11
  • MOSAIC 2015-2020
  • Pre-hospital Care
  • EMSMOSAIC Data Linkage
  • Slide Number 15
  • GWTG Special Initiatives Tab
  • Slide Number 17
  • MOSAIC Participating Hospitals
  • Hospital Infrastructure
  • Case Demographics MOSAIC Registry
  • Who receives data reports on your stroke quality of care
  • 1) In the most recent calendar year have you run additional analyses (beyond what was required for reporting) on your hospitalrsquos own stroke data 2)How frequently have you run and used the analyses generated
  • What is the main reason you do not run your own additional analyses (Select one best answer)
  • In the most recent calendar year what reports did you run
  • How do you use these analyses reports
  • If you run additional analysis what action items QI efforts did you plan as a result of these reports
  • Hospital Arrival Mode Door-to Needle and Pre-Notification Reports 2016
  • Percent of Cases Who Arrived via EMSMOSAIC 2009-2016
  • Table 1 Arrival Mode among Stroke Cases by Demographics MOSAIC 2016
  • Table 2 Door-to-Needle Times by Arrival Mode among Stroke Cases MOSAIC 2016
  • Table 3 Pre-Notification among Stroke Cases Who Arrived Via EMS by Demographics MOSAIC 2016
  • MOSAIC Transitions of Care Project
  • Slide Number 33
  • MOSAIC Website
  • Adrienne Nickles MPHnicklesamichigangov
Page 38: Michigan and MOSAIC Data Review...Michigan and MOSAIC Data Review 2017 ANNUAL WORKSHOP 4/26/2017. Adrienne Nickles, MPH. Michigan’s Ongoing Stroke Registry to Accelerate the Improvement

233214 212 207

175

10

15

20

25

30

MI 2011 MI 2013 MI 2014 MI 2015 US 2015

Current Smoking

342 346331

309

20

25

30

35

40

MI 2011 MI 2013 MI 2014 MI 2015 US 2015

Blood Pressure Ever told high

342 347 349 351 355

20

25

30

35

40

MI 2011 MI 2013 MI 2014 MI 2015 US 2015

Overweight (BMIgt25)

313 315 307 312298

20

25

30

35

40

MI 2011 MI 2013 MI 2014 MI 2015 US 2015

Obese (BMIgt30)

418406

382364

30

35

40

45

50

MI 2011 MI 2013 MI 2014 MI 2015 US 2015

Cholesterol Ever told high

10 104 104 10710

0

3

6

9

12

15

MI 2011 MI 2013 MI 2014 MI 2015 US 2015

Diabetes

236 244255 255 262

10

15

20

25

30

MI 2011 MI 2013 MI 2014 MI 2015 US 2015

No Leisure Time Physical Activity

11 1216 18

2732tied

05

101520253035404550

CurrentSmoking

CholesterolEver told high

Obese(BMIgt30)

BloodPressure Ever

told high

Diabetes No LeisureTime Physical

Activity

Overweight(BMIgt25)

2015 NATIONAL RANKING(1st is worst)

18tied

MOSAIC 2015-2020 Focus of Grant Developing Stroke Systems of

Care Community Awareness EMS In-hospital QI Transition of Care Post-Discharge

12

Pre-hospital Care

A V A I L A B L E D A T A

13

EMSMOSAIC Data Linkage

-The MOSAIC Team continues to link data from the Michigan EMS Information System (MiEMSIS) to MOSAIC Data- Reports have been created for and reviewed by the

Tri-County Area MCA and Detroit East MCA- This work will expand to other MCA regions that

serve hospitals participating in MOSAIC

GWTG Special Initiatives Tab

-A free tab that can be enabled in GWTG-The purpose of the tab is to collect data concerning patient hand-off from EMS

MOSAIC Participating Hospitals

Aspirus Keweenaw Hospital (Laurium)

Aspirus Grand View HospitalAspirus Iron River HospitalAspirus Ontonagon HospitalBixby Medical CenterBronson Methodist HospitalCovenant Health CareDetroit Receiving HospitalGenesys Regional Medical CenterHenry Ford Hospital Herrick Medical CenterHuron Valley-Sinai HospitalLakeland Regional Medical Center McLaren Bay Regional Medical CenterMcLaren Greater Medical Center

McLaren Macomb HospitalMcLaren Northern MI HospitalMcLaren Oakland Medical CenterMcLaren Port Huron HospitalMcLaren Regional Medical CenterMercy Health Saint Maryrsquos HospitalMetro Health HospitalMunson Medical Center

ProMedica Monroe Regional HospitalSparrow HospitalSt Joseph Mercy - Ann ArborSt Joseph Mercy ChelseaSt Joseph Mercy Livingston HospitalSt Mary MercySt Mary of Michigan HospitalU of M Hospital

Hospital Infrastructure19

Among all participating hospitals the average number of

Licensed beds was 374 (range 25 to 1059 beds)

Inpatient discharges was 17076 (range 1064 to 48916 patients)

Acute stroke discharges (primary diagnosis only) was 417 (range 34 to 982 patients)

Case Demographics MOSAIC Registry

VariablesN() or statistics(Total N=68906)

Age at admission (years)Median 710Range 180 - 1060Mean (SE) 697(01)

GenderMale 32886 (477)Female 36015 (523)

RaceAfrican American 9900 (197)AIAN 132 (03)Asian 320 (06)More than one race 44 (01)Unknown 3679 (73)White 36190 (720)Missing 70

EthnicityHispanic or Latino 804 (16)Others 49531 (984)

VariablesN() or statistics(Total N=68906)

Health insuranceMedicaid 2284 (45)MedicaidPrivate 211 (04)Medicare 16863 (336)Medicare Medicaid 2313 (46)

MedicareMedicaidPrivate125 (02)

MedicarePrivate 13640 (272)ND 268(05)No insurance 2123 (42)Private 12356 (246)

Arrival modeEMS 21052 (429)Private

transportationother19313 (393)

Transfer from another hospital

7733(157)

ND or unknown 1021 (21)Missing 1216

Who receives data reports on your stroke quality of care

21

7055

70

10085

65

40

Hos

pita

lC

EO

up

per

man

agem

ent

Hos

pita

lB

oard

Chi

efN

ursi

ngO

ffice

r(C

NO

)

Str

oke

Tea

m

Phy

sici

anS

trok

eC

ham

pion

Chi

ef o

fM

edic

ine

Oth

er

Data Use

1) In the most recent calendar year have you run additional analyses (beyond what was required for reporting) on your hospitalrsquos own stroke data

2)How frequently have you run and used the analyses generated

22

Yes (N=16) 80

No (N=4) 20Weekly (N=2) 125

Monthly (N=8) 500

Less than monthly but more

than 1-2 times(N=6) 375

Data Use

What is the main reason you do not run your own additional analyses (Select one best answer)

23

Not sure how to run analyses

25

Not sure what analyses are needed would be helpful 25

Other 50

Data Use

In the most recent calendar year what reports did you run

24

813 688

Pre-programmedautomated reports in thedata collection tool (eg GWTG)

Additional reports beyond pre-programmed reports from the tool

Data Use

How do you use these analyses reports

25

813 688375

Inform quality improvement (QI) efforts andor plan

ldquoaction itemsrdquo

Report to management administration on our

progress

Other

Data Use

If you run additional analysis what action items QI efforts did you plan as a result of these reports

26

o Discharge education intensive statin use

o Door to tPA time and dysphagia

o Review data between spoke amp hub hospitals regarding transfers IV-tPA administration Mechanical thrombectomy and SAH

o QI efforts were addressed in the department involving calling Stroke Alert on call for cases with FAST symptoms

o ED Medical Director works with team to fix fallouts and problematic areas We have seen improvement

o Process changes (ie fallout emails to RN manager) physician querieso Increased documentation of NIHSS ownership from individual units regarding stroke quality

improvement goalso Daily dysphagia screening determination of whowhat team responsible for documenting initial NIHSS

looking at patients beyond 2h LKW arrival

Hospital Arrival Mode Door-to Needle and Pre-Notification

Reports 2016

Percent of Cases Who Arrived via EMSMOSAIC 2009-2016

Table 1 Arrival Mode among Stroke Cases by Demographics MOSAIC 2016

Demographics N=3496 550 N=2938 450Stroke Type Ischemic 2558 542 2164 458 Hemorrhagic 560 728 209 272 TIA 378 478 413 522Age Group lt 50 Years 233 433 305 567 50-79 Years 1982 497 2008 503 ge 80 Years 1379 688 625 312Sex Female 1933 576 1422 424 Male 1661 523 1516 477Race Black 659 530 584 470 White 2824 557 2248 443 Other Missing 111 512 106 488

MOSAIC AggregateArrival Mode

EMS Private Mode

Table 2 Door-to-Needle Times by Arrival Mode among Stroke Cases MOSAIC 2016

Time Elements (in Minutes)Number of

Patients Mean (Minutes) Median

(Minutes)Range

(Minutes)Door-to-Image 4901 575 400 00-2700 Arrived via EMS 2767 463 270 00-2700 Arrived via Private Transportation 2134 720 570 00-2620

Door-to-Image (among t-PA treated) 492 155 130 00-970 Arrived via EMS 370 125 110 00-840 Arrived via Private Transportation 122 243 215 20-970Image-to Needle 492 500 450 70-2090 Arrived via EMS 370 503 460 70-2090 Arrived via Private Transportation 122 483 420 90-1770Door-to Needle 492 655 570 200-2180 Arrived via EMS 370 629 560 200-2180 Arrived via Private Transportation 122 726 650 290-2060Included ischemic or hemorrhagic cases with times that were less or equal to 270 minutes (45 hours)Transferred cases were excluded

MOSAIC Aggregate

Table 3 Pre-Notification among Stroke Cases Who Arrived Via EMS by Demographics MOSAIC 2016

Demographics N=2015 584 N=1437 416Stroke Type Ischemic 1523 622 924 378 Hemorrhagic 306 566 235 434 TIA 142 381 231 619Age Group lt 50 Years 133 607 86 393 50-79 Years 1105 585 784 415 ge 80 Years 777 578 567 422Sex Female 1075 578 786 422 Male 940 591 651 409Race Black 307 517 287 483 White 1657 602 1097 398 Other 51 490 53 510

All HospitalsPre-Notification

Yes No

MOSAIC Transitions of Care Project

Post-discharge data collection tool is being implemented into Outcome Science as a tab

Post-Discharge amp Transition of Care

Reporting on changes within 30 days of discharge from hospital via follow-up callschart review Interval events Physician follow-up visits Lifestyle changes Lab assessments Medication managementadherence Rehab amp Functional outcomes Falls

MOSAIC Website

wwwMichigangovstroke

Adrienne Nickles MPHnicklesamichigangov

Thank You

  • Michigan and MOSAIC Data Review
  • Overview
  • Age-adjusted Stroke Hospitalization Rates Michigan 2000-2015
  • Slide Number 4
  • Age-adjusted Stroke Mortality Rates Michigan 2000-2014
  • Slide Number 6
  • Slide Number 7
  • Slide Number 8
  • Slide Number 9
  • Slide Number 10
  • Slide Number 11
  • MOSAIC 2015-2020
  • Pre-hospital Care
  • EMSMOSAIC Data Linkage
  • Slide Number 15
  • GWTG Special Initiatives Tab
  • Slide Number 17
  • MOSAIC Participating Hospitals
  • Hospital Infrastructure
  • Case Demographics MOSAIC Registry
  • Who receives data reports on your stroke quality of care
  • 1) In the most recent calendar year have you run additional analyses (beyond what was required for reporting) on your hospitalrsquos own stroke data 2)How frequently have you run and used the analyses generated
  • What is the main reason you do not run your own additional analyses (Select one best answer)
  • In the most recent calendar year what reports did you run
  • How do you use these analyses reports
  • If you run additional analysis what action items QI efforts did you plan as a result of these reports
  • Hospital Arrival Mode Door-to Needle and Pre-Notification Reports 2016
  • Percent of Cases Who Arrived via EMSMOSAIC 2009-2016
  • Table 1 Arrival Mode among Stroke Cases by Demographics MOSAIC 2016
  • Table 2 Door-to-Needle Times by Arrival Mode among Stroke Cases MOSAIC 2016
  • Table 3 Pre-Notification among Stroke Cases Who Arrived Via EMS by Demographics MOSAIC 2016
  • MOSAIC Transitions of Care Project
  • Slide Number 33
  • MOSAIC Website
  • Adrienne Nickles MPHnicklesamichigangov
Page 39: Michigan and MOSAIC Data Review...Michigan and MOSAIC Data Review 2017 ANNUAL WORKSHOP 4/26/2017. Adrienne Nickles, MPH. Michigan’s Ongoing Stroke Registry to Accelerate the Improvement

342 347 349 351 355

20

25

30

35

40

MI 2011 MI 2013 MI 2014 MI 2015 US 2015

Overweight (BMIgt25)

313 315 307 312298

20

25

30

35

40

MI 2011 MI 2013 MI 2014 MI 2015 US 2015

Obese (BMIgt30)

418406

382364

30

35

40

45

50

MI 2011 MI 2013 MI 2014 MI 2015 US 2015

Cholesterol Ever told high

10 104 104 10710

0

3

6

9

12

15

MI 2011 MI 2013 MI 2014 MI 2015 US 2015

Diabetes

236 244255 255 262

10

15

20

25

30

MI 2011 MI 2013 MI 2014 MI 2015 US 2015

No Leisure Time Physical Activity

11 1216 18

2732tied

05

101520253035404550

CurrentSmoking

CholesterolEver told high

Obese(BMIgt30)

BloodPressure Ever

told high

Diabetes No LeisureTime Physical

Activity

Overweight(BMIgt25)

2015 NATIONAL RANKING(1st is worst)

18tied

MOSAIC 2015-2020 Focus of Grant Developing Stroke Systems of

Care Community Awareness EMS In-hospital QI Transition of Care Post-Discharge

12

Pre-hospital Care

A V A I L A B L E D A T A

13

EMSMOSAIC Data Linkage

-The MOSAIC Team continues to link data from the Michigan EMS Information System (MiEMSIS) to MOSAIC Data- Reports have been created for and reviewed by the

Tri-County Area MCA and Detroit East MCA- This work will expand to other MCA regions that

serve hospitals participating in MOSAIC

GWTG Special Initiatives Tab

-A free tab that can be enabled in GWTG-The purpose of the tab is to collect data concerning patient hand-off from EMS

MOSAIC Participating Hospitals

Aspirus Keweenaw Hospital (Laurium)

Aspirus Grand View HospitalAspirus Iron River HospitalAspirus Ontonagon HospitalBixby Medical CenterBronson Methodist HospitalCovenant Health CareDetroit Receiving HospitalGenesys Regional Medical CenterHenry Ford Hospital Herrick Medical CenterHuron Valley-Sinai HospitalLakeland Regional Medical Center McLaren Bay Regional Medical CenterMcLaren Greater Medical Center

McLaren Macomb HospitalMcLaren Northern MI HospitalMcLaren Oakland Medical CenterMcLaren Port Huron HospitalMcLaren Regional Medical CenterMercy Health Saint Maryrsquos HospitalMetro Health HospitalMunson Medical Center

ProMedica Monroe Regional HospitalSparrow HospitalSt Joseph Mercy - Ann ArborSt Joseph Mercy ChelseaSt Joseph Mercy Livingston HospitalSt Mary MercySt Mary of Michigan HospitalU of M Hospital

Hospital Infrastructure19

Among all participating hospitals the average number of

Licensed beds was 374 (range 25 to 1059 beds)

Inpatient discharges was 17076 (range 1064 to 48916 patients)

Acute stroke discharges (primary diagnosis only) was 417 (range 34 to 982 patients)

Case Demographics MOSAIC Registry

VariablesN() or statistics(Total N=68906)

Age at admission (years)Median 710Range 180 - 1060Mean (SE) 697(01)

GenderMale 32886 (477)Female 36015 (523)

RaceAfrican American 9900 (197)AIAN 132 (03)Asian 320 (06)More than one race 44 (01)Unknown 3679 (73)White 36190 (720)Missing 70

EthnicityHispanic or Latino 804 (16)Others 49531 (984)

VariablesN() or statistics(Total N=68906)

Health insuranceMedicaid 2284 (45)MedicaidPrivate 211 (04)Medicare 16863 (336)Medicare Medicaid 2313 (46)

MedicareMedicaidPrivate125 (02)

MedicarePrivate 13640 (272)ND 268(05)No insurance 2123 (42)Private 12356 (246)

Arrival modeEMS 21052 (429)Private

transportationother19313 (393)

Transfer from another hospital

7733(157)

ND or unknown 1021 (21)Missing 1216

Who receives data reports on your stroke quality of care

21

7055

70

10085

65

40

Hos

pita

lC

EO

up

per

man

agem

ent

Hos

pita

lB

oard

Chi

efN

ursi

ngO

ffice

r(C

NO

)

Str

oke

Tea

m

Phy

sici

anS

trok

eC

ham

pion

Chi

ef o

fM

edic

ine

Oth

er

Data Use

1) In the most recent calendar year have you run additional analyses (beyond what was required for reporting) on your hospitalrsquos own stroke data

2)How frequently have you run and used the analyses generated

22

Yes (N=16) 80

No (N=4) 20Weekly (N=2) 125

Monthly (N=8) 500

Less than monthly but more

than 1-2 times(N=6) 375

Data Use

What is the main reason you do not run your own additional analyses (Select one best answer)

23

Not sure how to run analyses

25

Not sure what analyses are needed would be helpful 25

Other 50

Data Use

In the most recent calendar year what reports did you run

24

813 688

Pre-programmedautomated reports in thedata collection tool (eg GWTG)

Additional reports beyond pre-programmed reports from the tool

Data Use

How do you use these analyses reports

25

813 688375

Inform quality improvement (QI) efforts andor plan

ldquoaction itemsrdquo

Report to management administration on our

progress

Other

Data Use

If you run additional analysis what action items QI efforts did you plan as a result of these reports

26

o Discharge education intensive statin use

o Door to tPA time and dysphagia

o Review data between spoke amp hub hospitals regarding transfers IV-tPA administration Mechanical thrombectomy and SAH

o QI efforts were addressed in the department involving calling Stroke Alert on call for cases with FAST symptoms

o ED Medical Director works with team to fix fallouts and problematic areas We have seen improvement

o Process changes (ie fallout emails to RN manager) physician querieso Increased documentation of NIHSS ownership from individual units regarding stroke quality

improvement goalso Daily dysphagia screening determination of whowhat team responsible for documenting initial NIHSS

looking at patients beyond 2h LKW arrival

Hospital Arrival Mode Door-to Needle and Pre-Notification

Reports 2016

Percent of Cases Who Arrived via EMSMOSAIC 2009-2016

Table 1 Arrival Mode among Stroke Cases by Demographics MOSAIC 2016

Demographics N=3496 550 N=2938 450Stroke Type Ischemic 2558 542 2164 458 Hemorrhagic 560 728 209 272 TIA 378 478 413 522Age Group lt 50 Years 233 433 305 567 50-79 Years 1982 497 2008 503 ge 80 Years 1379 688 625 312Sex Female 1933 576 1422 424 Male 1661 523 1516 477Race Black 659 530 584 470 White 2824 557 2248 443 Other Missing 111 512 106 488

MOSAIC AggregateArrival Mode

EMS Private Mode

Table 2 Door-to-Needle Times by Arrival Mode among Stroke Cases MOSAIC 2016

Time Elements (in Minutes)Number of

Patients Mean (Minutes) Median

(Minutes)Range

(Minutes)Door-to-Image 4901 575 400 00-2700 Arrived via EMS 2767 463 270 00-2700 Arrived via Private Transportation 2134 720 570 00-2620

Door-to-Image (among t-PA treated) 492 155 130 00-970 Arrived via EMS 370 125 110 00-840 Arrived via Private Transportation 122 243 215 20-970Image-to Needle 492 500 450 70-2090 Arrived via EMS 370 503 460 70-2090 Arrived via Private Transportation 122 483 420 90-1770Door-to Needle 492 655 570 200-2180 Arrived via EMS 370 629 560 200-2180 Arrived via Private Transportation 122 726 650 290-2060Included ischemic or hemorrhagic cases with times that were less or equal to 270 minutes (45 hours)Transferred cases were excluded

MOSAIC Aggregate

Table 3 Pre-Notification among Stroke Cases Who Arrived Via EMS by Demographics MOSAIC 2016

Demographics N=2015 584 N=1437 416Stroke Type Ischemic 1523 622 924 378 Hemorrhagic 306 566 235 434 TIA 142 381 231 619Age Group lt 50 Years 133 607 86 393 50-79 Years 1105 585 784 415 ge 80 Years 777 578 567 422Sex Female 1075 578 786 422 Male 940 591 651 409Race Black 307 517 287 483 White 1657 602 1097 398 Other 51 490 53 510

All HospitalsPre-Notification

Yes No

MOSAIC Transitions of Care Project

Post-discharge data collection tool is being implemented into Outcome Science as a tab

Post-Discharge amp Transition of Care

Reporting on changes within 30 days of discharge from hospital via follow-up callschart review Interval events Physician follow-up visits Lifestyle changes Lab assessments Medication managementadherence Rehab amp Functional outcomes Falls

MOSAIC Website

wwwMichigangovstroke

Adrienne Nickles MPHnicklesamichigangov

Thank You

  • Michigan and MOSAIC Data Review
  • Overview
  • Age-adjusted Stroke Hospitalization Rates Michigan 2000-2015
  • Slide Number 4
  • Age-adjusted Stroke Mortality Rates Michigan 2000-2014
  • Slide Number 6
  • Slide Number 7
  • Slide Number 8
  • Slide Number 9
  • Slide Number 10
  • Slide Number 11
  • MOSAIC 2015-2020
  • Pre-hospital Care
  • EMSMOSAIC Data Linkage
  • Slide Number 15
  • GWTG Special Initiatives Tab
  • Slide Number 17
  • MOSAIC Participating Hospitals
  • Hospital Infrastructure
  • Case Demographics MOSAIC Registry
  • Who receives data reports on your stroke quality of care
  • 1) In the most recent calendar year have you run additional analyses (beyond what was required for reporting) on your hospitalrsquos own stroke data 2)How frequently have you run and used the analyses generated
  • What is the main reason you do not run your own additional analyses (Select one best answer)
  • In the most recent calendar year what reports did you run
  • How do you use these analyses reports
  • If you run additional analysis what action items QI efforts did you plan as a result of these reports
  • Hospital Arrival Mode Door-to Needle and Pre-Notification Reports 2016
  • Percent of Cases Who Arrived via EMSMOSAIC 2009-2016
  • Table 1 Arrival Mode among Stroke Cases by Demographics MOSAIC 2016
  • Table 2 Door-to-Needle Times by Arrival Mode among Stroke Cases MOSAIC 2016
  • Table 3 Pre-Notification among Stroke Cases Who Arrived Via EMS by Demographics MOSAIC 2016
  • MOSAIC Transitions of Care Project
  • Slide Number 33
  • MOSAIC Website
  • Adrienne Nickles MPHnicklesamichigangov
Page 40: Michigan and MOSAIC Data Review...Michigan and MOSAIC Data Review 2017 ANNUAL WORKSHOP 4/26/2017. Adrienne Nickles, MPH. Michigan’s Ongoing Stroke Registry to Accelerate the Improvement

418406

382364

30

35

40

45

50

MI 2011 MI 2013 MI 2014 MI 2015 US 2015

Cholesterol Ever told high

10 104 104 10710

0

3

6

9

12

15

MI 2011 MI 2013 MI 2014 MI 2015 US 2015

Diabetes

236 244255 255 262

10

15

20

25

30

MI 2011 MI 2013 MI 2014 MI 2015 US 2015

No Leisure Time Physical Activity

11 1216 18

2732tied

05

101520253035404550

CurrentSmoking

CholesterolEver told high

Obese(BMIgt30)

BloodPressure Ever

told high

Diabetes No LeisureTime Physical

Activity

Overweight(BMIgt25)

2015 NATIONAL RANKING(1st is worst)

18tied

MOSAIC 2015-2020 Focus of Grant Developing Stroke Systems of

Care Community Awareness EMS In-hospital QI Transition of Care Post-Discharge

12

Pre-hospital Care

A V A I L A B L E D A T A

13

EMSMOSAIC Data Linkage

-The MOSAIC Team continues to link data from the Michigan EMS Information System (MiEMSIS) to MOSAIC Data- Reports have been created for and reviewed by the

Tri-County Area MCA and Detroit East MCA- This work will expand to other MCA regions that

serve hospitals participating in MOSAIC

GWTG Special Initiatives Tab

-A free tab that can be enabled in GWTG-The purpose of the tab is to collect data concerning patient hand-off from EMS

MOSAIC Participating Hospitals

Aspirus Keweenaw Hospital (Laurium)

Aspirus Grand View HospitalAspirus Iron River HospitalAspirus Ontonagon HospitalBixby Medical CenterBronson Methodist HospitalCovenant Health CareDetroit Receiving HospitalGenesys Regional Medical CenterHenry Ford Hospital Herrick Medical CenterHuron Valley-Sinai HospitalLakeland Regional Medical Center McLaren Bay Regional Medical CenterMcLaren Greater Medical Center

McLaren Macomb HospitalMcLaren Northern MI HospitalMcLaren Oakland Medical CenterMcLaren Port Huron HospitalMcLaren Regional Medical CenterMercy Health Saint Maryrsquos HospitalMetro Health HospitalMunson Medical Center

ProMedica Monroe Regional HospitalSparrow HospitalSt Joseph Mercy - Ann ArborSt Joseph Mercy ChelseaSt Joseph Mercy Livingston HospitalSt Mary MercySt Mary of Michigan HospitalU of M Hospital

Hospital Infrastructure19

Among all participating hospitals the average number of

Licensed beds was 374 (range 25 to 1059 beds)

Inpatient discharges was 17076 (range 1064 to 48916 patients)

Acute stroke discharges (primary diagnosis only) was 417 (range 34 to 982 patients)

Case Demographics MOSAIC Registry

VariablesN() or statistics(Total N=68906)

Age at admission (years)Median 710Range 180 - 1060Mean (SE) 697(01)

GenderMale 32886 (477)Female 36015 (523)

RaceAfrican American 9900 (197)AIAN 132 (03)Asian 320 (06)More than one race 44 (01)Unknown 3679 (73)White 36190 (720)Missing 70

EthnicityHispanic or Latino 804 (16)Others 49531 (984)

VariablesN() or statistics(Total N=68906)

Health insuranceMedicaid 2284 (45)MedicaidPrivate 211 (04)Medicare 16863 (336)Medicare Medicaid 2313 (46)

MedicareMedicaidPrivate125 (02)

MedicarePrivate 13640 (272)ND 268(05)No insurance 2123 (42)Private 12356 (246)

Arrival modeEMS 21052 (429)Private

transportationother19313 (393)

Transfer from another hospital

7733(157)

ND or unknown 1021 (21)Missing 1216

Who receives data reports on your stroke quality of care

21

7055

70

10085

65

40

Hos

pita

lC

EO

up

per

man

agem

ent

Hos

pita

lB

oard

Chi

efN

ursi

ngO

ffice

r(C

NO

)

Str

oke

Tea

m

Phy

sici

anS

trok

eC

ham

pion

Chi

ef o

fM

edic

ine

Oth

er

Data Use

1) In the most recent calendar year have you run additional analyses (beyond what was required for reporting) on your hospitalrsquos own stroke data

2)How frequently have you run and used the analyses generated

22

Yes (N=16) 80

No (N=4) 20Weekly (N=2) 125

Monthly (N=8) 500

Less than monthly but more

than 1-2 times(N=6) 375

Data Use

What is the main reason you do not run your own additional analyses (Select one best answer)

23

Not sure how to run analyses

25

Not sure what analyses are needed would be helpful 25

Other 50

Data Use

In the most recent calendar year what reports did you run

24

813 688

Pre-programmedautomated reports in thedata collection tool (eg GWTG)

Additional reports beyond pre-programmed reports from the tool

Data Use

How do you use these analyses reports

25

813 688375

Inform quality improvement (QI) efforts andor plan

ldquoaction itemsrdquo

Report to management administration on our

progress

Other

Data Use

If you run additional analysis what action items QI efforts did you plan as a result of these reports

26

o Discharge education intensive statin use

o Door to tPA time and dysphagia

o Review data between spoke amp hub hospitals regarding transfers IV-tPA administration Mechanical thrombectomy and SAH

o QI efforts were addressed in the department involving calling Stroke Alert on call for cases with FAST symptoms

o ED Medical Director works with team to fix fallouts and problematic areas We have seen improvement

o Process changes (ie fallout emails to RN manager) physician querieso Increased documentation of NIHSS ownership from individual units regarding stroke quality

improvement goalso Daily dysphagia screening determination of whowhat team responsible for documenting initial NIHSS

looking at patients beyond 2h LKW arrival

Hospital Arrival Mode Door-to Needle and Pre-Notification

Reports 2016

Percent of Cases Who Arrived via EMSMOSAIC 2009-2016

Table 1 Arrival Mode among Stroke Cases by Demographics MOSAIC 2016

Demographics N=3496 550 N=2938 450Stroke Type Ischemic 2558 542 2164 458 Hemorrhagic 560 728 209 272 TIA 378 478 413 522Age Group lt 50 Years 233 433 305 567 50-79 Years 1982 497 2008 503 ge 80 Years 1379 688 625 312Sex Female 1933 576 1422 424 Male 1661 523 1516 477Race Black 659 530 584 470 White 2824 557 2248 443 Other Missing 111 512 106 488

MOSAIC AggregateArrival Mode

EMS Private Mode

Table 2 Door-to-Needle Times by Arrival Mode among Stroke Cases MOSAIC 2016

Time Elements (in Minutes)Number of

Patients Mean (Minutes) Median

(Minutes)Range

(Minutes)Door-to-Image 4901 575 400 00-2700 Arrived via EMS 2767 463 270 00-2700 Arrived via Private Transportation 2134 720 570 00-2620

Door-to-Image (among t-PA treated) 492 155 130 00-970 Arrived via EMS 370 125 110 00-840 Arrived via Private Transportation 122 243 215 20-970Image-to Needle 492 500 450 70-2090 Arrived via EMS 370 503 460 70-2090 Arrived via Private Transportation 122 483 420 90-1770Door-to Needle 492 655 570 200-2180 Arrived via EMS 370 629 560 200-2180 Arrived via Private Transportation 122 726 650 290-2060Included ischemic or hemorrhagic cases with times that were less or equal to 270 minutes (45 hours)Transferred cases were excluded

MOSAIC Aggregate

Table 3 Pre-Notification among Stroke Cases Who Arrived Via EMS by Demographics MOSAIC 2016

Demographics N=2015 584 N=1437 416Stroke Type Ischemic 1523 622 924 378 Hemorrhagic 306 566 235 434 TIA 142 381 231 619Age Group lt 50 Years 133 607 86 393 50-79 Years 1105 585 784 415 ge 80 Years 777 578 567 422Sex Female 1075 578 786 422 Male 940 591 651 409Race Black 307 517 287 483 White 1657 602 1097 398 Other 51 490 53 510

All HospitalsPre-Notification

Yes No

MOSAIC Transitions of Care Project

Post-discharge data collection tool is being implemented into Outcome Science as a tab

Post-Discharge amp Transition of Care

Reporting on changes within 30 days of discharge from hospital via follow-up callschart review Interval events Physician follow-up visits Lifestyle changes Lab assessments Medication managementadherence Rehab amp Functional outcomes Falls

MOSAIC Website

wwwMichigangovstroke

Adrienne Nickles MPHnicklesamichigangov

Thank You

  • Michigan and MOSAIC Data Review
  • Overview
  • Age-adjusted Stroke Hospitalization Rates Michigan 2000-2015
  • Slide Number 4
  • Age-adjusted Stroke Mortality Rates Michigan 2000-2014
  • Slide Number 6
  • Slide Number 7
  • Slide Number 8
  • Slide Number 9
  • Slide Number 10
  • Slide Number 11
  • MOSAIC 2015-2020
  • Pre-hospital Care
  • EMSMOSAIC Data Linkage
  • Slide Number 15
  • GWTG Special Initiatives Tab
  • Slide Number 17
  • MOSAIC Participating Hospitals
  • Hospital Infrastructure
  • Case Demographics MOSAIC Registry
  • Who receives data reports on your stroke quality of care
  • 1) In the most recent calendar year have you run additional analyses (beyond what was required for reporting) on your hospitalrsquos own stroke data 2)How frequently have you run and used the analyses generated
  • What is the main reason you do not run your own additional analyses (Select one best answer)
  • In the most recent calendar year what reports did you run
  • How do you use these analyses reports
  • If you run additional analysis what action items QI efforts did you plan as a result of these reports
  • Hospital Arrival Mode Door-to Needle and Pre-Notification Reports 2016
  • Percent of Cases Who Arrived via EMSMOSAIC 2009-2016
  • Table 1 Arrival Mode among Stroke Cases by Demographics MOSAIC 2016
  • Table 2 Door-to-Needle Times by Arrival Mode among Stroke Cases MOSAIC 2016
  • Table 3 Pre-Notification among Stroke Cases Who Arrived Via EMS by Demographics MOSAIC 2016
  • MOSAIC Transitions of Care Project
  • Slide Number 33
  • MOSAIC Website
  • Adrienne Nickles MPHnicklesamichigangov
Page 41: Michigan and MOSAIC Data Review...Michigan and MOSAIC Data Review 2017 ANNUAL WORKSHOP 4/26/2017. Adrienne Nickles, MPH. Michigan’s Ongoing Stroke Registry to Accelerate the Improvement

236 244255 255 262

10

15

20

25

30

MI 2011 MI 2013 MI 2014 MI 2015 US 2015

No Leisure Time Physical Activity

11 1216 18

2732tied

05

101520253035404550

CurrentSmoking

CholesterolEver told high

Obese(BMIgt30)

BloodPressure Ever

told high

Diabetes No LeisureTime Physical

Activity

Overweight(BMIgt25)

2015 NATIONAL RANKING(1st is worst)

18tied

MOSAIC 2015-2020 Focus of Grant Developing Stroke Systems of

Care Community Awareness EMS In-hospital QI Transition of Care Post-Discharge

12

Pre-hospital Care

A V A I L A B L E D A T A

13

EMSMOSAIC Data Linkage

-The MOSAIC Team continues to link data from the Michigan EMS Information System (MiEMSIS) to MOSAIC Data- Reports have been created for and reviewed by the

Tri-County Area MCA and Detroit East MCA- This work will expand to other MCA regions that

serve hospitals participating in MOSAIC

GWTG Special Initiatives Tab

-A free tab that can be enabled in GWTG-The purpose of the tab is to collect data concerning patient hand-off from EMS

MOSAIC Participating Hospitals

Aspirus Keweenaw Hospital (Laurium)

Aspirus Grand View HospitalAspirus Iron River HospitalAspirus Ontonagon HospitalBixby Medical CenterBronson Methodist HospitalCovenant Health CareDetroit Receiving HospitalGenesys Regional Medical CenterHenry Ford Hospital Herrick Medical CenterHuron Valley-Sinai HospitalLakeland Regional Medical Center McLaren Bay Regional Medical CenterMcLaren Greater Medical Center

McLaren Macomb HospitalMcLaren Northern MI HospitalMcLaren Oakland Medical CenterMcLaren Port Huron HospitalMcLaren Regional Medical CenterMercy Health Saint Maryrsquos HospitalMetro Health HospitalMunson Medical Center

ProMedica Monroe Regional HospitalSparrow HospitalSt Joseph Mercy - Ann ArborSt Joseph Mercy ChelseaSt Joseph Mercy Livingston HospitalSt Mary MercySt Mary of Michigan HospitalU of M Hospital

Hospital Infrastructure19

Among all participating hospitals the average number of

Licensed beds was 374 (range 25 to 1059 beds)

Inpatient discharges was 17076 (range 1064 to 48916 patients)

Acute stroke discharges (primary diagnosis only) was 417 (range 34 to 982 patients)

Case Demographics MOSAIC Registry

VariablesN() or statistics(Total N=68906)

Age at admission (years)Median 710Range 180 - 1060Mean (SE) 697(01)

GenderMale 32886 (477)Female 36015 (523)

RaceAfrican American 9900 (197)AIAN 132 (03)Asian 320 (06)More than one race 44 (01)Unknown 3679 (73)White 36190 (720)Missing 70

EthnicityHispanic or Latino 804 (16)Others 49531 (984)

VariablesN() or statistics(Total N=68906)

Health insuranceMedicaid 2284 (45)MedicaidPrivate 211 (04)Medicare 16863 (336)Medicare Medicaid 2313 (46)

MedicareMedicaidPrivate125 (02)

MedicarePrivate 13640 (272)ND 268(05)No insurance 2123 (42)Private 12356 (246)

Arrival modeEMS 21052 (429)Private

transportationother19313 (393)

Transfer from another hospital

7733(157)

ND or unknown 1021 (21)Missing 1216

Who receives data reports on your stroke quality of care

21

7055

70

10085

65

40

Hos

pita

lC

EO

up

per

man

agem

ent

Hos

pita

lB

oard

Chi

efN

ursi

ngO

ffice

r(C

NO

)

Str

oke

Tea

m

Phy

sici

anS

trok

eC

ham

pion

Chi

ef o

fM

edic

ine

Oth

er

Data Use

1) In the most recent calendar year have you run additional analyses (beyond what was required for reporting) on your hospitalrsquos own stroke data

2)How frequently have you run and used the analyses generated

22

Yes (N=16) 80

No (N=4) 20Weekly (N=2) 125

Monthly (N=8) 500

Less than monthly but more

than 1-2 times(N=6) 375

Data Use

What is the main reason you do not run your own additional analyses (Select one best answer)

23

Not sure how to run analyses

25

Not sure what analyses are needed would be helpful 25

Other 50

Data Use

In the most recent calendar year what reports did you run

24

813 688

Pre-programmedautomated reports in thedata collection tool (eg GWTG)

Additional reports beyond pre-programmed reports from the tool

Data Use

How do you use these analyses reports

25

813 688375

Inform quality improvement (QI) efforts andor plan

ldquoaction itemsrdquo

Report to management administration on our

progress

Other

Data Use

If you run additional analysis what action items QI efforts did you plan as a result of these reports

26

o Discharge education intensive statin use

o Door to tPA time and dysphagia

o Review data between spoke amp hub hospitals regarding transfers IV-tPA administration Mechanical thrombectomy and SAH

o QI efforts were addressed in the department involving calling Stroke Alert on call for cases with FAST symptoms

o ED Medical Director works with team to fix fallouts and problematic areas We have seen improvement

o Process changes (ie fallout emails to RN manager) physician querieso Increased documentation of NIHSS ownership from individual units regarding stroke quality

improvement goalso Daily dysphagia screening determination of whowhat team responsible for documenting initial NIHSS

looking at patients beyond 2h LKW arrival

Hospital Arrival Mode Door-to Needle and Pre-Notification

Reports 2016

Percent of Cases Who Arrived via EMSMOSAIC 2009-2016

Table 1 Arrival Mode among Stroke Cases by Demographics MOSAIC 2016

Demographics N=3496 550 N=2938 450Stroke Type Ischemic 2558 542 2164 458 Hemorrhagic 560 728 209 272 TIA 378 478 413 522Age Group lt 50 Years 233 433 305 567 50-79 Years 1982 497 2008 503 ge 80 Years 1379 688 625 312Sex Female 1933 576 1422 424 Male 1661 523 1516 477Race Black 659 530 584 470 White 2824 557 2248 443 Other Missing 111 512 106 488

MOSAIC AggregateArrival Mode

EMS Private Mode

Table 2 Door-to-Needle Times by Arrival Mode among Stroke Cases MOSAIC 2016

Time Elements (in Minutes)Number of

Patients Mean (Minutes) Median

(Minutes)Range

(Minutes)Door-to-Image 4901 575 400 00-2700 Arrived via EMS 2767 463 270 00-2700 Arrived via Private Transportation 2134 720 570 00-2620

Door-to-Image (among t-PA treated) 492 155 130 00-970 Arrived via EMS 370 125 110 00-840 Arrived via Private Transportation 122 243 215 20-970Image-to Needle 492 500 450 70-2090 Arrived via EMS 370 503 460 70-2090 Arrived via Private Transportation 122 483 420 90-1770Door-to Needle 492 655 570 200-2180 Arrived via EMS 370 629 560 200-2180 Arrived via Private Transportation 122 726 650 290-2060Included ischemic or hemorrhagic cases with times that were less or equal to 270 minutes (45 hours)Transferred cases were excluded

MOSAIC Aggregate

Table 3 Pre-Notification among Stroke Cases Who Arrived Via EMS by Demographics MOSAIC 2016

Demographics N=2015 584 N=1437 416Stroke Type Ischemic 1523 622 924 378 Hemorrhagic 306 566 235 434 TIA 142 381 231 619Age Group lt 50 Years 133 607 86 393 50-79 Years 1105 585 784 415 ge 80 Years 777 578 567 422Sex Female 1075 578 786 422 Male 940 591 651 409Race Black 307 517 287 483 White 1657 602 1097 398 Other 51 490 53 510

All HospitalsPre-Notification

Yes No

MOSAIC Transitions of Care Project

Post-discharge data collection tool is being implemented into Outcome Science as a tab

Post-Discharge amp Transition of Care

Reporting on changes within 30 days of discharge from hospital via follow-up callschart review Interval events Physician follow-up visits Lifestyle changes Lab assessments Medication managementadherence Rehab amp Functional outcomes Falls

MOSAIC Website

wwwMichigangovstroke

Adrienne Nickles MPHnicklesamichigangov

Thank You

  • Michigan and MOSAIC Data Review
  • Overview
  • Age-adjusted Stroke Hospitalization Rates Michigan 2000-2015
  • Slide Number 4
  • Age-adjusted Stroke Mortality Rates Michigan 2000-2014
  • Slide Number 6
  • Slide Number 7
  • Slide Number 8
  • Slide Number 9
  • Slide Number 10
  • Slide Number 11
  • MOSAIC 2015-2020
  • Pre-hospital Care
  • EMSMOSAIC Data Linkage
  • Slide Number 15
  • GWTG Special Initiatives Tab
  • Slide Number 17
  • MOSAIC Participating Hospitals
  • Hospital Infrastructure
  • Case Demographics MOSAIC Registry
  • Who receives data reports on your stroke quality of care
  • 1) In the most recent calendar year have you run additional analyses (beyond what was required for reporting) on your hospitalrsquos own stroke data 2)How frequently have you run and used the analyses generated
  • What is the main reason you do not run your own additional analyses (Select one best answer)
  • In the most recent calendar year what reports did you run
  • How do you use these analyses reports
  • If you run additional analysis what action items QI efforts did you plan as a result of these reports
  • Hospital Arrival Mode Door-to Needle and Pre-Notification Reports 2016
  • Percent of Cases Who Arrived via EMSMOSAIC 2009-2016
  • Table 1 Arrival Mode among Stroke Cases by Demographics MOSAIC 2016
  • Table 2 Door-to-Needle Times by Arrival Mode among Stroke Cases MOSAIC 2016
  • Table 3 Pre-Notification among Stroke Cases Who Arrived Via EMS by Demographics MOSAIC 2016
  • MOSAIC Transitions of Care Project
  • Slide Number 33
  • MOSAIC Website
  • Adrienne Nickles MPHnicklesamichigangov
Page 42: Michigan and MOSAIC Data Review...Michigan and MOSAIC Data Review 2017 ANNUAL WORKSHOP 4/26/2017. Adrienne Nickles, MPH. Michigan’s Ongoing Stroke Registry to Accelerate the Improvement

MOSAIC 2015-2020 Focus of Grant Developing Stroke Systems of

Care Community Awareness EMS In-hospital QI Transition of Care Post-Discharge

12

Pre-hospital Care

A V A I L A B L E D A T A

13

EMSMOSAIC Data Linkage

-The MOSAIC Team continues to link data from the Michigan EMS Information System (MiEMSIS) to MOSAIC Data- Reports have been created for and reviewed by the

Tri-County Area MCA and Detroit East MCA- This work will expand to other MCA regions that

serve hospitals participating in MOSAIC

GWTG Special Initiatives Tab

-A free tab that can be enabled in GWTG-The purpose of the tab is to collect data concerning patient hand-off from EMS

MOSAIC Participating Hospitals

Aspirus Keweenaw Hospital (Laurium)

Aspirus Grand View HospitalAspirus Iron River HospitalAspirus Ontonagon HospitalBixby Medical CenterBronson Methodist HospitalCovenant Health CareDetroit Receiving HospitalGenesys Regional Medical CenterHenry Ford Hospital Herrick Medical CenterHuron Valley-Sinai HospitalLakeland Regional Medical Center McLaren Bay Regional Medical CenterMcLaren Greater Medical Center

McLaren Macomb HospitalMcLaren Northern MI HospitalMcLaren Oakland Medical CenterMcLaren Port Huron HospitalMcLaren Regional Medical CenterMercy Health Saint Maryrsquos HospitalMetro Health HospitalMunson Medical Center

ProMedica Monroe Regional HospitalSparrow HospitalSt Joseph Mercy - Ann ArborSt Joseph Mercy ChelseaSt Joseph Mercy Livingston HospitalSt Mary MercySt Mary of Michigan HospitalU of M Hospital

Hospital Infrastructure19

Among all participating hospitals the average number of

Licensed beds was 374 (range 25 to 1059 beds)

Inpatient discharges was 17076 (range 1064 to 48916 patients)

Acute stroke discharges (primary diagnosis only) was 417 (range 34 to 982 patients)

Case Demographics MOSAIC Registry

VariablesN() or statistics(Total N=68906)

Age at admission (years)Median 710Range 180 - 1060Mean (SE) 697(01)

GenderMale 32886 (477)Female 36015 (523)

RaceAfrican American 9900 (197)AIAN 132 (03)Asian 320 (06)More than one race 44 (01)Unknown 3679 (73)White 36190 (720)Missing 70

EthnicityHispanic or Latino 804 (16)Others 49531 (984)

VariablesN() or statistics(Total N=68906)

Health insuranceMedicaid 2284 (45)MedicaidPrivate 211 (04)Medicare 16863 (336)Medicare Medicaid 2313 (46)

MedicareMedicaidPrivate125 (02)

MedicarePrivate 13640 (272)ND 268(05)No insurance 2123 (42)Private 12356 (246)

Arrival modeEMS 21052 (429)Private

transportationother19313 (393)

Transfer from another hospital

7733(157)

ND or unknown 1021 (21)Missing 1216

Who receives data reports on your stroke quality of care

21

7055

70

10085

65

40

Hos

pita

lC

EO

up

per

man

agem

ent

Hos

pita

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oard

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ursi

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ffice

r(C

NO

)

Str

oke

Tea

m

Phy

sici

anS

trok

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ham

pion

Chi

ef o

fM

edic

ine

Oth

er

Data Use

1) In the most recent calendar year have you run additional analyses (beyond what was required for reporting) on your hospitalrsquos own stroke data

2)How frequently have you run and used the analyses generated

22

Yes (N=16) 80

No (N=4) 20Weekly (N=2) 125

Monthly (N=8) 500

Less than monthly but more

than 1-2 times(N=6) 375

Data Use

What is the main reason you do not run your own additional analyses (Select one best answer)

23

Not sure how to run analyses

25

Not sure what analyses are needed would be helpful 25

Other 50

Data Use

In the most recent calendar year what reports did you run

24

813 688

Pre-programmedautomated reports in thedata collection tool (eg GWTG)

Additional reports beyond pre-programmed reports from the tool

Data Use

How do you use these analyses reports

25

813 688375

Inform quality improvement (QI) efforts andor plan

ldquoaction itemsrdquo

Report to management administration on our

progress

Other

Data Use

If you run additional analysis what action items QI efforts did you plan as a result of these reports

26

o Discharge education intensive statin use

o Door to tPA time and dysphagia

o Review data between spoke amp hub hospitals regarding transfers IV-tPA administration Mechanical thrombectomy and SAH

o QI efforts were addressed in the department involving calling Stroke Alert on call for cases with FAST symptoms

o ED Medical Director works with team to fix fallouts and problematic areas We have seen improvement

o Process changes (ie fallout emails to RN manager) physician querieso Increased documentation of NIHSS ownership from individual units regarding stroke quality

improvement goalso Daily dysphagia screening determination of whowhat team responsible for documenting initial NIHSS

looking at patients beyond 2h LKW arrival

Hospital Arrival Mode Door-to Needle and Pre-Notification

Reports 2016

Percent of Cases Who Arrived via EMSMOSAIC 2009-2016

Table 1 Arrival Mode among Stroke Cases by Demographics MOSAIC 2016

Demographics N=3496 550 N=2938 450Stroke Type Ischemic 2558 542 2164 458 Hemorrhagic 560 728 209 272 TIA 378 478 413 522Age Group lt 50 Years 233 433 305 567 50-79 Years 1982 497 2008 503 ge 80 Years 1379 688 625 312Sex Female 1933 576 1422 424 Male 1661 523 1516 477Race Black 659 530 584 470 White 2824 557 2248 443 Other Missing 111 512 106 488

MOSAIC AggregateArrival Mode

EMS Private Mode

Table 2 Door-to-Needle Times by Arrival Mode among Stroke Cases MOSAIC 2016

Time Elements (in Minutes)Number of

Patients Mean (Minutes) Median

(Minutes)Range

(Minutes)Door-to-Image 4901 575 400 00-2700 Arrived via EMS 2767 463 270 00-2700 Arrived via Private Transportation 2134 720 570 00-2620

Door-to-Image (among t-PA treated) 492 155 130 00-970 Arrived via EMS 370 125 110 00-840 Arrived via Private Transportation 122 243 215 20-970Image-to Needle 492 500 450 70-2090 Arrived via EMS 370 503 460 70-2090 Arrived via Private Transportation 122 483 420 90-1770Door-to Needle 492 655 570 200-2180 Arrived via EMS 370 629 560 200-2180 Arrived via Private Transportation 122 726 650 290-2060Included ischemic or hemorrhagic cases with times that were less or equal to 270 minutes (45 hours)Transferred cases were excluded

MOSAIC Aggregate

Table 3 Pre-Notification among Stroke Cases Who Arrived Via EMS by Demographics MOSAIC 2016

Demographics N=2015 584 N=1437 416Stroke Type Ischemic 1523 622 924 378 Hemorrhagic 306 566 235 434 TIA 142 381 231 619Age Group lt 50 Years 133 607 86 393 50-79 Years 1105 585 784 415 ge 80 Years 777 578 567 422Sex Female 1075 578 786 422 Male 940 591 651 409Race Black 307 517 287 483 White 1657 602 1097 398 Other 51 490 53 510

All HospitalsPre-Notification

Yes No

MOSAIC Transitions of Care Project

Post-discharge data collection tool is being implemented into Outcome Science as a tab

Post-Discharge amp Transition of Care

Reporting on changes within 30 days of discharge from hospital via follow-up callschart review Interval events Physician follow-up visits Lifestyle changes Lab assessments Medication managementadherence Rehab amp Functional outcomes Falls

MOSAIC Website

wwwMichigangovstroke

Adrienne Nickles MPHnicklesamichigangov

Thank You

  • Michigan and MOSAIC Data Review
  • Overview
  • Age-adjusted Stroke Hospitalization Rates Michigan 2000-2015
  • Slide Number 4
  • Age-adjusted Stroke Mortality Rates Michigan 2000-2014
  • Slide Number 6
  • Slide Number 7
  • Slide Number 8
  • Slide Number 9
  • Slide Number 10
  • Slide Number 11
  • MOSAIC 2015-2020
  • Pre-hospital Care
  • EMSMOSAIC Data Linkage
  • Slide Number 15
  • GWTG Special Initiatives Tab
  • Slide Number 17
  • MOSAIC Participating Hospitals
  • Hospital Infrastructure
  • Case Demographics MOSAIC Registry
  • Who receives data reports on your stroke quality of care
  • 1) In the most recent calendar year have you run additional analyses (beyond what was required for reporting) on your hospitalrsquos own stroke data 2)How frequently have you run and used the analyses generated
  • What is the main reason you do not run your own additional analyses (Select one best answer)
  • In the most recent calendar year what reports did you run
  • How do you use these analyses reports
  • If you run additional analysis what action items QI efforts did you plan as a result of these reports
  • Hospital Arrival Mode Door-to Needle and Pre-Notification Reports 2016
  • Percent of Cases Who Arrived via EMSMOSAIC 2009-2016
  • Table 1 Arrival Mode among Stroke Cases by Demographics MOSAIC 2016
  • Table 2 Door-to-Needle Times by Arrival Mode among Stroke Cases MOSAIC 2016
  • Table 3 Pre-Notification among Stroke Cases Who Arrived Via EMS by Demographics MOSAIC 2016
  • MOSAIC Transitions of Care Project
  • Slide Number 33
  • MOSAIC Website
  • Adrienne Nickles MPHnicklesamichigangov
Page 43: Michigan and MOSAIC Data Review...Michigan and MOSAIC Data Review 2017 ANNUAL WORKSHOP 4/26/2017. Adrienne Nickles, MPH. Michigan’s Ongoing Stroke Registry to Accelerate the Improvement

Pre-hospital Care

A V A I L A B L E D A T A

13

EMSMOSAIC Data Linkage

-The MOSAIC Team continues to link data from the Michigan EMS Information System (MiEMSIS) to MOSAIC Data- Reports have been created for and reviewed by the

Tri-County Area MCA and Detroit East MCA- This work will expand to other MCA regions that

serve hospitals participating in MOSAIC

GWTG Special Initiatives Tab

-A free tab that can be enabled in GWTG-The purpose of the tab is to collect data concerning patient hand-off from EMS

MOSAIC Participating Hospitals

Aspirus Keweenaw Hospital (Laurium)

Aspirus Grand View HospitalAspirus Iron River HospitalAspirus Ontonagon HospitalBixby Medical CenterBronson Methodist HospitalCovenant Health CareDetroit Receiving HospitalGenesys Regional Medical CenterHenry Ford Hospital Herrick Medical CenterHuron Valley-Sinai HospitalLakeland Regional Medical Center McLaren Bay Regional Medical CenterMcLaren Greater Medical Center

McLaren Macomb HospitalMcLaren Northern MI HospitalMcLaren Oakland Medical CenterMcLaren Port Huron HospitalMcLaren Regional Medical CenterMercy Health Saint Maryrsquos HospitalMetro Health HospitalMunson Medical Center

ProMedica Monroe Regional HospitalSparrow HospitalSt Joseph Mercy - Ann ArborSt Joseph Mercy ChelseaSt Joseph Mercy Livingston HospitalSt Mary MercySt Mary of Michigan HospitalU of M Hospital

Hospital Infrastructure19

Among all participating hospitals the average number of

Licensed beds was 374 (range 25 to 1059 beds)

Inpatient discharges was 17076 (range 1064 to 48916 patients)

Acute stroke discharges (primary diagnosis only) was 417 (range 34 to 982 patients)

Case Demographics MOSAIC Registry

VariablesN() or statistics(Total N=68906)

Age at admission (years)Median 710Range 180 - 1060Mean (SE) 697(01)

GenderMale 32886 (477)Female 36015 (523)

RaceAfrican American 9900 (197)AIAN 132 (03)Asian 320 (06)More than one race 44 (01)Unknown 3679 (73)White 36190 (720)Missing 70

EthnicityHispanic or Latino 804 (16)Others 49531 (984)

VariablesN() or statistics(Total N=68906)

Health insuranceMedicaid 2284 (45)MedicaidPrivate 211 (04)Medicare 16863 (336)Medicare Medicaid 2313 (46)

MedicareMedicaidPrivate125 (02)

MedicarePrivate 13640 (272)ND 268(05)No insurance 2123 (42)Private 12356 (246)

Arrival modeEMS 21052 (429)Private

transportationother19313 (393)

Transfer from another hospital

7733(157)

ND or unknown 1021 (21)Missing 1216

Who receives data reports on your stroke quality of care

21

7055

70

10085

65

40

Hos

pita

lC

EO

up

per

man

agem

ent

Hos

pita

lB

oard

Chi

efN

ursi

ngO

ffice

r(C

NO

)

Str

oke

Tea

m

Phy

sici

anS

trok

eC

ham

pion

Chi

ef o

fM

edic

ine

Oth

er

Data Use

1) In the most recent calendar year have you run additional analyses (beyond what was required for reporting) on your hospitalrsquos own stroke data

2)How frequently have you run and used the analyses generated

22

Yes (N=16) 80

No (N=4) 20Weekly (N=2) 125

Monthly (N=8) 500

Less than monthly but more

than 1-2 times(N=6) 375

Data Use

What is the main reason you do not run your own additional analyses (Select one best answer)

23

Not sure how to run analyses

25

Not sure what analyses are needed would be helpful 25

Other 50

Data Use

In the most recent calendar year what reports did you run

24

813 688

Pre-programmedautomated reports in thedata collection tool (eg GWTG)

Additional reports beyond pre-programmed reports from the tool

Data Use

How do you use these analyses reports

25

813 688375

Inform quality improvement (QI) efforts andor plan

ldquoaction itemsrdquo

Report to management administration on our

progress

Other

Data Use

If you run additional analysis what action items QI efforts did you plan as a result of these reports

26

o Discharge education intensive statin use

o Door to tPA time and dysphagia

o Review data between spoke amp hub hospitals regarding transfers IV-tPA administration Mechanical thrombectomy and SAH

o QI efforts were addressed in the department involving calling Stroke Alert on call for cases with FAST symptoms

o ED Medical Director works with team to fix fallouts and problematic areas We have seen improvement

o Process changes (ie fallout emails to RN manager) physician querieso Increased documentation of NIHSS ownership from individual units regarding stroke quality

improvement goalso Daily dysphagia screening determination of whowhat team responsible for documenting initial NIHSS

looking at patients beyond 2h LKW arrival

Hospital Arrival Mode Door-to Needle and Pre-Notification

Reports 2016

Percent of Cases Who Arrived via EMSMOSAIC 2009-2016

Table 1 Arrival Mode among Stroke Cases by Demographics MOSAIC 2016

Demographics N=3496 550 N=2938 450Stroke Type Ischemic 2558 542 2164 458 Hemorrhagic 560 728 209 272 TIA 378 478 413 522Age Group lt 50 Years 233 433 305 567 50-79 Years 1982 497 2008 503 ge 80 Years 1379 688 625 312Sex Female 1933 576 1422 424 Male 1661 523 1516 477Race Black 659 530 584 470 White 2824 557 2248 443 Other Missing 111 512 106 488

MOSAIC AggregateArrival Mode

EMS Private Mode

Table 2 Door-to-Needle Times by Arrival Mode among Stroke Cases MOSAIC 2016

Time Elements (in Minutes)Number of

Patients Mean (Minutes) Median

(Minutes)Range

(Minutes)Door-to-Image 4901 575 400 00-2700 Arrived via EMS 2767 463 270 00-2700 Arrived via Private Transportation 2134 720 570 00-2620

Door-to-Image (among t-PA treated) 492 155 130 00-970 Arrived via EMS 370 125 110 00-840 Arrived via Private Transportation 122 243 215 20-970Image-to Needle 492 500 450 70-2090 Arrived via EMS 370 503 460 70-2090 Arrived via Private Transportation 122 483 420 90-1770Door-to Needle 492 655 570 200-2180 Arrived via EMS 370 629 560 200-2180 Arrived via Private Transportation 122 726 650 290-2060Included ischemic or hemorrhagic cases with times that were less or equal to 270 minutes (45 hours)Transferred cases were excluded

MOSAIC Aggregate

Table 3 Pre-Notification among Stroke Cases Who Arrived Via EMS by Demographics MOSAIC 2016

Demographics N=2015 584 N=1437 416Stroke Type Ischemic 1523 622 924 378 Hemorrhagic 306 566 235 434 TIA 142 381 231 619Age Group lt 50 Years 133 607 86 393 50-79 Years 1105 585 784 415 ge 80 Years 777 578 567 422Sex Female 1075 578 786 422 Male 940 591 651 409Race Black 307 517 287 483 White 1657 602 1097 398 Other 51 490 53 510

All HospitalsPre-Notification

Yes No

MOSAIC Transitions of Care Project

Post-discharge data collection tool is being implemented into Outcome Science as a tab

Post-Discharge amp Transition of Care

Reporting on changes within 30 days of discharge from hospital via follow-up callschart review Interval events Physician follow-up visits Lifestyle changes Lab assessments Medication managementadherence Rehab amp Functional outcomes Falls

MOSAIC Website

wwwMichigangovstroke

Adrienne Nickles MPHnicklesamichigangov

Thank You

  • Michigan and MOSAIC Data Review
  • Overview
  • Age-adjusted Stroke Hospitalization Rates Michigan 2000-2015
  • Slide Number 4
  • Age-adjusted Stroke Mortality Rates Michigan 2000-2014
  • Slide Number 6
  • Slide Number 7
  • Slide Number 8
  • Slide Number 9
  • Slide Number 10
  • Slide Number 11
  • MOSAIC 2015-2020
  • Pre-hospital Care
  • EMSMOSAIC Data Linkage
  • Slide Number 15
  • GWTG Special Initiatives Tab
  • Slide Number 17
  • MOSAIC Participating Hospitals
  • Hospital Infrastructure
  • Case Demographics MOSAIC Registry
  • Who receives data reports on your stroke quality of care
  • 1) In the most recent calendar year have you run additional analyses (beyond what was required for reporting) on your hospitalrsquos own stroke data 2)How frequently have you run and used the analyses generated
  • What is the main reason you do not run your own additional analyses (Select one best answer)
  • In the most recent calendar year what reports did you run
  • How do you use these analyses reports
  • If you run additional analysis what action items QI efforts did you plan as a result of these reports
  • Hospital Arrival Mode Door-to Needle and Pre-Notification Reports 2016
  • Percent of Cases Who Arrived via EMSMOSAIC 2009-2016
  • Table 1 Arrival Mode among Stroke Cases by Demographics MOSAIC 2016
  • Table 2 Door-to-Needle Times by Arrival Mode among Stroke Cases MOSAIC 2016
  • Table 3 Pre-Notification among Stroke Cases Who Arrived Via EMS by Demographics MOSAIC 2016
  • MOSAIC Transitions of Care Project
  • Slide Number 33
  • MOSAIC Website
  • Adrienne Nickles MPHnicklesamichigangov
Page 44: Michigan and MOSAIC Data Review...Michigan and MOSAIC Data Review 2017 ANNUAL WORKSHOP 4/26/2017. Adrienne Nickles, MPH. Michigan’s Ongoing Stroke Registry to Accelerate the Improvement

EMSMOSAIC Data Linkage

-The MOSAIC Team continues to link data from the Michigan EMS Information System (MiEMSIS) to MOSAIC Data- Reports have been created for and reviewed by the

Tri-County Area MCA and Detroit East MCA- This work will expand to other MCA regions that

serve hospitals participating in MOSAIC

GWTG Special Initiatives Tab

-A free tab that can be enabled in GWTG-The purpose of the tab is to collect data concerning patient hand-off from EMS

MOSAIC Participating Hospitals

Aspirus Keweenaw Hospital (Laurium)

Aspirus Grand View HospitalAspirus Iron River HospitalAspirus Ontonagon HospitalBixby Medical CenterBronson Methodist HospitalCovenant Health CareDetroit Receiving HospitalGenesys Regional Medical CenterHenry Ford Hospital Herrick Medical CenterHuron Valley-Sinai HospitalLakeland Regional Medical Center McLaren Bay Regional Medical CenterMcLaren Greater Medical Center

McLaren Macomb HospitalMcLaren Northern MI HospitalMcLaren Oakland Medical CenterMcLaren Port Huron HospitalMcLaren Regional Medical CenterMercy Health Saint Maryrsquos HospitalMetro Health HospitalMunson Medical Center

ProMedica Monroe Regional HospitalSparrow HospitalSt Joseph Mercy - Ann ArborSt Joseph Mercy ChelseaSt Joseph Mercy Livingston HospitalSt Mary MercySt Mary of Michigan HospitalU of M Hospital

Hospital Infrastructure19

Among all participating hospitals the average number of

Licensed beds was 374 (range 25 to 1059 beds)

Inpatient discharges was 17076 (range 1064 to 48916 patients)

Acute stroke discharges (primary diagnosis only) was 417 (range 34 to 982 patients)

Case Demographics MOSAIC Registry

VariablesN() or statistics(Total N=68906)

Age at admission (years)Median 710Range 180 - 1060Mean (SE) 697(01)

GenderMale 32886 (477)Female 36015 (523)

RaceAfrican American 9900 (197)AIAN 132 (03)Asian 320 (06)More than one race 44 (01)Unknown 3679 (73)White 36190 (720)Missing 70

EthnicityHispanic or Latino 804 (16)Others 49531 (984)

VariablesN() or statistics(Total N=68906)

Health insuranceMedicaid 2284 (45)MedicaidPrivate 211 (04)Medicare 16863 (336)Medicare Medicaid 2313 (46)

MedicareMedicaidPrivate125 (02)

MedicarePrivate 13640 (272)ND 268(05)No insurance 2123 (42)Private 12356 (246)

Arrival modeEMS 21052 (429)Private

transportationother19313 (393)

Transfer from another hospital

7733(157)

ND or unknown 1021 (21)Missing 1216

Who receives data reports on your stroke quality of care

21

7055

70

10085

65

40

Hos

pita

lC

EO

up

per

man

agem

ent

Hos

pita

lB

oard

Chi

efN

ursi

ngO

ffice

r(C

NO

)

Str

oke

Tea

m

Phy

sici

anS

trok

eC

ham

pion

Chi

ef o

fM

edic

ine

Oth

er

Data Use

1) In the most recent calendar year have you run additional analyses (beyond what was required for reporting) on your hospitalrsquos own stroke data

2)How frequently have you run and used the analyses generated

22

Yes (N=16) 80

No (N=4) 20Weekly (N=2) 125

Monthly (N=8) 500

Less than monthly but more

than 1-2 times(N=6) 375

Data Use

What is the main reason you do not run your own additional analyses (Select one best answer)

23

Not sure how to run analyses

25

Not sure what analyses are needed would be helpful 25

Other 50

Data Use

In the most recent calendar year what reports did you run

24

813 688

Pre-programmedautomated reports in thedata collection tool (eg GWTG)

Additional reports beyond pre-programmed reports from the tool

Data Use

How do you use these analyses reports

25

813 688375

Inform quality improvement (QI) efforts andor plan

ldquoaction itemsrdquo

Report to management administration on our

progress

Other

Data Use

If you run additional analysis what action items QI efforts did you plan as a result of these reports

26

o Discharge education intensive statin use

o Door to tPA time and dysphagia

o Review data between spoke amp hub hospitals regarding transfers IV-tPA administration Mechanical thrombectomy and SAH

o QI efforts were addressed in the department involving calling Stroke Alert on call for cases with FAST symptoms

o ED Medical Director works with team to fix fallouts and problematic areas We have seen improvement

o Process changes (ie fallout emails to RN manager) physician querieso Increased documentation of NIHSS ownership from individual units regarding stroke quality

improvement goalso Daily dysphagia screening determination of whowhat team responsible for documenting initial NIHSS

looking at patients beyond 2h LKW arrival

Hospital Arrival Mode Door-to Needle and Pre-Notification

Reports 2016

Percent of Cases Who Arrived via EMSMOSAIC 2009-2016

Table 1 Arrival Mode among Stroke Cases by Demographics MOSAIC 2016

Demographics N=3496 550 N=2938 450Stroke Type Ischemic 2558 542 2164 458 Hemorrhagic 560 728 209 272 TIA 378 478 413 522Age Group lt 50 Years 233 433 305 567 50-79 Years 1982 497 2008 503 ge 80 Years 1379 688 625 312Sex Female 1933 576 1422 424 Male 1661 523 1516 477Race Black 659 530 584 470 White 2824 557 2248 443 Other Missing 111 512 106 488

MOSAIC AggregateArrival Mode

EMS Private Mode

Table 2 Door-to-Needle Times by Arrival Mode among Stroke Cases MOSAIC 2016

Time Elements (in Minutes)Number of

Patients Mean (Minutes) Median

(Minutes)Range

(Minutes)Door-to-Image 4901 575 400 00-2700 Arrived via EMS 2767 463 270 00-2700 Arrived via Private Transportation 2134 720 570 00-2620

Door-to-Image (among t-PA treated) 492 155 130 00-970 Arrived via EMS 370 125 110 00-840 Arrived via Private Transportation 122 243 215 20-970Image-to Needle 492 500 450 70-2090 Arrived via EMS 370 503 460 70-2090 Arrived via Private Transportation 122 483 420 90-1770Door-to Needle 492 655 570 200-2180 Arrived via EMS 370 629 560 200-2180 Arrived via Private Transportation 122 726 650 290-2060Included ischemic or hemorrhagic cases with times that were less or equal to 270 minutes (45 hours)Transferred cases were excluded

MOSAIC Aggregate

Table 3 Pre-Notification among Stroke Cases Who Arrived Via EMS by Demographics MOSAIC 2016

Demographics N=2015 584 N=1437 416Stroke Type Ischemic 1523 622 924 378 Hemorrhagic 306 566 235 434 TIA 142 381 231 619Age Group lt 50 Years 133 607 86 393 50-79 Years 1105 585 784 415 ge 80 Years 777 578 567 422Sex Female 1075 578 786 422 Male 940 591 651 409Race Black 307 517 287 483 White 1657 602 1097 398 Other 51 490 53 510

All HospitalsPre-Notification

Yes No

MOSAIC Transitions of Care Project

Post-discharge data collection tool is being implemented into Outcome Science as a tab

Post-Discharge amp Transition of Care

Reporting on changes within 30 days of discharge from hospital via follow-up callschart review Interval events Physician follow-up visits Lifestyle changes Lab assessments Medication managementadherence Rehab amp Functional outcomes Falls

MOSAIC Website

wwwMichigangovstroke

Adrienne Nickles MPHnicklesamichigangov

Thank You

  • Michigan and MOSAIC Data Review
  • Overview
  • Age-adjusted Stroke Hospitalization Rates Michigan 2000-2015
  • Slide Number 4
  • Age-adjusted Stroke Mortality Rates Michigan 2000-2014
  • Slide Number 6
  • Slide Number 7
  • Slide Number 8
  • Slide Number 9
  • Slide Number 10
  • Slide Number 11
  • MOSAIC 2015-2020
  • Pre-hospital Care
  • EMSMOSAIC Data Linkage
  • Slide Number 15
  • GWTG Special Initiatives Tab
  • Slide Number 17
  • MOSAIC Participating Hospitals
  • Hospital Infrastructure
  • Case Demographics MOSAIC Registry
  • Who receives data reports on your stroke quality of care
  • 1) In the most recent calendar year have you run additional analyses (beyond what was required for reporting) on your hospitalrsquos own stroke data 2)How frequently have you run and used the analyses generated
  • What is the main reason you do not run your own additional analyses (Select one best answer)
  • In the most recent calendar year what reports did you run
  • How do you use these analyses reports
  • If you run additional analysis what action items QI efforts did you plan as a result of these reports
  • Hospital Arrival Mode Door-to Needle and Pre-Notification Reports 2016
  • Percent of Cases Who Arrived via EMSMOSAIC 2009-2016
  • Table 1 Arrival Mode among Stroke Cases by Demographics MOSAIC 2016
  • Table 2 Door-to-Needle Times by Arrival Mode among Stroke Cases MOSAIC 2016
  • Table 3 Pre-Notification among Stroke Cases Who Arrived Via EMS by Demographics MOSAIC 2016
  • MOSAIC Transitions of Care Project
  • Slide Number 33
  • MOSAIC Website
  • Adrienne Nickles MPHnicklesamichigangov
Page 45: Michigan and MOSAIC Data Review...Michigan and MOSAIC Data Review 2017 ANNUAL WORKSHOP 4/26/2017. Adrienne Nickles, MPH. Michigan’s Ongoing Stroke Registry to Accelerate the Improvement

GWTG Special Initiatives Tab

-A free tab that can be enabled in GWTG-The purpose of the tab is to collect data concerning patient hand-off from EMS

MOSAIC Participating Hospitals

Aspirus Keweenaw Hospital (Laurium)

Aspirus Grand View HospitalAspirus Iron River HospitalAspirus Ontonagon HospitalBixby Medical CenterBronson Methodist HospitalCovenant Health CareDetroit Receiving HospitalGenesys Regional Medical CenterHenry Ford Hospital Herrick Medical CenterHuron Valley-Sinai HospitalLakeland Regional Medical Center McLaren Bay Regional Medical CenterMcLaren Greater Medical Center

McLaren Macomb HospitalMcLaren Northern MI HospitalMcLaren Oakland Medical CenterMcLaren Port Huron HospitalMcLaren Regional Medical CenterMercy Health Saint Maryrsquos HospitalMetro Health HospitalMunson Medical Center

ProMedica Monroe Regional HospitalSparrow HospitalSt Joseph Mercy - Ann ArborSt Joseph Mercy ChelseaSt Joseph Mercy Livingston HospitalSt Mary MercySt Mary of Michigan HospitalU of M Hospital

Hospital Infrastructure19

Among all participating hospitals the average number of

Licensed beds was 374 (range 25 to 1059 beds)

Inpatient discharges was 17076 (range 1064 to 48916 patients)

Acute stroke discharges (primary diagnosis only) was 417 (range 34 to 982 patients)

Case Demographics MOSAIC Registry

VariablesN() or statistics(Total N=68906)

Age at admission (years)Median 710Range 180 - 1060Mean (SE) 697(01)

GenderMale 32886 (477)Female 36015 (523)

RaceAfrican American 9900 (197)AIAN 132 (03)Asian 320 (06)More than one race 44 (01)Unknown 3679 (73)White 36190 (720)Missing 70

EthnicityHispanic or Latino 804 (16)Others 49531 (984)

VariablesN() or statistics(Total N=68906)

Health insuranceMedicaid 2284 (45)MedicaidPrivate 211 (04)Medicare 16863 (336)Medicare Medicaid 2313 (46)

MedicareMedicaidPrivate125 (02)

MedicarePrivate 13640 (272)ND 268(05)No insurance 2123 (42)Private 12356 (246)

Arrival modeEMS 21052 (429)Private

transportationother19313 (393)

Transfer from another hospital

7733(157)

ND or unknown 1021 (21)Missing 1216

Who receives data reports on your stroke quality of care

21

7055

70

10085

65

40

Hos

pita

lC

EO

up

per

man

agem

ent

Hos

pita

lB

oard

Chi

efN

ursi

ngO

ffice

r(C

NO

)

Str

oke

Tea

m

Phy

sici

anS

trok

eC

ham

pion

Chi

ef o

fM

edic

ine

Oth

er

Data Use

1) In the most recent calendar year have you run additional analyses (beyond what was required for reporting) on your hospitalrsquos own stroke data

2)How frequently have you run and used the analyses generated

22

Yes (N=16) 80

No (N=4) 20Weekly (N=2) 125

Monthly (N=8) 500

Less than monthly but more

than 1-2 times(N=6) 375

Data Use

What is the main reason you do not run your own additional analyses (Select one best answer)

23

Not sure how to run analyses

25

Not sure what analyses are needed would be helpful 25

Other 50

Data Use

In the most recent calendar year what reports did you run

24

813 688

Pre-programmedautomated reports in thedata collection tool (eg GWTG)

Additional reports beyond pre-programmed reports from the tool

Data Use

How do you use these analyses reports

25

813 688375

Inform quality improvement (QI) efforts andor plan

ldquoaction itemsrdquo

Report to management administration on our

progress

Other

Data Use

If you run additional analysis what action items QI efforts did you plan as a result of these reports

26

o Discharge education intensive statin use

o Door to tPA time and dysphagia

o Review data between spoke amp hub hospitals regarding transfers IV-tPA administration Mechanical thrombectomy and SAH

o QI efforts were addressed in the department involving calling Stroke Alert on call for cases with FAST symptoms

o ED Medical Director works with team to fix fallouts and problematic areas We have seen improvement

o Process changes (ie fallout emails to RN manager) physician querieso Increased documentation of NIHSS ownership from individual units regarding stroke quality

improvement goalso Daily dysphagia screening determination of whowhat team responsible for documenting initial NIHSS

looking at patients beyond 2h LKW arrival

Hospital Arrival Mode Door-to Needle and Pre-Notification

Reports 2016

Percent of Cases Who Arrived via EMSMOSAIC 2009-2016

Table 1 Arrival Mode among Stroke Cases by Demographics MOSAIC 2016

Demographics N=3496 550 N=2938 450Stroke Type Ischemic 2558 542 2164 458 Hemorrhagic 560 728 209 272 TIA 378 478 413 522Age Group lt 50 Years 233 433 305 567 50-79 Years 1982 497 2008 503 ge 80 Years 1379 688 625 312Sex Female 1933 576 1422 424 Male 1661 523 1516 477Race Black 659 530 584 470 White 2824 557 2248 443 Other Missing 111 512 106 488

MOSAIC AggregateArrival Mode

EMS Private Mode

Table 2 Door-to-Needle Times by Arrival Mode among Stroke Cases MOSAIC 2016

Time Elements (in Minutes)Number of

Patients Mean (Minutes) Median

(Minutes)Range

(Minutes)Door-to-Image 4901 575 400 00-2700 Arrived via EMS 2767 463 270 00-2700 Arrived via Private Transportation 2134 720 570 00-2620

Door-to-Image (among t-PA treated) 492 155 130 00-970 Arrived via EMS 370 125 110 00-840 Arrived via Private Transportation 122 243 215 20-970Image-to Needle 492 500 450 70-2090 Arrived via EMS 370 503 460 70-2090 Arrived via Private Transportation 122 483 420 90-1770Door-to Needle 492 655 570 200-2180 Arrived via EMS 370 629 560 200-2180 Arrived via Private Transportation 122 726 650 290-2060Included ischemic or hemorrhagic cases with times that were less or equal to 270 minutes (45 hours)Transferred cases were excluded

MOSAIC Aggregate

Table 3 Pre-Notification among Stroke Cases Who Arrived Via EMS by Demographics MOSAIC 2016

Demographics N=2015 584 N=1437 416Stroke Type Ischemic 1523 622 924 378 Hemorrhagic 306 566 235 434 TIA 142 381 231 619Age Group lt 50 Years 133 607 86 393 50-79 Years 1105 585 784 415 ge 80 Years 777 578 567 422Sex Female 1075 578 786 422 Male 940 591 651 409Race Black 307 517 287 483 White 1657 602 1097 398 Other 51 490 53 510

All HospitalsPre-Notification

Yes No

MOSAIC Transitions of Care Project

Post-discharge data collection tool is being implemented into Outcome Science as a tab

Post-Discharge amp Transition of Care

Reporting on changes within 30 days of discharge from hospital via follow-up callschart review Interval events Physician follow-up visits Lifestyle changes Lab assessments Medication managementadherence Rehab amp Functional outcomes Falls

MOSAIC Website

wwwMichigangovstroke

Adrienne Nickles MPHnicklesamichigangov

Thank You

  • Michigan and MOSAIC Data Review
  • Overview
  • Age-adjusted Stroke Hospitalization Rates Michigan 2000-2015
  • Slide Number 4
  • Age-adjusted Stroke Mortality Rates Michigan 2000-2014
  • Slide Number 6
  • Slide Number 7
  • Slide Number 8
  • Slide Number 9
  • Slide Number 10
  • Slide Number 11
  • MOSAIC 2015-2020
  • Pre-hospital Care
  • EMSMOSAIC Data Linkage
  • Slide Number 15
  • GWTG Special Initiatives Tab
  • Slide Number 17
  • MOSAIC Participating Hospitals
  • Hospital Infrastructure
  • Case Demographics MOSAIC Registry
  • Who receives data reports on your stroke quality of care
  • 1) In the most recent calendar year have you run additional analyses (beyond what was required for reporting) on your hospitalrsquos own stroke data 2)How frequently have you run and used the analyses generated
  • What is the main reason you do not run your own additional analyses (Select one best answer)
  • In the most recent calendar year what reports did you run
  • How do you use these analyses reports
  • If you run additional analysis what action items QI efforts did you plan as a result of these reports
  • Hospital Arrival Mode Door-to Needle and Pre-Notification Reports 2016
  • Percent of Cases Who Arrived via EMSMOSAIC 2009-2016
  • Table 1 Arrival Mode among Stroke Cases by Demographics MOSAIC 2016
  • Table 2 Door-to-Needle Times by Arrival Mode among Stroke Cases MOSAIC 2016
  • Table 3 Pre-Notification among Stroke Cases Who Arrived Via EMS by Demographics MOSAIC 2016
  • MOSAIC Transitions of Care Project
  • Slide Number 33
  • MOSAIC Website
  • Adrienne Nickles MPHnicklesamichigangov
Page 46: Michigan and MOSAIC Data Review...Michigan and MOSAIC Data Review 2017 ANNUAL WORKSHOP 4/26/2017. Adrienne Nickles, MPH. Michigan’s Ongoing Stroke Registry to Accelerate the Improvement

MOSAIC Participating Hospitals

Aspirus Keweenaw Hospital (Laurium)

Aspirus Grand View HospitalAspirus Iron River HospitalAspirus Ontonagon HospitalBixby Medical CenterBronson Methodist HospitalCovenant Health CareDetroit Receiving HospitalGenesys Regional Medical CenterHenry Ford Hospital Herrick Medical CenterHuron Valley-Sinai HospitalLakeland Regional Medical Center McLaren Bay Regional Medical CenterMcLaren Greater Medical Center

McLaren Macomb HospitalMcLaren Northern MI HospitalMcLaren Oakland Medical CenterMcLaren Port Huron HospitalMcLaren Regional Medical CenterMercy Health Saint Maryrsquos HospitalMetro Health HospitalMunson Medical Center

ProMedica Monroe Regional HospitalSparrow HospitalSt Joseph Mercy - Ann ArborSt Joseph Mercy ChelseaSt Joseph Mercy Livingston HospitalSt Mary MercySt Mary of Michigan HospitalU of M Hospital

Hospital Infrastructure19

Among all participating hospitals the average number of

Licensed beds was 374 (range 25 to 1059 beds)

Inpatient discharges was 17076 (range 1064 to 48916 patients)

Acute stroke discharges (primary diagnosis only) was 417 (range 34 to 982 patients)

Case Demographics MOSAIC Registry

VariablesN() or statistics(Total N=68906)

Age at admission (years)Median 710Range 180 - 1060Mean (SE) 697(01)

GenderMale 32886 (477)Female 36015 (523)

RaceAfrican American 9900 (197)AIAN 132 (03)Asian 320 (06)More than one race 44 (01)Unknown 3679 (73)White 36190 (720)Missing 70

EthnicityHispanic or Latino 804 (16)Others 49531 (984)

VariablesN() or statistics(Total N=68906)

Health insuranceMedicaid 2284 (45)MedicaidPrivate 211 (04)Medicare 16863 (336)Medicare Medicaid 2313 (46)

MedicareMedicaidPrivate125 (02)

MedicarePrivate 13640 (272)ND 268(05)No insurance 2123 (42)Private 12356 (246)

Arrival modeEMS 21052 (429)Private

transportationother19313 (393)

Transfer from another hospital

7733(157)

ND or unknown 1021 (21)Missing 1216

Who receives data reports on your stroke quality of care

21

7055

70

10085

65

40

Hos

pita

lC

EO

up

per

man

agem

ent

Hos

pita

lB

oard

Chi

efN

ursi

ngO

ffice

r(C

NO

)

Str

oke

Tea

m

Phy

sici

anS

trok

eC

ham

pion

Chi

ef o

fM

edic

ine

Oth

er

Data Use

1) In the most recent calendar year have you run additional analyses (beyond what was required for reporting) on your hospitalrsquos own stroke data

2)How frequently have you run and used the analyses generated

22

Yes (N=16) 80

No (N=4) 20Weekly (N=2) 125

Monthly (N=8) 500

Less than monthly but more

than 1-2 times(N=6) 375

Data Use

What is the main reason you do not run your own additional analyses (Select one best answer)

23

Not sure how to run analyses

25

Not sure what analyses are needed would be helpful 25

Other 50

Data Use

In the most recent calendar year what reports did you run

24

813 688

Pre-programmedautomated reports in thedata collection tool (eg GWTG)

Additional reports beyond pre-programmed reports from the tool

Data Use

How do you use these analyses reports

25

813 688375

Inform quality improvement (QI) efforts andor plan

ldquoaction itemsrdquo

Report to management administration on our

progress

Other

Data Use

If you run additional analysis what action items QI efforts did you plan as a result of these reports

26

o Discharge education intensive statin use

o Door to tPA time and dysphagia

o Review data between spoke amp hub hospitals regarding transfers IV-tPA administration Mechanical thrombectomy and SAH

o QI efforts were addressed in the department involving calling Stroke Alert on call for cases with FAST symptoms

o ED Medical Director works with team to fix fallouts and problematic areas We have seen improvement

o Process changes (ie fallout emails to RN manager) physician querieso Increased documentation of NIHSS ownership from individual units regarding stroke quality

improvement goalso Daily dysphagia screening determination of whowhat team responsible for documenting initial NIHSS

looking at patients beyond 2h LKW arrival

Hospital Arrival Mode Door-to Needle and Pre-Notification

Reports 2016

Percent of Cases Who Arrived via EMSMOSAIC 2009-2016

Table 1 Arrival Mode among Stroke Cases by Demographics MOSAIC 2016

Demographics N=3496 550 N=2938 450Stroke Type Ischemic 2558 542 2164 458 Hemorrhagic 560 728 209 272 TIA 378 478 413 522Age Group lt 50 Years 233 433 305 567 50-79 Years 1982 497 2008 503 ge 80 Years 1379 688 625 312Sex Female 1933 576 1422 424 Male 1661 523 1516 477Race Black 659 530 584 470 White 2824 557 2248 443 Other Missing 111 512 106 488

MOSAIC AggregateArrival Mode

EMS Private Mode

Table 2 Door-to-Needle Times by Arrival Mode among Stroke Cases MOSAIC 2016

Time Elements (in Minutes)Number of

Patients Mean (Minutes) Median

(Minutes)Range

(Minutes)Door-to-Image 4901 575 400 00-2700 Arrived via EMS 2767 463 270 00-2700 Arrived via Private Transportation 2134 720 570 00-2620

Door-to-Image (among t-PA treated) 492 155 130 00-970 Arrived via EMS 370 125 110 00-840 Arrived via Private Transportation 122 243 215 20-970Image-to Needle 492 500 450 70-2090 Arrived via EMS 370 503 460 70-2090 Arrived via Private Transportation 122 483 420 90-1770Door-to Needle 492 655 570 200-2180 Arrived via EMS 370 629 560 200-2180 Arrived via Private Transportation 122 726 650 290-2060Included ischemic or hemorrhagic cases with times that were less or equal to 270 minutes (45 hours)Transferred cases were excluded

MOSAIC Aggregate

Table 3 Pre-Notification among Stroke Cases Who Arrived Via EMS by Demographics MOSAIC 2016

Demographics N=2015 584 N=1437 416Stroke Type Ischemic 1523 622 924 378 Hemorrhagic 306 566 235 434 TIA 142 381 231 619Age Group lt 50 Years 133 607 86 393 50-79 Years 1105 585 784 415 ge 80 Years 777 578 567 422Sex Female 1075 578 786 422 Male 940 591 651 409Race Black 307 517 287 483 White 1657 602 1097 398 Other 51 490 53 510

All HospitalsPre-Notification

Yes No

MOSAIC Transitions of Care Project

Post-discharge data collection tool is being implemented into Outcome Science as a tab

Post-Discharge amp Transition of Care

Reporting on changes within 30 days of discharge from hospital via follow-up callschart review Interval events Physician follow-up visits Lifestyle changes Lab assessments Medication managementadherence Rehab amp Functional outcomes Falls

MOSAIC Website

wwwMichigangovstroke

Adrienne Nickles MPHnicklesamichigangov

Thank You

  • Michigan and MOSAIC Data Review
  • Overview
  • Age-adjusted Stroke Hospitalization Rates Michigan 2000-2015
  • Slide Number 4
  • Age-adjusted Stroke Mortality Rates Michigan 2000-2014
  • Slide Number 6
  • Slide Number 7
  • Slide Number 8
  • Slide Number 9
  • Slide Number 10
  • Slide Number 11
  • MOSAIC 2015-2020
  • Pre-hospital Care
  • EMSMOSAIC Data Linkage
  • Slide Number 15
  • GWTG Special Initiatives Tab
  • Slide Number 17
  • MOSAIC Participating Hospitals
  • Hospital Infrastructure
  • Case Demographics MOSAIC Registry
  • Who receives data reports on your stroke quality of care
  • 1) In the most recent calendar year have you run additional analyses (beyond what was required for reporting) on your hospitalrsquos own stroke data 2)How frequently have you run and used the analyses generated
  • What is the main reason you do not run your own additional analyses (Select one best answer)
  • In the most recent calendar year what reports did you run
  • How do you use these analyses reports
  • If you run additional analysis what action items QI efforts did you plan as a result of these reports
  • Hospital Arrival Mode Door-to Needle and Pre-Notification Reports 2016
  • Percent of Cases Who Arrived via EMSMOSAIC 2009-2016
  • Table 1 Arrival Mode among Stroke Cases by Demographics MOSAIC 2016
  • Table 2 Door-to-Needle Times by Arrival Mode among Stroke Cases MOSAIC 2016
  • Table 3 Pre-Notification among Stroke Cases Who Arrived Via EMS by Demographics MOSAIC 2016
  • MOSAIC Transitions of Care Project
  • Slide Number 33
  • MOSAIC Website
  • Adrienne Nickles MPHnicklesamichigangov
Page 47: Michigan and MOSAIC Data Review...Michigan and MOSAIC Data Review 2017 ANNUAL WORKSHOP 4/26/2017. Adrienne Nickles, MPH. Michigan’s Ongoing Stroke Registry to Accelerate the Improvement

Hospital Infrastructure19

Among all participating hospitals the average number of

Licensed beds was 374 (range 25 to 1059 beds)

Inpatient discharges was 17076 (range 1064 to 48916 patients)

Acute stroke discharges (primary diagnosis only) was 417 (range 34 to 982 patients)

Case Demographics MOSAIC Registry

VariablesN() or statistics(Total N=68906)

Age at admission (years)Median 710Range 180 - 1060Mean (SE) 697(01)

GenderMale 32886 (477)Female 36015 (523)

RaceAfrican American 9900 (197)AIAN 132 (03)Asian 320 (06)More than one race 44 (01)Unknown 3679 (73)White 36190 (720)Missing 70

EthnicityHispanic or Latino 804 (16)Others 49531 (984)

VariablesN() or statistics(Total N=68906)

Health insuranceMedicaid 2284 (45)MedicaidPrivate 211 (04)Medicare 16863 (336)Medicare Medicaid 2313 (46)

MedicareMedicaidPrivate125 (02)

MedicarePrivate 13640 (272)ND 268(05)No insurance 2123 (42)Private 12356 (246)

Arrival modeEMS 21052 (429)Private

transportationother19313 (393)

Transfer from another hospital

7733(157)

ND or unknown 1021 (21)Missing 1216

Who receives data reports on your stroke quality of care

21

7055

70

10085

65

40

Hos

pita

lC

EO

up

per

man

agem

ent

Hos

pita

lB

oard

Chi

efN

ursi

ngO

ffice

r(C

NO

)

Str

oke

Tea

m

Phy

sici

anS

trok

eC

ham

pion

Chi

ef o

fM

edic

ine

Oth

er

Data Use

1) In the most recent calendar year have you run additional analyses (beyond what was required for reporting) on your hospitalrsquos own stroke data

2)How frequently have you run and used the analyses generated

22

Yes (N=16) 80

No (N=4) 20Weekly (N=2) 125

Monthly (N=8) 500

Less than monthly but more

than 1-2 times(N=6) 375

Data Use

What is the main reason you do not run your own additional analyses (Select one best answer)

23

Not sure how to run analyses

25

Not sure what analyses are needed would be helpful 25

Other 50

Data Use

In the most recent calendar year what reports did you run

24

813 688

Pre-programmedautomated reports in thedata collection tool (eg GWTG)

Additional reports beyond pre-programmed reports from the tool

Data Use

How do you use these analyses reports

25

813 688375

Inform quality improvement (QI) efforts andor plan

ldquoaction itemsrdquo

Report to management administration on our

progress

Other

Data Use

If you run additional analysis what action items QI efforts did you plan as a result of these reports

26

o Discharge education intensive statin use

o Door to tPA time and dysphagia

o Review data between spoke amp hub hospitals regarding transfers IV-tPA administration Mechanical thrombectomy and SAH

o QI efforts were addressed in the department involving calling Stroke Alert on call for cases with FAST symptoms

o ED Medical Director works with team to fix fallouts and problematic areas We have seen improvement

o Process changes (ie fallout emails to RN manager) physician querieso Increased documentation of NIHSS ownership from individual units regarding stroke quality

improvement goalso Daily dysphagia screening determination of whowhat team responsible for documenting initial NIHSS

looking at patients beyond 2h LKW arrival

Hospital Arrival Mode Door-to Needle and Pre-Notification

Reports 2016

Percent of Cases Who Arrived via EMSMOSAIC 2009-2016

Table 1 Arrival Mode among Stroke Cases by Demographics MOSAIC 2016

Demographics N=3496 550 N=2938 450Stroke Type Ischemic 2558 542 2164 458 Hemorrhagic 560 728 209 272 TIA 378 478 413 522Age Group lt 50 Years 233 433 305 567 50-79 Years 1982 497 2008 503 ge 80 Years 1379 688 625 312Sex Female 1933 576 1422 424 Male 1661 523 1516 477Race Black 659 530 584 470 White 2824 557 2248 443 Other Missing 111 512 106 488

MOSAIC AggregateArrival Mode

EMS Private Mode

Table 2 Door-to-Needle Times by Arrival Mode among Stroke Cases MOSAIC 2016

Time Elements (in Minutes)Number of

Patients Mean (Minutes) Median

(Minutes)Range

(Minutes)Door-to-Image 4901 575 400 00-2700 Arrived via EMS 2767 463 270 00-2700 Arrived via Private Transportation 2134 720 570 00-2620

Door-to-Image (among t-PA treated) 492 155 130 00-970 Arrived via EMS 370 125 110 00-840 Arrived via Private Transportation 122 243 215 20-970Image-to Needle 492 500 450 70-2090 Arrived via EMS 370 503 460 70-2090 Arrived via Private Transportation 122 483 420 90-1770Door-to Needle 492 655 570 200-2180 Arrived via EMS 370 629 560 200-2180 Arrived via Private Transportation 122 726 650 290-2060Included ischemic or hemorrhagic cases with times that were less or equal to 270 minutes (45 hours)Transferred cases were excluded

MOSAIC Aggregate

Table 3 Pre-Notification among Stroke Cases Who Arrived Via EMS by Demographics MOSAIC 2016

Demographics N=2015 584 N=1437 416Stroke Type Ischemic 1523 622 924 378 Hemorrhagic 306 566 235 434 TIA 142 381 231 619Age Group lt 50 Years 133 607 86 393 50-79 Years 1105 585 784 415 ge 80 Years 777 578 567 422Sex Female 1075 578 786 422 Male 940 591 651 409Race Black 307 517 287 483 White 1657 602 1097 398 Other 51 490 53 510

All HospitalsPre-Notification

Yes No

MOSAIC Transitions of Care Project

Post-discharge data collection tool is being implemented into Outcome Science as a tab

Post-Discharge amp Transition of Care

Reporting on changes within 30 days of discharge from hospital via follow-up callschart review Interval events Physician follow-up visits Lifestyle changes Lab assessments Medication managementadherence Rehab amp Functional outcomes Falls

MOSAIC Website

wwwMichigangovstroke

Adrienne Nickles MPHnicklesamichigangov

Thank You

  • Michigan and MOSAIC Data Review
  • Overview
  • Age-adjusted Stroke Hospitalization Rates Michigan 2000-2015
  • Slide Number 4
  • Age-adjusted Stroke Mortality Rates Michigan 2000-2014
  • Slide Number 6
  • Slide Number 7
  • Slide Number 8
  • Slide Number 9
  • Slide Number 10
  • Slide Number 11
  • MOSAIC 2015-2020
  • Pre-hospital Care
  • EMSMOSAIC Data Linkage
  • Slide Number 15
  • GWTG Special Initiatives Tab
  • Slide Number 17
  • MOSAIC Participating Hospitals
  • Hospital Infrastructure
  • Case Demographics MOSAIC Registry
  • Who receives data reports on your stroke quality of care
  • 1) In the most recent calendar year have you run additional analyses (beyond what was required for reporting) on your hospitalrsquos own stroke data 2)How frequently have you run and used the analyses generated
  • What is the main reason you do not run your own additional analyses (Select one best answer)
  • In the most recent calendar year what reports did you run
  • How do you use these analyses reports
  • If you run additional analysis what action items QI efforts did you plan as a result of these reports
  • Hospital Arrival Mode Door-to Needle and Pre-Notification Reports 2016
  • Percent of Cases Who Arrived via EMSMOSAIC 2009-2016
  • Table 1 Arrival Mode among Stroke Cases by Demographics MOSAIC 2016
  • Table 2 Door-to-Needle Times by Arrival Mode among Stroke Cases MOSAIC 2016
  • Table 3 Pre-Notification among Stroke Cases Who Arrived Via EMS by Demographics MOSAIC 2016
  • MOSAIC Transitions of Care Project
  • Slide Number 33
  • MOSAIC Website
  • Adrienne Nickles MPHnicklesamichigangov
Page 48: Michigan and MOSAIC Data Review...Michigan and MOSAIC Data Review 2017 ANNUAL WORKSHOP 4/26/2017. Adrienne Nickles, MPH. Michigan’s Ongoing Stroke Registry to Accelerate the Improvement

Case Demographics MOSAIC Registry

VariablesN() or statistics(Total N=68906)

Age at admission (years)Median 710Range 180 - 1060Mean (SE) 697(01)

GenderMale 32886 (477)Female 36015 (523)

RaceAfrican American 9900 (197)AIAN 132 (03)Asian 320 (06)More than one race 44 (01)Unknown 3679 (73)White 36190 (720)Missing 70

EthnicityHispanic or Latino 804 (16)Others 49531 (984)

VariablesN() or statistics(Total N=68906)

Health insuranceMedicaid 2284 (45)MedicaidPrivate 211 (04)Medicare 16863 (336)Medicare Medicaid 2313 (46)

MedicareMedicaidPrivate125 (02)

MedicarePrivate 13640 (272)ND 268(05)No insurance 2123 (42)Private 12356 (246)

Arrival modeEMS 21052 (429)Private

transportationother19313 (393)

Transfer from another hospital

7733(157)

ND or unknown 1021 (21)Missing 1216

Who receives data reports on your stroke quality of care

21

7055

70

10085

65

40

Hos

pita

lC

EO

up

per

man

agem

ent

Hos

pita

lB

oard

Chi

efN

ursi

ngO

ffice

r(C

NO

)

Str

oke

Tea

m

Phy

sici

anS

trok

eC

ham

pion

Chi

ef o

fM

edic

ine

Oth

er

Data Use

1) In the most recent calendar year have you run additional analyses (beyond what was required for reporting) on your hospitalrsquos own stroke data

2)How frequently have you run and used the analyses generated

22

Yes (N=16) 80

No (N=4) 20Weekly (N=2) 125

Monthly (N=8) 500

Less than monthly but more

than 1-2 times(N=6) 375

Data Use

What is the main reason you do not run your own additional analyses (Select one best answer)

23

Not sure how to run analyses

25

Not sure what analyses are needed would be helpful 25

Other 50

Data Use

In the most recent calendar year what reports did you run

24

813 688

Pre-programmedautomated reports in thedata collection tool (eg GWTG)

Additional reports beyond pre-programmed reports from the tool

Data Use

How do you use these analyses reports

25

813 688375

Inform quality improvement (QI) efforts andor plan

ldquoaction itemsrdquo

Report to management administration on our

progress

Other

Data Use

If you run additional analysis what action items QI efforts did you plan as a result of these reports

26

o Discharge education intensive statin use

o Door to tPA time and dysphagia

o Review data between spoke amp hub hospitals regarding transfers IV-tPA administration Mechanical thrombectomy and SAH

o QI efforts were addressed in the department involving calling Stroke Alert on call for cases with FAST symptoms

o ED Medical Director works with team to fix fallouts and problematic areas We have seen improvement

o Process changes (ie fallout emails to RN manager) physician querieso Increased documentation of NIHSS ownership from individual units regarding stroke quality

improvement goalso Daily dysphagia screening determination of whowhat team responsible for documenting initial NIHSS

looking at patients beyond 2h LKW arrival

Hospital Arrival Mode Door-to Needle and Pre-Notification

Reports 2016

Percent of Cases Who Arrived via EMSMOSAIC 2009-2016

Table 1 Arrival Mode among Stroke Cases by Demographics MOSAIC 2016

Demographics N=3496 550 N=2938 450Stroke Type Ischemic 2558 542 2164 458 Hemorrhagic 560 728 209 272 TIA 378 478 413 522Age Group lt 50 Years 233 433 305 567 50-79 Years 1982 497 2008 503 ge 80 Years 1379 688 625 312Sex Female 1933 576 1422 424 Male 1661 523 1516 477Race Black 659 530 584 470 White 2824 557 2248 443 Other Missing 111 512 106 488

MOSAIC AggregateArrival Mode

EMS Private Mode

Table 2 Door-to-Needle Times by Arrival Mode among Stroke Cases MOSAIC 2016

Time Elements (in Minutes)Number of

Patients Mean (Minutes) Median

(Minutes)Range

(Minutes)Door-to-Image 4901 575 400 00-2700 Arrived via EMS 2767 463 270 00-2700 Arrived via Private Transportation 2134 720 570 00-2620

Door-to-Image (among t-PA treated) 492 155 130 00-970 Arrived via EMS 370 125 110 00-840 Arrived via Private Transportation 122 243 215 20-970Image-to Needle 492 500 450 70-2090 Arrived via EMS 370 503 460 70-2090 Arrived via Private Transportation 122 483 420 90-1770Door-to Needle 492 655 570 200-2180 Arrived via EMS 370 629 560 200-2180 Arrived via Private Transportation 122 726 650 290-2060Included ischemic or hemorrhagic cases with times that were less or equal to 270 minutes (45 hours)Transferred cases were excluded

MOSAIC Aggregate

Table 3 Pre-Notification among Stroke Cases Who Arrived Via EMS by Demographics MOSAIC 2016

Demographics N=2015 584 N=1437 416Stroke Type Ischemic 1523 622 924 378 Hemorrhagic 306 566 235 434 TIA 142 381 231 619Age Group lt 50 Years 133 607 86 393 50-79 Years 1105 585 784 415 ge 80 Years 777 578 567 422Sex Female 1075 578 786 422 Male 940 591 651 409Race Black 307 517 287 483 White 1657 602 1097 398 Other 51 490 53 510

All HospitalsPre-Notification

Yes No

MOSAIC Transitions of Care Project

Post-discharge data collection tool is being implemented into Outcome Science as a tab

Post-Discharge amp Transition of Care

Reporting on changes within 30 days of discharge from hospital via follow-up callschart review Interval events Physician follow-up visits Lifestyle changes Lab assessments Medication managementadherence Rehab amp Functional outcomes Falls

MOSAIC Website

wwwMichigangovstroke

Adrienne Nickles MPHnicklesamichigangov

Thank You

  • Michigan and MOSAIC Data Review
  • Overview
  • Age-adjusted Stroke Hospitalization Rates Michigan 2000-2015
  • Slide Number 4
  • Age-adjusted Stroke Mortality Rates Michigan 2000-2014
  • Slide Number 6
  • Slide Number 7
  • Slide Number 8
  • Slide Number 9
  • Slide Number 10
  • Slide Number 11
  • MOSAIC 2015-2020
  • Pre-hospital Care
  • EMSMOSAIC Data Linkage
  • Slide Number 15
  • GWTG Special Initiatives Tab
  • Slide Number 17
  • MOSAIC Participating Hospitals
  • Hospital Infrastructure
  • Case Demographics MOSAIC Registry
  • Who receives data reports on your stroke quality of care
  • 1) In the most recent calendar year have you run additional analyses (beyond what was required for reporting) on your hospitalrsquos own stroke data 2)How frequently have you run and used the analyses generated
  • What is the main reason you do not run your own additional analyses (Select one best answer)
  • In the most recent calendar year what reports did you run
  • How do you use these analyses reports
  • If you run additional analysis what action items QI efforts did you plan as a result of these reports
  • Hospital Arrival Mode Door-to Needle and Pre-Notification Reports 2016
  • Percent of Cases Who Arrived via EMSMOSAIC 2009-2016
  • Table 1 Arrival Mode among Stroke Cases by Demographics MOSAIC 2016
  • Table 2 Door-to-Needle Times by Arrival Mode among Stroke Cases MOSAIC 2016
  • Table 3 Pre-Notification among Stroke Cases Who Arrived Via EMS by Demographics MOSAIC 2016
  • MOSAIC Transitions of Care Project
  • Slide Number 33
  • MOSAIC Website
  • Adrienne Nickles MPHnicklesamichigangov
Page 49: Michigan and MOSAIC Data Review...Michigan and MOSAIC Data Review 2017 ANNUAL WORKSHOP 4/26/2017. Adrienne Nickles, MPH. Michigan’s Ongoing Stroke Registry to Accelerate the Improvement

Who receives data reports on your stroke quality of care

21

7055

70

10085

65

40

Hos

pita

lC

EO

up

per

man

agem

ent

Hos

pita

lB

oard

Chi

efN

ursi

ngO

ffice

r(C

NO

)

Str

oke

Tea

m

Phy

sici

anS

trok

eC

ham

pion

Chi

ef o

fM

edic

ine

Oth

er

Data Use

1) In the most recent calendar year have you run additional analyses (beyond what was required for reporting) on your hospitalrsquos own stroke data

2)How frequently have you run and used the analyses generated

22

Yes (N=16) 80

No (N=4) 20Weekly (N=2) 125

Monthly (N=8) 500

Less than monthly but more

than 1-2 times(N=6) 375

Data Use

What is the main reason you do not run your own additional analyses (Select one best answer)

23

Not sure how to run analyses

25

Not sure what analyses are needed would be helpful 25

Other 50

Data Use

In the most recent calendar year what reports did you run

24

813 688

Pre-programmedautomated reports in thedata collection tool (eg GWTG)

Additional reports beyond pre-programmed reports from the tool

Data Use

How do you use these analyses reports

25

813 688375

Inform quality improvement (QI) efforts andor plan

ldquoaction itemsrdquo

Report to management administration on our

progress

Other

Data Use

If you run additional analysis what action items QI efforts did you plan as a result of these reports

26

o Discharge education intensive statin use

o Door to tPA time and dysphagia

o Review data between spoke amp hub hospitals regarding transfers IV-tPA administration Mechanical thrombectomy and SAH

o QI efforts were addressed in the department involving calling Stroke Alert on call for cases with FAST symptoms

o ED Medical Director works with team to fix fallouts and problematic areas We have seen improvement

o Process changes (ie fallout emails to RN manager) physician querieso Increased documentation of NIHSS ownership from individual units regarding stroke quality

improvement goalso Daily dysphagia screening determination of whowhat team responsible for documenting initial NIHSS

looking at patients beyond 2h LKW arrival

Hospital Arrival Mode Door-to Needle and Pre-Notification

Reports 2016

Percent of Cases Who Arrived via EMSMOSAIC 2009-2016

Table 1 Arrival Mode among Stroke Cases by Demographics MOSAIC 2016

Demographics N=3496 550 N=2938 450Stroke Type Ischemic 2558 542 2164 458 Hemorrhagic 560 728 209 272 TIA 378 478 413 522Age Group lt 50 Years 233 433 305 567 50-79 Years 1982 497 2008 503 ge 80 Years 1379 688 625 312Sex Female 1933 576 1422 424 Male 1661 523 1516 477Race Black 659 530 584 470 White 2824 557 2248 443 Other Missing 111 512 106 488

MOSAIC AggregateArrival Mode

EMS Private Mode

Table 2 Door-to-Needle Times by Arrival Mode among Stroke Cases MOSAIC 2016

Time Elements (in Minutes)Number of

Patients Mean (Minutes) Median

(Minutes)Range

(Minutes)Door-to-Image 4901 575 400 00-2700 Arrived via EMS 2767 463 270 00-2700 Arrived via Private Transportation 2134 720 570 00-2620

Door-to-Image (among t-PA treated) 492 155 130 00-970 Arrived via EMS 370 125 110 00-840 Arrived via Private Transportation 122 243 215 20-970Image-to Needle 492 500 450 70-2090 Arrived via EMS 370 503 460 70-2090 Arrived via Private Transportation 122 483 420 90-1770Door-to Needle 492 655 570 200-2180 Arrived via EMS 370 629 560 200-2180 Arrived via Private Transportation 122 726 650 290-2060Included ischemic or hemorrhagic cases with times that were less or equal to 270 minutes (45 hours)Transferred cases were excluded

MOSAIC Aggregate

Table 3 Pre-Notification among Stroke Cases Who Arrived Via EMS by Demographics MOSAIC 2016

Demographics N=2015 584 N=1437 416Stroke Type Ischemic 1523 622 924 378 Hemorrhagic 306 566 235 434 TIA 142 381 231 619Age Group lt 50 Years 133 607 86 393 50-79 Years 1105 585 784 415 ge 80 Years 777 578 567 422Sex Female 1075 578 786 422 Male 940 591 651 409Race Black 307 517 287 483 White 1657 602 1097 398 Other 51 490 53 510

All HospitalsPre-Notification

Yes No

MOSAIC Transitions of Care Project

Post-discharge data collection tool is being implemented into Outcome Science as a tab

Post-Discharge amp Transition of Care

Reporting on changes within 30 days of discharge from hospital via follow-up callschart review Interval events Physician follow-up visits Lifestyle changes Lab assessments Medication managementadherence Rehab amp Functional outcomes Falls

MOSAIC Website

wwwMichigangovstroke

Adrienne Nickles MPHnicklesamichigangov

Thank You

  • Michigan and MOSAIC Data Review
  • Overview
  • Age-adjusted Stroke Hospitalization Rates Michigan 2000-2015
  • Slide Number 4
  • Age-adjusted Stroke Mortality Rates Michigan 2000-2014
  • Slide Number 6
  • Slide Number 7
  • Slide Number 8
  • Slide Number 9
  • Slide Number 10
  • Slide Number 11
  • MOSAIC 2015-2020
  • Pre-hospital Care
  • EMSMOSAIC Data Linkage
  • Slide Number 15
  • GWTG Special Initiatives Tab
  • Slide Number 17
  • MOSAIC Participating Hospitals
  • Hospital Infrastructure
  • Case Demographics MOSAIC Registry
  • Who receives data reports on your stroke quality of care
  • 1) In the most recent calendar year have you run additional analyses (beyond what was required for reporting) on your hospitalrsquos own stroke data 2)How frequently have you run and used the analyses generated
  • What is the main reason you do not run your own additional analyses (Select one best answer)
  • In the most recent calendar year what reports did you run
  • How do you use these analyses reports
  • If you run additional analysis what action items QI efforts did you plan as a result of these reports
  • Hospital Arrival Mode Door-to Needle and Pre-Notification Reports 2016
  • Percent of Cases Who Arrived via EMSMOSAIC 2009-2016
  • Table 1 Arrival Mode among Stroke Cases by Demographics MOSAIC 2016
  • Table 2 Door-to-Needle Times by Arrival Mode among Stroke Cases MOSAIC 2016
  • Table 3 Pre-Notification among Stroke Cases Who Arrived Via EMS by Demographics MOSAIC 2016
  • MOSAIC Transitions of Care Project
  • Slide Number 33
  • MOSAIC Website
  • Adrienne Nickles MPHnicklesamichigangov
Page 50: Michigan and MOSAIC Data Review...Michigan and MOSAIC Data Review 2017 ANNUAL WORKSHOP 4/26/2017. Adrienne Nickles, MPH. Michigan’s Ongoing Stroke Registry to Accelerate the Improvement

1) In the most recent calendar year have you run additional analyses (beyond what was required for reporting) on your hospitalrsquos own stroke data

2)How frequently have you run and used the analyses generated

22

Yes (N=16) 80

No (N=4) 20Weekly (N=2) 125

Monthly (N=8) 500

Less than monthly but more

than 1-2 times(N=6) 375

Data Use

What is the main reason you do not run your own additional analyses (Select one best answer)

23

Not sure how to run analyses

25

Not sure what analyses are needed would be helpful 25

Other 50

Data Use

In the most recent calendar year what reports did you run

24

813 688

Pre-programmedautomated reports in thedata collection tool (eg GWTG)

Additional reports beyond pre-programmed reports from the tool

Data Use

How do you use these analyses reports

25

813 688375

Inform quality improvement (QI) efforts andor plan

ldquoaction itemsrdquo

Report to management administration on our

progress

Other

Data Use

If you run additional analysis what action items QI efforts did you plan as a result of these reports

26

o Discharge education intensive statin use

o Door to tPA time and dysphagia

o Review data between spoke amp hub hospitals regarding transfers IV-tPA administration Mechanical thrombectomy and SAH

o QI efforts were addressed in the department involving calling Stroke Alert on call for cases with FAST symptoms

o ED Medical Director works with team to fix fallouts and problematic areas We have seen improvement

o Process changes (ie fallout emails to RN manager) physician querieso Increased documentation of NIHSS ownership from individual units regarding stroke quality

improvement goalso Daily dysphagia screening determination of whowhat team responsible for documenting initial NIHSS

looking at patients beyond 2h LKW arrival

Hospital Arrival Mode Door-to Needle and Pre-Notification

Reports 2016

Percent of Cases Who Arrived via EMSMOSAIC 2009-2016

Table 1 Arrival Mode among Stroke Cases by Demographics MOSAIC 2016

Demographics N=3496 550 N=2938 450Stroke Type Ischemic 2558 542 2164 458 Hemorrhagic 560 728 209 272 TIA 378 478 413 522Age Group lt 50 Years 233 433 305 567 50-79 Years 1982 497 2008 503 ge 80 Years 1379 688 625 312Sex Female 1933 576 1422 424 Male 1661 523 1516 477Race Black 659 530 584 470 White 2824 557 2248 443 Other Missing 111 512 106 488

MOSAIC AggregateArrival Mode

EMS Private Mode

Table 2 Door-to-Needle Times by Arrival Mode among Stroke Cases MOSAIC 2016

Time Elements (in Minutes)Number of

Patients Mean (Minutes) Median

(Minutes)Range

(Minutes)Door-to-Image 4901 575 400 00-2700 Arrived via EMS 2767 463 270 00-2700 Arrived via Private Transportation 2134 720 570 00-2620

Door-to-Image (among t-PA treated) 492 155 130 00-970 Arrived via EMS 370 125 110 00-840 Arrived via Private Transportation 122 243 215 20-970Image-to Needle 492 500 450 70-2090 Arrived via EMS 370 503 460 70-2090 Arrived via Private Transportation 122 483 420 90-1770Door-to Needle 492 655 570 200-2180 Arrived via EMS 370 629 560 200-2180 Arrived via Private Transportation 122 726 650 290-2060Included ischemic or hemorrhagic cases with times that were less or equal to 270 minutes (45 hours)Transferred cases were excluded

MOSAIC Aggregate

Table 3 Pre-Notification among Stroke Cases Who Arrived Via EMS by Demographics MOSAIC 2016

Demographics N=2015 584 N=1437 416Stroke Type Ischemic 1523 622 924 378 Hemorrhagic 306 566 235 434 TIA 142 381 231 619Age Group lt 50 Years 133 607 86 393 50-79 Years 1105 585 784 415 ge 80 Years 777 578 567 422Sex Female 1075 578 786 422 Male 940 591 651 409Race Black 307 517 287 483 White 1657 602 1097 398 Other 51 490 53 510

All HospitalsPre-Notification

Yes No

MOSAIC Transitions of Care Project

Post-discharge data collection tool is being implemented into Outcome Science as a tab

Post-Discharge amp Transition of Care

Reporting on changes within 30 days of discharge from hospital via follow-up callschart review Interval events Physician follow-up visits Lifestyle changes Lab assessments Medication managementadherence Rehab amp Functional outcomes Falls

MOSAIC Website

wwwMichigangovstroke

Adrienne Nickles MPHnicklesamichigangov

Thank You

  • Michigan and MOSAIC Data Review
  • Overview
  • Age-adjusted Stroke Hospitalization Rates Michigan 2000-2015
  • Slide Number 4
  • Age-adjusted Stroke Mortality Rates Michigan 2000-2014
  • Slide Number 6
  • Slide Number 7
  • Slide Number 8
  • Slide Number 9
  • Slide Number 10
  • Slide Number 11
  • MOSAIC 2015-2020
  • Pre-hospital Care
  • EMSMOSAIC Data Linkage
  • Slide Number 15
  • GWTG Special Initiatives Tab
  • Slide Number 17
  • MOSAIC Participating Hospitals
  • Hospital Infrastructure
  • Case Demographics MOSAIC Registry
  • Who receives data reports on your stroke quality of care
  • 1) In the most recent calendar year have you run additional analyses (beyond what was required for reporting) on your hospitalrsquos own stroke data 2)How frequently have you run and used the analyses generated
  • What is the main reason you do not run your own additional analyses (Select one best answer)
  • In the most recent calendar year what reports did you run
  • How do you use these analyses reports
  • If you run additional analysis what action items QI efforts did you plan as a result of these reports
  • Hospital Arrival Mode Door-to Needle and Pre-Notification Reports 2016
  • Percent of Cases Who Arrived via EMSMOSAIC 2009-2016
  • Table 1 Arrival Mode among Stroke Cases by Demographics MOSAIC 2016
  • Table 2 Door-to-Needle Times by Arrival Mode among Stroke Cases MOSAIC 2016
  • Table 3 Pre-Notification among Stroke Cases Who Arrived Via EMS by Demographics MOSAIC 2016
  • MOSAIC Transitions of Care Project
  • Slide Number 33
  • MOSAIC Website
  • Adrienne Nickles MPHnicklesamichigangov
Page 51: Michigan and MOSAIC Data Review...Michigan and MOSAIC Data Review 2017 ANNUAL WORKSHOP 4/26/2017. Adrienne Nickles, MPH. Michigan’s Ongoing Stroke Registry to Accelerate the Improvement

What is the main reason you do not run your own additional analyses (Select one best answer)

23

Not sure how to run analyses

25

Not sure what analyses are needed would be helpful 25

Other 50

Data Use

In the most recent calendar year what reports did you run

24

813 688

Pre-programmedautomated reports in thedata collection tool (eg GWTG)

Additional reports beyond pre-programmed reports from the tool

Data Use

How do you use these analyses reports

25

813 688375

Inform quality improvement (QI) efforts andor plan

ldquoaction itemsrdquo

Report to management administration on our

progress

Other

Data Use

If you run additional analysis what action items QI efforts did you plan as a result of these reports

26

o Discharge education intensive statin use

o Door to tPA time and dysphagia

o Review data between spoke amp hub hospitals regarding transfers IV-tPA administration Mechanical thrombectomy and SAH

o QI efforts were addressed in the department involving calling Stroke Alert on call for cases with FAST symptoms

o ED Medical Director works with team to fix fallouts and problematic areas We have seen improvement

o Process changes (ie fallout emails to RN manager) physician querieso Increased documentation of NIHSS ownership from individual units regarding stroke quality

improvement goalso Daily dysphagia screening determination of whowhat team responsible for documenting initial NIHSS

looking at patients beyond 2h LKW arrival

Hospital Arrival Mode Door-to Needle and Pre-Notification

Reports 2016

Percent of Cases Who Arrived via EMSMOSAIC 2009-2016

Table 1 Arrival Mode among Stroke Cases by Demographics MOSAIC 2016

Demographics N=3496 550 N=2938 450Stroke Type Ischemic 2558 542 2164 458 Hemorrhagic 560 728 209 272 TIA 378 478 413 522Age Group lt 50 Years 233 433 305 567 50-79 Years 1982 497 2008 503 ge 80 Years 1379 688 625 312Sex Female 1933 576 1422 424 Male 1661 523 1516 477Race Black 659 530 584 470 White 2824 557 2248 443 Other Missing 111 512 106 488

MOSAIC AggregateArrival Mode

EMS Private Mode

Table 2 Door-to-Needle Times by Arrival Mode among Stroke Cases MOSAIC 2016

Time Elements (in Minutes)Number of

Patients Mean (Minutes) Median

(Minutes)Range

(Minutes)Door-to-Image 4901 575 400 00-2700 Arrived via EMS 2767 463 270 00-2700 Arrived via Private Transportation 2134 720 570 00-2620

Door-to-Image (among t-PA treated) 492 155 130 00-970 Arrived via EMS 370 125 110 00-840 Arrived via Private Transportation 122 243 215 20-970Image-to Needle 492 500 450 70-2090 Arrived via EMS 370 503 460 70-2090 Arrived via Private Transportation 122 483 420 90-1770Door-to Needle 492 655 570 200-2180 Arrived via EMS 370 629 560 200-2180 Arrived via Private Transportation 122 726 650 290-2060Included ischemic or hemorrhagic cases with times that were less or equal to 270 minutes (45 hours)Transferred cases were excluded

MOSAIC Aggregate

Table 3 Pre-Notification among Stroke Cases Who Arrived Via EMS by Demographics MOSAIC 2016

Demographics N=2015 584 N=1437 416Stroke Type Ischemic 1523 622 924 378 Hemorrhagic 306 566 235 434 TIA 142 381 231 619Age Group lt 50 Years 133 607 86 393 50-79 Years 1105 585 784 415 ge 80 Years 777 578 567 422Sex Female 1075 578 786 422 Male 940 591 651 409Race Black 307 517 287 483 White 1657 602 1097 398 Other 51 490 53 510

All HospitalsPre-Notification

Yes No

MOSAIC Transitions of Care Project

Post-discharge data collection tool is being implemented into Outcome Science as a tab

Post-Discharge amp Transition of Care

Reporting on changes within 30 days of discharge from hospital via follow-up callschart review Interval events Physician follow-up visits Lifestyle changes Lab assessments Medication managementadherence Rehab amp Functional outcomes Falls

MOSAIC Website

wwwMichigangovstroke

Adrienne Nickles MPHnicklesamichigangov

Thank You

  • Michigan and MOSAIC Data Review
  • Overview
  • Age-adjusted Stroke Hospitalization Rates Michigan 2000-2015
  • Slide Number 4
  • Age-adjusted Stroke Mortality Rates Michigan 2000-2014
  • Slide Number 6
  • Slide Number 7
  • Slide Number 8
  • Slide Number 9
  • Slide Number 10
  • Slide Number 11
  • MOSAIC 2015-2020
  • Pre-hospital Care
  • EMSMOSAIC Data Linkage
  • Slide Number 15
  • GWTG Special Initiatives Tab
  • Slide Number 17
  • MOSAIC Participating Hospitals
  • Hospital Infrastructure
  • Case Demographics MOSAIC Registry
  • Who receives data reports on your stroke quality of care
  • 1) In the most recent calendar year have you run additional analyses (beyond what was required for reporting) on your hospitalrsquos own stroke data 2)How frequently have you run and used the analyses generated
  • What is the main reason you do not run your own additional analyses (Select one best answer)
  • In the most recent calendar year what reports did you run
  • How do you use these analyses reports
  • If you run additional analysis what action items QI efforts did you plan as a result of these reports
  • Hospital Arrival Mode Door-to Needle and Pre-Notification Reports 2016
  • Percent of Cases Who Arrived via EMSMOSAIC 2009-2016
  • Table 1 Arrival Mode among Stroke Cases by Demographics MOSAIC 2016
  • Table 2 Door-to-Needle Times by Arrival Mode among Stroke Cases MOSAIC 2016
  • Table 3 Pre-Notification among Stroke Cases Who Arrived Via EMS by Demographics MOSAIC 2016
  • MOSAIC Transitions of Care Project
  • Slide Number 33
  • MOSAIC Website
  • Adrienne Nickles MPHnicklesamichigangov
Page 52: Michigan and MOSAIC Data Review...Michigan and MOSAIC Data Review 2017 ANNUAL WORKSHOP 4/26/2017. Adrienne Nickles, MPH. Michigan’s Ongoing Stroke Registry to Accelerate the Improvement

In the most recent calendar year what reports did you run

24

813 688

Pre-programmedautomated reports in thedata collection tool (eg GWTG)

Additional reports beyond pre-programmed reports from the tool

Data Use

How do you use these analyses reports

25

813 688375

Inform quality improvement (QI) efforts andor plan

ldquoaction itemsrdquo

Report to management administration on our

progress

Other

Data Use

If you run additional analysis what action items QI efforts did you plan as a result of these reports

26

o Discharge education intensive statin use

o Door to tPA time and dysphagia

o Review data between spoke amp hub hospitals regarding transfers IV-tPA administration Mechanical thrombectomy and SAH

o QI efforts were addressed in the department involving calling Stroke Alert on call for cases with FAST symptoms

o ED Medical Director works with team to fix fallouts and problematic areas We have seen improvement

o Process changes (ie fallout emails to RN manager) physician querieso Increased documentation of NIHSS ownership from individual units regarding stroke quality

improvement goalso Daily dysphagia screening determination of whowhat team responsible for documenting initial NIHSS

looking at patients beyond 2h LKW arrival

Hospital Arrival Mode Door-to Needle and Pre-Notification

Reports 2016

Percent of Cases Who Arrived via EMSMOSAIC 2009-2016

Table 1 Arrival Mode among Stroke Cases by Demographics MOSAIC 2016

Demographics N=3496 550 N=2938 450Stroke Type Ischemic 2558 542 2164 458 Hemorrhagic 560 728 209 272 TIA 378 478 413 522Age Group lt 50 Years 233 433 305 567 50-79 Years 1982 497 2008 503 ge 80 Years 1379 688 625 312Sex Female 1933 576 1422 424 Male 1661 523 1516 477Race Black 659 530 584 470 White 2824 557 2248 443 Other Missing 111 512 106 488

MOSAIC AggregateArrival Mode

EMS Private Mode

Table 2 Door-to-Needle Times by Arrival Mode among Stroke Cases MOSAIC 2016

Time Elements (in Minutes)Number of

Patients Mean (Minutes) Median

(Minutes)Range

(Minutes)Door-to-Image 4901 575 400 00-2700 Arrived via EMS 2767 463 270 00-2700 Arrived via Private Transportation 2134 720 570 00-2620

Door-to-Image (among t-PA treated) 492 155 130 00-970 Arrived via EMS 370 125 110 00-840 Arrived via Private Transportation 122 243 215 20-970Image-to Needle 492 500 450 70-2090 Arrived via EMS 370 503 460 70-2090 Arrived via Private Transportation 122 483 420 90-1770Door-to Needle 492 655 570 200-2180 Arrived via EMS 370 629 560 200-2180 Arrived via Private Transportation 122 726 650 290-2060Included ischemic or hemorrhagic cases with times that were less or equal to 270 minutes (45 hours)Transferred cases were excluded

MOSAIC Aggregate

Table 3 Pre-Notification among Stroke Cases Who Arrived Via EMS by Demographics MOSAIC 2016

Demographics N=2015 584 N=1437 416Stroke Type Ischemic 1523 622 924 378 Hemorrhagic 306 566 235 434 TIA 142 381 231 619Age Group lt 50 Years 133 607 86 393 50-79 Years 1105 585 784 415 ge 80 Years 777 578 567 422Sex Female 1075 578 786 422 Male 940 591 651 409Race Black 307 517 287 483 White 1657 602 1097 398 Other 51 490 53 510

All HospitalsPre-Notification

Yes No

MOSAIC Transitions of Care Project

Post-discharge data collection tool is being implemented into Outcome Science as a tab

Post-Discharge amp Transition of Care

Reporting on changes within 30 days of discharge from hospital via follow-up callschart review Interval events Physician follow-up visits Lifestyle changes Lab assessments Medication managementadherence Rehab amp Functional outcomes Falls

MOSAIC Website

wwwMichigangovstroke

Adrienne Nickles MPHnicklesamichigangov

Thank You

  • Michigan and MOSAIC Data Review
  • Overview
  • Age-adjusted Stroke Hospitalization Rates Michigan 2000-2015
  • Slide Number 4
  • Age-adjusted Stroke Mortality Rates Michigan 2000-2014
  • Slide Number 6
  • Slide Number 7
  • Slide Number 8
  • Slide Number 9
  • Slide Number 10
  • Slide Number 11
  • MOSAIC 2015-2020
  • Pre-hospital Care
  • EMSMOSAIC Data Linkage
  • Slide Number 15
  • GWTG Special Initiatives Tab
  • Slide Number 17
  • MOSAIC Participating Hospitals
  • Hospital Infrastructure
  • Case Demographics MOSAIC Registry
  • Who receives data reports on your stroke quality of care
  • 1) In the most recent calendar year have you run additional analyses (beyond what was required for reporting) on your hospitalrsquos own stroke data 2)How frequently have you run and used the analyses generated
  • What is the main reason you do not run your own additional analyses (Select one best answer)
  • In the most recent calendar year what reports did you run
  • How do you use these analyses reports
  • If you run additional analysis what action items QI efforts did you plan as a result of these reports
  • Hospital Arrival Mode Door-to Needle and Pre-Notification Reports 2016
  • Percent of Cases Who Arrived via EMSMOSAIC 2009-2016
  • Table 1 Arrival Mode among Stroke Cases by Demographics MOSAIC 2016
  • Table 2 Door-to-Needle Times by Arrival Mode among Stroke Cases MOSAIC 2016
  • Table 3 Pre-Notification among Stroke Cases Who Arrived Via EMS by Demographics MOSAIC 2016
  • MOSAIC Transitions of Care Project
  • Slide Number 33
  • MOSAIC Website
  • Adrienne Nickles MPHnicklesamichigangov
Page 53: Michigan and MOSAIC Data Review...Michigan and MOSAIC Data Review 2017 ANNUAL WORKSHOP 4/26/2017. Adrienne Nickles, MPH. Michigan’s Ongoing Stroke Registry to Accelerate the Improvement

How do you use these analyses reports

25

813 688375

Inform quality improvement (QI) efforts andor plan

ldquoaction itemsrdquo

Report to management administration on our

progress

Other

Data Use

If you run additional analysis what action items QI efforts did you plan as a result of these reports

26

o Discharge education intensive statin use

o Door to tPA time and dysphagia

o Review data between spoke amp hub hospitals regarding transfers IV-tPA administration Mechanical thrombectomy and SAH

o QI efforts were addressed in the department involving calling Stroke Alert on call for cases with FAST symptoms

o ED Medical Director works with team to fix fallouts and problematic areas We have seen improvement

o Process changes (ie fallout emails to RN manager) physician querieso Increased documentation of NIHSS ownership from individual units regarding stroke quality

improvement goalso Daily dysphagia screening determination of whowhat team responsible for documenting initial NIHSS

looking at patients beyond 2h LKW arrival

Hospital Arrival Mode Door-to Needle and Pre-Notification

Reports 2016

Percent of Cases Who Arrived via EMSMOSAIC 2009-2016

Table 1 Arrival Mode among Stroke Cases by Demographics MOSAIC 2016

Demographics N=3496 550 N=2938 450Stroke Type Ischemic 2558 542 2164 458 Hemorrhagic 560 728 209 272 TIA 378 478 413 522Age Group lt 50 Years 233 433 305 567 50-79 Years 1982 497 2008 503 ge 80 Years 1379 688 625 312Sex Female 1933 576 1422 424 Male 1661 523 1516 477Race Black 659 530 584 470 White 2824 557 2248 443 Other Missing 111 512 106 488

MOSAIC AggregateArrival Mode

EMS Private Mode

Table 2 Door-to-Needle Times by Arrival Mode among Stroke Cases MOSAIC 2016

Time Elements (in Minutes)Number of

Patients Mean (Minutes) Median

(Minutes)Range

(Minutes)Door-to-Image 4901 575 400 00-2700 Arrived via EMS 2767 463 270 00-2700 Arrived via Private Transportation 2134 720 570 00-2620

Door-to-Image (among t-PA treated) 492 155 130 00-970 Arrived via EMS 370 125 110 00-840 Arrived via Private Transportation 122 243 215 20-970Image-to Needle 492 500 450 70-2090 Arrived via EMS 370 503 460 70-2090 Arrived via Private Transportation 122 483 420 90-1770Door-to Needle 492 655 570 200-2180 Arrived via EMS 370 629 560 200-2180 Arrived via Private Transportation 122 726 650 290-2060Included ischemic or hemorrhagic cases with times that were less or equal to 270 minutes (45 hours)Transferred cases were excluded

MOSAIC Aggregate

Table 3 Pre-Notification among Stroke Cases Who Arrived Via EMS by Demographics MOSAIC 2016

Demographics N=2015 584 N=1437 416Stroke Type Ischemic 1523 622 924 378 Hemorrhagic 306 566 235 434 TIA 142 381 231 619Age Group lt 50 Years 133 607 86 393 50-79 Years 1105 585 784 415 ge 80 Years 777 578 567 422Sex Female 1075 578 786 422 Male 940 591 651 409Race Black 307 517 287 483 White 1657 602 1097 398 Other 51 490 53 510

All HospitalsPre-Notification

Yes No

MOSAIC Transitions of Care Project

Post-discharge data collection tool is being implemented into Outcome Science as a tab

Post-Discharge amp Transition of Care

Reporting on changes within 30 days of discharge from hospital via follow-up callschart review Interval events Physician follow-up visits Lifestyle changes Lab assessments Medication managementadherence Rehab amp Functional outcomes Falls

MOSAIC Website

wwwMichigangovstroke

Adrienne Nickles MPHnicklesamichigangov

Thank You

  • Michigan and MOSAIC Data Review
  • Overview
  • Age-adjusted Stroke Hospitalization Rates Michigan 2000-2015
  • Slide Number 4
  • Age-adjusted Stroke Mortality Rates Michigan 2000-2014
  • Slide Number 6
  • Slide Number 7
  • Slide Number 8
  • Slide Number 9
  • Slide Number 10
  • Slide Number 11
  • MOSAIC 2015-2020
  • Pre-hospital Care
  • EMSMOSAIC Data Linkage
  • Slide Number 15
  • GWTG Special Initiatives Tab
  • Slide Number 17
  • MOSAIC Participating Hospitals
  • Hospital Infrastructure
  • Case Demographics MOSAIC Registry
  • Who receives data reports on your stroke quality of care
  • 1) In the most recent calendar year have you run additional analyses (beyond what was required for reporting) on your hospitalrsquos own stroke data 2)How frequently have you run and used the analyses generated
  • What is the main reason you do not run your own additional analyses (Select one best answer)
  • In the most recent calendar year what reports did you run
  • How do you use these analyses reports
  • If you run additional analysis what action items QI efforts did you plan as a result of these reports
  • Hospital Arrival Mode Door-to Needle and Pre-Notification Reports 2016
  • Percent of Cases Who Arrived via EMSMOSAIC 2009-2016
  • Table 1 Arrival Mode among Stroke Cases by Demographics MOSAIC 2016
  • Table 2 Door-to-Needle Times by Arrival Mode among Stroke Cases MOSAIC 2016
  • Table 3 Pre-Notification among Stroke Cases Who Arrived Via EMS by Demographics MOSAIC 2016
  • MOSAIC Transitions of Care Project
  • Slide Number 33
  • MOSAIC Website
  • Adrienne Nickles MPHnicklesamichigangov
Page 54: Michigan and MOSAIC Data Review...Michigan and MOSAIC Data Review 2017 ANNUAL WORKSHOP 4/26/2017. Adrienne Nickles, MPH. Michigan’s Ongoing Stroke Registry to Accelerate the Improvement

If you run additional analysis what action items QI efforts did you plan as a result of these reports

26

o Discharge education intensive statin use

o Door to tPA time and dysphagia

o Review data between spoke amp hub hospitals regarding transfers IV-tPA administration Mechanical thrombectomy and SAH

o QI efforts were addressed in the department involving calling Stroke Alert on call for cases with FAST symptoms

o ED Medical Director works with team to fix fallouts and problematic areas We have seen improvement

o Process changes (ie fallout emails to RN manager) physician querieso Increased documentation of NIHSS ownership from individual units regarding stroke quality

improvement goalso Daily dysphagia screening determination of whowhat team responsible for documenting initial NIHSS

looking at patients beyond 2h LKW arrival

Hospital Arrival Mode Door-to Needle and Pre-Notification

Reports 2016

Percent of Cases Who Arrived via EMSMOSAIC 2009-2016

Table 1 Arrival Mode among Stroke Cases by Demographics MOSAIC 2016

Demographics N=3496 550 N=2938 450Stroke Type Ischemic 2558 542 2164 458 Hemorrhagic 560 728 209 272 TIA 378 478 413 522Age Group lt 50 Years 233 433 305 567 50-79 Years 1982 497 2008 503 ge 80 Years 1379 688 625 312Sex Female 1933 576 1422 424 Male 1661 523 1516 477Race Black 659 530 584 470 White 2824 557 2248 443 Other Missing 111 512 106 488

MOSAIC AggregateArrival Mode

EMS Private Mode

Table 2 Door-to-Needle Times by Arrival Mode among Stroke Cases MOSAIC 2016

Time Elements (in Minutes)Number of

Patients Mean (Minutes) Median

(Minutes)Range

(Minutes)Door-to-Image 4901 575 400 00-2700 Arrived via EMS 2767 463 270 00-2700 Arrived via Private Transportation 2134 720 570 00-2620

Door-to-Image (among t-PA treated) 492 155 130 00-970 Arrived via EMS 370 125 110 00-840 Arrived via Private Transportation 122 243 215 20-970Image-to Needle 492 500 450 70-2090 Arrived via EMS 370 503 460 70-2090 Arrived via Private Transportation 122 483 420 90-1770Door-to Needle 492 655 570 200-2180 Arrived via EMS 370 629 560 200-2180 Arrived via Private Transportation 122 726 650 290-2060Included ischemic or hemorrhagic cases with times that were less or equal to 270 minutes (45 hours)Transferred cases were excluded

MOSAIC Aggregate

Table 3 Pre-Notification among Stroke Cases Who Arrived Via EMS by Demographics MOSAIC 2016

Demographics N=2015 584 N=1437 416Stroke Type Ischemic 1523 622 924 378 Hemorrhagic 306 566 235 434 TIA 142 381 231 619Age Group lt 50 Years 133 607 86 393 50-79 Years 1105 585 784 415 ge 80 Years 777 578 567 422Sex Female 1075 578 786 422 Male 940 591 651 409Race Black 307 517 287 483 White 1657 602 1097 398 Other 51 490 53 510

All HospitalsPre-Notification

Yes No

MOSAIC Transitions of Care Project

Post-discharge data collection tool is being implemented into Outcome Science as a tab

Post-Discharge amp Transition of Care

Reporting on changes within 30 days of discharge from hospital via follow-up callschart review Interval events Physician follow-up visits Lifestyle changes Lab assessments Medication managementadherence Rehab amp Functional outcomes Falls

MOSAIC Website

wwwMichigangovstroke

Adrienne Nickles MPHnicklesamichigangov

Thank You

  • Michigan and MOSAIC Data Review
  • Overview
  • Age-adjusted Stroke Hospitalization Rates Michigan 2000-2015
  • Slide Number 4
  • Age-adjusted Stroke Mortality Rates Michigan 2000-2014
  • Slide Number 6
  • Slide Number 7
  • Slide Number 8
  • Slide Number 9
  • Slide Number 10
  • Slide Number 11
  • MOSAIC 2015-2020
  • Pre-hospital Care
  • EMSMOSAIC Data Linkage
  • Slide Number 15
  • GWTG Special Initiatives Tab
  • Slide Number 17
  • MOSAIC Participating Hospitals
  • Hospital Infrastructure
  • Case Demographics MOSAIC Registry
  • Who receives data reports on your stroke quality of care
  • 1) In the most recent calendar year have you run additional analyses (beyond what was required for reporting) on your hospitalrsquos own stroke data 2)How frequently have you run and used the analyses generated
  • What is the main reason you do not run your own additional analyses (Select one best answer)
  • In the most recent calendar year what reports did you run
  • How do you use these analyses reports
  • If you run additional analysis what action items QI efforts did you plan as a result of these reports
  • Hospital Arrival Mode Door-to Needle and Pre-Notification Reports 2016
  • Percent of Cases Who Arrived via EMSMOSAIC 2009-2016
  • Table 1 Arrival Mode among Stroke Cases by Demographics MOSAIC 2016
  • Table 2 Door-to-Needle Times by Arrival Mode among Stroke Cases MOSAIC 2016
  • Table 3 Pre-Notification among Stroke Cases Who Arrived Via EMS by Demographics MOSAIC 2016
  • MOSAIC Transitions of Care Project
  • Slide Number 33
  • MOSAIC Website
  • Adrienne Nickles MPHnicklesamichigangov
Page 55: Michigan and MOSAIC Data Review...Michigan and MOSAIC Data Review 2017 ANNUAL WORKSHOP 4/26/2017. Adrienne Nickles, MPH. Michigan’s Ongoing Stroke Registry to Accelerate the Improvement

Hospital Arrival Mode Door-to Needle and Pre-Notification

Reports 2016

Percent of Cases Who Arrived via EMSMOSAIC 2009-2016

Table 1 Arrival Mode among Stroke Cases by Demographics MOSAIC 2016

Demographics N=3496 550 N=2938 450Stroke Type Ischemic 2558 542 2164 458 Hemorrhagic 560 728 209 272 TIA 378 478 413 522Age Group lt 50 Years 233 433 305 567 50-79 Years 1982 497 2008 503 ge 80 Years 1379 688 625 312Sex Female 1933 576 1422 424 Male 1661 523 1516 477Race Black 659 530 584 470 White 2824 557 2248 443 Other Missing 111 512 106 488

MOSAIC AggregateArrival Mode

EMS Private Mode

Table 2 Door-to-Needle Times by Arrival Mode among Stroke Cases MOSAIC 2016

Time Elements (in Minutes)Number of

Patients Mean (Minutes) Median

(Minutes)Range

(Minutes)Door-to-Image 4901 575 400 00-2700 Arrived via EMS 2767 463 270 00-2700 Arrived via Private Transportation 2134 720 570 00-2620

Door-to-Image (among t-PA treated) 492 155 130 00-970 Arrived via EMS 370 125 110 00-840 Arrived via Private Transportation 122 243 215 20-970Image-to Needle 492 500 450 70-2090 Arrived via EMS 370 503 460 70-2090 Arrived via Private Transportation 122 483 420 90-1770Door-to Needle 492 655 570 200-2180 Arrived via EMS 370 629 560 200-2180 Arrived via Private Transportation 122 726 650 290-2060Included ischemic or hemorrhagic cases with times that were less or equal to 270 minutes (45 hours)Transferred cases were excluded

MOSAIC Aggregate

Table 3 Pre-Notification among Stroke Cases Who Arrived Via EMS by Demographics MOSAIC 2016

Demographics N=2015 584 N=1437 416Stroke Type Ischemic 1523 622 924 378 Hemorrhagic 306 566 235 434 TIA 142 381 231 619Age Group lt 50 Years 133 607 86 393 50-79 Years 1105 585 784 415 ge 80 Years 777 578 567 422Sex Female 1075 578 786 422 Male 940 591 651 409Race Black 307 517 287 483 White 1657 602 1097 398 Other 51 490 53 510

All HospitalsPre-Notification

Yes No

MOSAIC Transitions of Care Project

Post-discharge data collection tool is being implemented into Outcome Science as a tab

Post-Discharge amp Transition of Care

Reporting on changes within 30 days of discharge from hospital via follow-up callschart review Interval events Physician follow-up visits Lifestyle changes Lab assessments Medication managementadherence Rehab amp Functional outcomes Falls

MOSAIC Website

wwwMichigangovstroke

Adrienne Nickles MPHnicklesamichigangov

Thank You

  • Michigan and MOSAIC Data Review
  • Overview
  • Age-adjusted Stroke Hospitalization Rates Michigan 2000-2015
  • Slide Number 4
  • Age-adjusted Stroke Mortality Rates Michigan 2000-2014
  • Slide Number 6
  • Slide Number 7
  • Slide Number 8
  • Slide Number 9
  • Slide Number 10
  • Slide Number 11
  • MOSAIC 2015-2020
  • Pre-hospital Care
  • EMSMOSAIC Data Linkage
  • Slide Number 15
  • GWTG Special Initiatives Tab
  • Slide Number 17
  • MOSAIC Participating Hospitals
  • Hospital Infrastructure
  • Case Demographics MOSAIC Registry
  • Who receives data reports on your stroke quality of care
  • 1) In the most recent calendar year have you run additional analyses (beyond what was required for reporting) on your hospitalrsquos own stroke data 2)How frequently have you run and used the analyses generated
  • What is the main reason you do not run your own additional analyses (Select one best answer)
  • In the most recent calendar year what reports did you run
  • How do you use these analyses reports
  • If you run additional analysis what action items QI efforts did you plan as a result of these reports
  • Hospital Arrival Mode Door-to Needle and Pre-Notification Reports 2016
  • Percent of Cases Who Arrived via EMSMOSAIC 2009-2016
  • Table 1 Arrival Mode among Stroke Cases by Demographics MOSAIC 2016
  • Table 2 Door-to-Needle Times by Arrival Mode among Stroke Cases MOSAIC 2016
  • Table 3 Pre-Notification among Stroke Cases Who Arrived Via EMS by Demographics MOSAIC 2016
  • MOSAIC Transitions of Care Project
  • Slide Number 33
  • MOSAIC Website
  • Adrienne Nickles MPHnicklesamichigangov
Page 56: Michigan and MOSAIC Data Review...Michigan and MOSAIC Data Review 2017 ANNUAL WORKSHOP 4/26/2017. Adrienne Nickles, MPH. Michigan’s Ongoing Stroke Registry to Accelerate the Improvement

Percent of Cases Who Arrived via EMSMOSAIC 2009-2016

Table 1 Arrival Mode among Stroke Cases by Demographics MOSAIC 2016

Demographics N=3496 550 N=2938 450Stroke Type Ischemic 2558 542 2164 458 Hemorrhagic 560 728 209 272 TIA 378 478 413 522Age Group lt 50 Years 233 433 305 567 50-79 Years 1982 497 2008 503 ge 80 Years 1379 688 625 312Sex Female 1933 576 1422 424 Male 1661 523 1516 477Race Black 659 530 584 470 White 2824 557 2248 443 Other Missing 111 512 106 488

MOSAIC AggregateArrival Mode

EMS Private Mode

Table 2 Door-to-Needle Times by Arrival Mode among Stroke Cases MOSAIC 2016

Time Elements (in Minutes)Number of

Patients Mean (Minutes) Median

(Minutes)Range

(Minutes)Door-to-Image 4901 575 400 00-2700 Arrived via EMS 2767 463 270 00-2700 Arrived via Private Transportation 2134 720 570 00-2620

Door-to-Image (among t-PA treated) 492 155 130 00-970 Arrived via EMS 370 125 110 00-840 Arrived via Private Transportation 122 243 215 20-970Image-to Needle 492 500 450 70-2090 Arrived via EMS 370 503 460 70-2090 Arrived via Private Transportation 122 483 420 90-1770Door-to Needle 492 655 570 200-2180 Arrived via EMS 370 629 560 200-2180 Arrived via Private Transportation 122 726 650 290-2060Included ischemic or hemorrhagic cases with times that were less or equal to 270 minutes (45 hours)Transferred cases were excluded

MOSAIC Aggregate

Table 3 Pre-Notification among Stroke Cases Who Arrived Via EMS by Demographics MOSAIC 2016

Demographics N=2015 584 N=1437 416Stroke Type Ischemic 1523 622 924 378 Hemorrhagic 306 566 235 434 TIA 142 381 231 619Age Group lt 50 Years 133 607 86 393 50-79 Years 1105 585 784 415 ge 80 Years 777 578 567 422Sex Female 1075 578 786 422 Male 940 591 651 409Race Black 307 517 287 483 White 1657 602 1097 398 Other 51 490 53 510

All HospitalsPre-Notification

Yes No

MOSAIC Transitions of Care Project

Post-discharge data collection tool is being implemented into Outcome Science as a tab

Post-Discharge amp Transition of Care

Reporting on changes within 30 days of discharge from hospital via follow-up callschart review Interval events Physician follow-up visits Lifestyle changes Lab assessments Medication managementadherence Rehab amp Functional outcomes Falls

MOSAIC Website

wwwMichigangovstroke

Adrienne Nickles MPHnicklesamichigangov

Thank You

  • Michigan and MOSAIC Data Review
  • Overview
  • Age-adjusted Stroke Hospitalization Rates Michigan 2000-2015
  • Slide Number 4
  • Age-adjusted Stroke Mortality Rates Michigan 2000-2014
  • Slide Number 6
  • Slide Number 7
  • Slide Number 8
  • Slide Number 9
  • Slide Number 10
  • Slide Number 11
  • MOSAIC 2015-2020
  • Pre-hospital Care
  • EMSMOSAIC Data Linkage
  • Slide Number 15
  • GWTG Special Initiatives Tab
  • Slide Number 17
  • MOSAIC Participating Hospitals
  • Hospital Infrastructure
  • Case Demographics MOSAIC Registry
  • Who receives data reports on your stroke quality of care
  • 1) In the most recent calendar year have you run additional analyses (beyond what was required for reporting) on your hospitalrsquos own stroke data 2)How frequently have you run and used the analyses generated
  • What is the main reason you do not run your own additional analyses (Select one best answer)
  • In the most recent calendar year what reports did you run
  • How do you use these analyses reports
  • If you run additional analysis what action items QI efforts did you plan as a result of these reports
  • Hospital Arrival Mode Door-to Needle and Pre-Notification Reports 2016
  • Percent of Cases Who Arrived via EMSMOSAIC 2009-2016
  • Table 1 Arrival Mode among Stroke Cases by Demographics MOSAIC 2016
  • Table 2 Door-to-Needle Times by Arrival Mode among Stroke Cases MOSAIC 2016
  • Table 3 Pre-Notification among Stroke Cases Who Arrived Via EMS by Demographics MOSAIC 2016
  • MOSAIC Transitions of Care Project
  • Slide Number 33
  • MOSAIC Website
  • Adrienne Nickles MPHnicklesamichigangov
Page 57: Michigan and MOSAIC Data Review...Michigan and MOSAIC Data Review 2017 ANNUAL WORKSHOP 4/26/2017. Adrienne Nickles, MPH. Michigan’s Ongoing Stroke Registry to Accelerate the Improvement

Table 1 Arrival Mode among Stroke Cases by Demographics MOSAIC 2016

Demographics N=3496 550 N=2938 450Stroke Type Ischemic 2558 542 2164 458 Hemorrhagic 560 728 209 272 TIA 378 478 413 522Age Group lt 50 Years 233 433 305 567 50-79 Years 1982 497 2008 503 ge 80 Years 1379 688 625 312Sex Female 1933 576 1422 424 Male 1661 523 1516 477Race Black 659 530 584 470 White 2824 557 2248 443 Other Missing 111 512 106 488

MOSAIC AggregateArrival Mode

EMS Private Mode

Table 2 Door-to-Needle Times by Arrival Mode among Stroke Cases MOSAIC 2016

Time Elements (in Minutes)Number of

Patients Mean (Minutes) Median

(Minutes)Range

(Minutes)Door-to-Image 4901 575 400 00-2700 Arrived via EMS 2767 463 270 00-2700 Arrived via Private Transportation 2134 720 570 00-2620

Door-to-Image (among t-PA treated) 492 155 130 00-970 Arrived via EMS 370 125 110 00-840 Arrived via Private Transportation 122 243 215 20-970Image-to Needle 492 500 450 70-2090 Arrived via EMS 370 503 460 70-2090 Arrived via Private Transportation 122 483 420 90-1770Door-to Needle 492 655 570 200-2180 Arrived via EMS 370 629 560 200-2180 Arrived via Private Transportation 122 726 650 290-2060Included ischemic or hemorrhagic cases with times that were less or equal to 270 minutes (45 hours)Transferred cases were excluded

MOSAIC Aggregate

Table 3 Pre-Notification among Stroke Cases Who Arrived Via EMS by Demographics MOSAIC 2016

Demographics N=2015 584 N=1437 416Stroke Type Ischemic 1523 622 924 378 Hemorrhagic 306 566 235 434 TIA 142 381 231 619Age Group lt 50 Years 133 607 86 393 50-79 Years 1105 585 784 415 ge 80 Years 777 578 567 422Sex Female 1075 578 786 422 Male 940 591 651 409Race Black 307 517 287 483 White 1657 602 1097 398 Other 51 490 53 510

All HospitalsPre-Notification

Yes No

MOSAIC Transitions of Care Project

Post-discharge data collection tool is being implemented into Outcome Science as a tab

Post-Discharge amp Transition of Care

Reporting on changes within 30 days of discharge from hospital via follow-up callschart review Interval events Physician follow-up visits Lifestyle changes Lab assessments Medication managementadherence Rehab amp Functional outcomes Falls

MOSAIC Website

wwwMichigangovstroke

Adrienne Nickles MPHnicklesamichigangov

Thank You

  • Michigan and MOSAIC Data Review
  • Overview
  • Age-adjusted Stroke Hospitalization Rates Michigan 2000-2015
  • Slide Number 4
  • Age-adjusted Stroke Mortality Rates Michigan 2000-2014
  • Slide Number 6
  • Slide Number 7
  • Slide Number 8
  • Slide Number 9
  • Slide Number 10
  • Slide Number 11
  • MOSAIC 2015-2020
  • Pre-hospital Care
  • EMSMOSAIC Data Linkage
  • Slide Number 15
  • GWTG Special Initiatives Tab
  • Slide Number 17
  • MOSAIC Participating Hospitals
  • Hospital Infrastructure
  • Case Demographics MOSAIC Registry
  • Who receives data reports on your stroke quality of care
  • 1) In the most recent calendar year have you run additional analyses (beyond what was required for reporting) on your hospitalrsquos own stroke data 2)How frequently have you run and used the analyses generated
  • What is the main reason you do not run your own additional analyses (Select one best answer)
  • In the most recent calendar year what reports did you run
  • How do you use these analyses reports
  • If you run additional analysis what action items QI efforts did you plan as a result of these reports
  • Hospital Arrival Mode Door-to Needle and Pre-Notification Reports 2016
  • Percent of Cases Who Arrived via EMSMOSAIC 2009-2016
  • Table 1 Arrival Mode among Stroke Cases by Demographics MOSAIC 2016
  • Table 2 Door-to-Needle Times by Arrival Mode among Stroke Cases MOSAIC 2016
  • Table 3 Pre-Notification among Stroke Cases Who Arrived Via EMS by Demographics MOSAIC 2016
  • MOSAIC Transitions of Care Project
  • Slide Number 33
  • MOSAIC Website
  • Adrienne Nickles MPHnicklesamichigangov
Page 58: Michigan and MOSAIC Data Review...Michigan and MOSAIC Data Review 2017 ANNUAL WORKSHOP 4/26/2017. Adrienne Nickles, MPH. Michigan’s Ongoing Stroke Registry to Accelerate the Improvement

Table 2 Door-to-Needle Times by Arrival Mode among Stroke Cases MOSAIC 2016

Time Elements (in Minutes)Number of

Patients Mean (Minutes) Median

(Minutes)Range

(Minutes)Door-to-Image 4901 575 400 00-2700 Arrived via EMS 2767 463 270 00-2700 Arrived via Private Transportation 2134 720 570 00-2620

Door-to-Image (among t-PA treated) 492 155 130 00-970 Arrived via EMS 370 125 110 00-840 Arrived via Private Transportation 122 243 215 20-970Image-to Needle 492 500 450 70-2090 Arrived via EMS 370 503 460 70-2090 Arrived via Private Transportation 122 483 420 90-1770Door-to Needle 492 655 570 200-2180 Arrived via EMS 370 629 560 200-2180 Arrived via Private Transportation 122 726 650 290-2060Included ischemic or hemorrhagic cases with times that were less or equal to 270 minutes (45 hours)Transferred cases were excluded

MOSAIC Aggregate

Table 3 Pre-Notification among Stroke Cases Who Arrived Via EMS by Demographics MOSAIC 2016

Demographics N=2015 584 N=1437 416Stroke Type Ischemic 1523 622 924 378 Hemorrhagic 306 566 235 434 TIA 142 381 231 619Age Group lt 50 Years 133 607 86 393 50-79 Years 1105 585 784 415 ge 80 Years 777 578 567 422Sex Female 1075 578 786 422 Male 940 591 651 409Race Black 307 517 287 483 White 1657 602 1097 398 Other 51 490 53 510

All HospitalsPre-Notification

Yes No

MOSAIC Transitions of Care Project

Post-discharge data collection tool is being implemented into Outcome Science as a tab

Post-Discharge amp Transition of Care

Reporting on changes within 30 days of discharge from hospital via follow-up callschart review Interval events Physician follow-up visits Lifestyle changes Lab assessments Medication managementadherence Rehab amp Functional outcomes Falls

MOSAIC Website

wwwMichigangovstroke

Adrienne Nickles MPHnicklesamichigangov

Thank You

  • Michigan and MOSAIC Data Review
  • Overview
  • Age-adjusted Stroke Hospitalization Rates Michigan 2000-2015
  • Slide Number 4
  • Age-adjusted Stroke Mortality Rates Michigan 2000-2014
  • Slide Number 6
  • Slide Number 7
  • Slide Number 8
  • Slide Number 9
  • Slide Number 10
  • Slide Number 11
  • MOSAIC 2015-2020
  • Pre-hospital Care
  • EMSMOSAIC Data Linkage
  • Slide Number 15
  • GWTG Special Initiatives Tab
  • Slide Number 17
  • MOSAIC Participating Hospitals
  • Hospital Infrastructure
  • Case Demographics MOSAIC Registry
  • Who receives data reports on your stroke quality of care
  • 1) In the most recent calendar year have you run additional analyses (beyond what was required for reporting) on your hospitalrsquos own stroke data 2)How frequently have you run and used the analyses generated
  • What is the main reason you do not run your own additional analyses (Select one best answer)
  • In the most recent calendar year what reports did you run
  • How do you use these analyses reports
  • If you run additional analysis what action items QI efforts did you plan as a result of these reports
  • Hospital Arrival Mode Door-to Needle and Pre-Notification Reports 2016
  • Percent of Cases Who Arrived via EMSMOSAIC 2009-2016
  • Table 1 Arrival Mode among Stroke Cases by Demographics MOSAIC 2016
  • Table 2 Door-to-Needle Times by Arrival Mode among Stroke Cases MOSAIC 2016
  • Table 3 Pre-Notification among Stroke Cases Who Arrived Via EMS by Demographics MOSAIC 2016
  • MOSAIC Transitions of Care Project
  • Slide Number 33
  • MOSAIC Website
  • Adrienne Nickles MPHnicklesamichigangov
Page 59: Michigan and MOSAIC Data Review...Michigan and MOSAIC Data Review 2017 ANNUAL WORKSHOP 4/26/2017. Adrienne Nickles, MPH. Michigan’s Ongoing Stroke Registry to Accelerate the Improvement

Table 3 Pre-Notification among Stroke Cases Who Arrived Via EMS by Demographics MOSAIC 2016

Demographics N=2015 584 N=1437 416Stroke Type Ischemic 1523 622 924 378 Hemorrhagic 306 566 235 434 TIA 142 381 231 619Age Group lt 50 Years 133 607 86 393 50-79 Years 1105 585 784 415 ge 80 Years 777 578 567 422Sex Female 1075 578 786 422 Male 940 591 651 409Race Black 307 517 287 483 White 1657 602 1097 398 Other 51 490 53 510

All HospitalsPre-Notification

Yes No

MOSAIC Transitions of Care Project

Post-discharge data collection tool is being implemented into Outcome Science as a tab

Post-Discharge amp Transition of Care

Reporting on changes within 30 days of discharge from hospital via follow-up callschart review Interval events Physician follow-up visits Lifestyle changes Lab assessments Medication managementadherence Rehab amp Functional outcomes Falls

MOSAIC Website

wwwMichigangovstroke

Adrienne Nickles MPHnicklesamichigangov

Thank You

  • Michigan and MOSAIC Data Review
  • Overview
  • Age-adjusted Stroke Hospitalization Rates Michigan 2000-2015
  • Slide Number 4
  • Age-adjusted Stroke Mortality Rates Michigan 2000-2014
  • Slide Number 6
  • Slide Number 7
  • Slide Number 8
  • Slide Number 9
  • Slide Number 10
  • Slide Number 11
  • MOSAIC 2015-2020
  • Pre-hospital Care
  • EMSMOSAIC Data Linkage
  • Slide Number 15
  • GWTG Special Initiatives Tab
  • Slide Number 17
  • MOSAIC Participating Hospitals
  • Hospital Infrastructure
  • Case Demographics MOSAIC Registry
  • Who receives data reports on your stroke quality of care
  • 1) In the most recent calendar year have you run additional analyses (beyond what was required for reporting) on your hospitalrsquos own stroke data 2)How frequently have you run and used the analyses generated
  • What is the main reason you do not run your own additional analyses (Select one best answer)
  • In the most recent calendar year what reports did you run
  • How do you use these analyses reports
  • If you run additional analysis what action items QI efforts did you plan as a result of these reports
  • Hospital Arrival Mode Door-to Needle and Pre-Notification Reports 2016
  • Percent of Cases Who Arrived via EMSMOSAIC 2009-2016
  • Table 1 Arrival Mode among Stroke Cases by Demographics MOSAIC 2016
  • Table 2 Door-to-Needle Times by Arrival Mode among Stroke Cases MOSAIC 2016
  • Table 3 Pre-Notification among Stroke Cases Who Arrived Via EMS by Demographics MOSAIC 2016
  • MOSAIC Transitions of Care Project
  • Slide Number 33
  • MOSAIC Website
  • Adrienne Nickles MPHnicklesamichigangov
Page 60: Michigan and MOSAIC Data Review...Michigan and MOSAIC Data Review 2017 ANNUAL WORKSHOP 4/26/2017. Adrienne Nickles, MPH. Michigan’s Ongoing Stroke Registry to Accelerate the Improvement

MOSAIC Transitions of Care Project

Post-discharge data collection tool is being implemented into Outcome Science as a tab

Post-Discharge amp Transition of Care

Reporting on changes within 30 days of discharge from hospital via follow-up callschart review Interval events Physician follow-up visits Lifestyle changes Lab assessments Medication managementadherence Rehab amp Functional outcomes Falls

MOSAIC Website

wwwMichigangovstroke

Adrienne Nickles MPHnicklesamichigangov

Thank You

  • Michigan and MOSAIC Data Review
  • Overview
  • Age-adjusted Stroke Hospitalization Rates Michigan 2000-2015
  • Slide Number 4
  • Age-adjusted Stroke Mortality Rates Michigan 2000-2014
  • Slide Number 6
  • Slide Number 7
  • Slide Number 8
  • Slide Number 9
  • Slide Number 10
  • Slide Number 11
  • MOSAIC 2015-2020
  • Pre-hospital Care
  • EMSMOSAIC Data Linkage
  • Slide Number 15
  • GWTG Special Initiatives Tab
  • Slide Number 17
  • MOSAIC Participating Hospitals
  • Hospital Infrastructure
  • Case Demographics MOSAIC Registry
  • Who receives data reports on your stroke quality of care
  • 1) In the most recent calendar year have you run additional analyses (beyond what was required for reporting) on your hospitalrsquos own stroke data 2)How frequently have you run and used the analyses generated
  • What is the main reason you do not run your own additional analyses (Select one best answer)
  • In the most recent calendar year what reports did you run
  • How do you use these analyses reports
  • If you run additional analysis what action items QI efforts did you plan as a result of these reports
  • Hospital Arrival Mode Door-to Needle and Pre-Notification Reports 2016
  • Percent of Cases Who Arrived via EMSMOSAIC 2009-2016
  • Table 1 Arrival Mode among Stroke Cases by Demographics MOSAIC 2016
  • Table 2 Door-to-Needle Times by Arrival Mode among Stroke Cases MOSAIC 2016
  • Table 3 Pre-Notification among Stroke Cases Who Arrived Via EMS by Demographics MOSAIC 2016
  • MOSAIC Transitions of Care Project
  • Slide Number 33
  • MOSAIC Website
  • Adrienne Nickles MPHnicklesamichigangov
Page 61: Michigan and MOSAIC Data Review...Michigan and MOSAIC Data Review 2017 ANNUAL WORKSHOP 4/26/2017. Adrienne Nickles, MPH. Michigan’s Ongoing Stroke Registry to Accelerate the Improvement

Post-Discharge amp Transition of Care

Reporting on changes within 30 days of discharge from hospital via follow-up callschart review Interval events Physician follow-up visits Lifestyle changes Lab assessments Medication managementadherence Rehab amp Functional outcomes Falls

MOSAIC Website

wwwMichigangovstroke

Adrienne Nickles MPHnicklesamichigangov

Thank You

  • Michigan and MOSAIC Data Review
  • Overview
  • Age-adjusted Stroke Hospitalization Rates Michigan 2000-2015
  • Slide Number 4
  • Age-adjusted Stroke Mortality Rates Michigan 2000-2014
  • Slide Number 6
  • Slide Number 7
  • Slide Number 8
  • Slide Number 9
  • Slide Number 10
  • Slide Number 11
  • MOSAIC 2015-2020
  • Pre-hospital Care
  • EMSMOSAIC Data Linkage
  • Slide Number 15
  • GWTG Special Initiatives Tab
  • Slide Number 17
  • MOSAIC Participating Hospitals
  • Hospital Infrastructure
  • Case Demographics MOSAIC Registry
  • Who receives data reports on your stroke quality of care
  • 1) In the most recent calendar year have you run additional analyses (beyond what was required for reporting) on your hospitalrsquos own stroke data 2)How frequently have you run and used the analyses generated
  • What is the main reason you do not run your own additional analyses (Select one best answer)
  • In the most recent calendar year what reports did you run
  • How do you use these analyses reports
  • If you run additional analysis what action items QI efforts did you plan as a result of these reports
  • Hospital Arrival Mode Door-to Needle and Pre-Notification Reports 2016
  • Percent of Cases Who Arrived via EMSMOSAIC 2009-2016
  • Table 1 Arrival Mode among Stroke Cases by Demographics MOSAIC 2016
  • Table 2 Door-to-Needle Times by Arrival Mode among Stroke Cases MOSAIC 2016
  • Table 3 Pre-Notification among Stroke Cases Who Arrived Via EMS by Demographics MOSAIC 2016
  • MOSAIC Transitions of Care Project
  • Slide Number 33
  • MOSAIC Website
  • Adrienne Nickles MPHnicklesamichigangov
Page 62: Michigan and MOSAIC Data Review...Michigan and MOSAIC Data Review 2017 ANNUAL WORKSHOP 4/26/2017. Adrienne Nickles, MPH. Michigan’s Ongoing Stroke Registry to Accelerate the Improvement

MOSAIC Website

wwwMichigangovstroke

Adrienne Nickles MPHnicklesamichigangov

Thank You

  • Michigan and MOSAIC Data Review
  • Overview
  • Age-adjusted Stroke Hospitalization Rates Michigan 2000-2015
  • Slide Number 4
  • Age-adjusted Stroke Mortality Rates Michigan 2000-2014
  • Slide Number 6
  • Slide Number 7
  • Slide Number 8
  • Slide Number 9
  • Slide Number 10
  • Slide Number 11
  • MOSAIC 2015-2020
  • Pre-hospital Care
  • EMSMOSAIC Data Linkage
  • Slide Number 15
  • GWTG Special Initiatives Tab
  • Slide Number 17
  • MOSAIC Participating Hospitals
  • Hospital Infrastructure
  • Case Demographics MOSAIC Registry
  • Who receives data reports on your stroke quality of care
  • 1) In the most recent calendar year have you run additional analyses (beyond what was required for reporting) on your hospitalrsquos own stroke data 2)How frequently have you run and used the analyses generated
  • What is the main reason you do not run your own additional analyses (Select one best answer)
  • In the most recent calendar year what reports did you run
  • How do you use these analyses reports
  • If you run additional analysis what action items QI efforts did you plan as a result of these reports
  • Hospital Arrival Mode Door-to Needle and Pre-Notification Reports 2016
  • Percent of Cases Who Arrived via EMSMOSAIC 2009-2016
  • Table 1 Arrival Mode among Stroke Cases by Demographics MOSAIC 2016
  • Table 2 Door-to-Needle Times by Arrival Mode among Stroke Cases MOSAIC 2016
  • Table 3 Pre-Notification among Stroke Cases Who Arrived Via EMS by Demographics MOSAIC 2016
  • MOSAIC Transitions of Care Project
  • Slide Number 33
  • MOSAIC Website
  • Adrienne Nickles MPHnicklesamichigangov
Page 63: Michigan and MOSAIC Data Review...Michigan and MOSAIC Data Review 2017 ANNUAL WORKSHOP 4/26/2017. Adrienne Nickles, MPH. Michigan’s Ongoing Stroke Registry to Accelerate the Improvement

Adrienne Nickles MPHnicklesamichigangov

Thank You

  • Michigan and MOSAIC Data Review
  • Overview
  • Age-adjusted Stroke Hospitalization Rates Michigan 2000-2015
  • Slide Number 4
  • Age-adjusted Stroke Mortality Rates Michigan 2000-2014
  • Slide Number 6
  • Slide Number 7
  • Slide Number 8
  • Slide Number 9
  • Slide Number 10
  • Slide Number 11
  • MOSAIC 2015-2020
  • Pre-hospital Care
  • EMSMOSAIC Data Linkage
  • Slide Number 15
  • GWTG Special Initiatives Tab
  • Slide Number 17
  • MOSAIC Participating Hospitals
  • Hospital Infrastructure
  • Case Demographics MOSAIC Registry
  • Who receives data reports on your stroke quality of care
  • 1) In the most recent calendar year have you run additional analyses (beyond what was required for reporting) on your hospitalrsquos own stroke data 2)How frequently have you run and used the analyses generated
  • What is the main reason you do not run your own additional analyses (Select one best answer)
  • In the most recent calendar year what reports did you run
  • How do you use these analyses reports
  • If you run additional analysis what action items QI efforts did you plan as a result of these reports
  • Hospital Arrival Mode Door-to Needle and Pre-Notification Reports 2016
  • Percent of Cases Who Arrived via EMSMOSAIC 2009-2016
  • Table 1 Arrival Mode among Stroke Cases by Demographics MOSAIC 2016
  • Table 2 Door-to-Needle Times by Arrival Mode among Stroke Cases MOSAIC 2016
  • Table 3 Pre-Notification among Stroke Cases Who Arrived Via EMS by Demographics MOSAIC 2016
  • MOSAIC Transitions of Care Project
  • Slide Number 33
  • MOSAIC Website
  • Adrienne Nickles MPHnicklesamichigangov

For all the nights of chanukKah - Mosaic | Mosaic Jewish ...

For all the nights of chanukKah - Mosaic | Mosaic Jewish ...

White mosaic - Marbles Tiles and Mosaic

White mosaic - Marbles Tiles and Mosaic

INSTALLATION MOSAIC TILE INSTALLATION MOSAIC TILE STEP …pdf.lowes.com/installationguides/081516694587_install.pdf · 2019-04-02 · Mosaic Tile Installation Mosaic Tile Installation

INSTALLATION MOSAIC TILE INSTALLATION MOSAIC TILE STEP …pdf.lowes.com/installationguides/081516694587_install.pdf · 2019-04-02 · Mosaic Tile Installation Mosaic Tile Installation

Nickles-Stearns Is Not the Market Choice for Health Care ... · Nickles-Stearns Is Not the Market Choice for Health Care Reform ... It provides inadequate incentives for ... advantage

Nickles-Stearns Is Not the Market Choice for Health Care ... · Nickles-Stearns Is Not the Market Choice for Health Care Reform ... It provides inadequate incentives for ... advantage

Abandoning the ‘Mosaic Theory’: Why the ‘Mosaic Theory’ of ...

Abandoning the ‘Mosaic Theory’: Why the ‘Mosaic Theory’ of ...

Brand Development Expert, Liz Nickles

Brand Development Expert, Liz Nickles

Mosaic Mosaic Mosaic - New West End Synagogue · Mosaic Mosaic Magazine of the New West End Synagogue Rosh Hashanah 5773 / 2012 ... - Sunday 18th November - and keep it free in your

Mosaic Mosaic Mosaic - New West End Synagogue · Mosaic Mosaic Magazine of the New West End Synagogue Rosh Hashanah 5773 / 2012 ... - Sunday 18th November - and keep it free in your

City of Polk City Newsletter · Page 3 Sharon Nickles Celebrates 25 Years Of Service To Polk City In July of 1983 Sharon Nickles was hired for twenty hours at $4.45 an hour as Polk

City of Polk City Newsletter · Page 3 Sharon Nickles Celebrates 25 Years Of Service To Polk City In July of 1983 Sharon Nickles was hired for twenty hours at $4.45 an hour as Polk

Nickles Linux Report Nickles Linux Report … · 9 Inhaltsverzeichnis 2.5 PRAXIS: Debian-Linux installieren – Original statt Abklatsch. . . . . . . . . . . . . . . . . . . . . .

Nickles Linux Report Nickles Linux Report … · 9 Inhaltsverzeichnis 2.5 PRAXIS: Debian-Linux installieren – Original statt Abklatsch. . . . . . . . . . . . . . . . . . . . . .

ConsumerView - Experian Data Quality...Fact Sheet | Page 4 ConsumerView Attributes: Mosaic Mosaic Summary Mosaic Groups and Types Mosaic is a household based consumer lifestyle segmentation

ConsumerView - Experian Data Quality...Fact Sheet | Page 4 ConsumerView Attributes: Mosaic Mosaic Summary Mosaic Groups and Types Mosaic is a household based consumer lifestyle segmentation

Characterization of Cucumber Mosaic Virus (CMV) Causing Mosaic

Characterization of Cucumber Mosaic Virus (CMV) Causing Mosaic

Rose Mosaic Virus - agrilifeextension.tamu.eduagrilifeextension.tamu.edu/.../2018/10/EPLP-027-rose-mosaic-virus.pdf · mosaic virus (ApMV), and Arabis mosaic virus (ArMV). These viruses

Rose Mosaic Virus - agrilifeextension.tamu.eduagrilifeextension.tamu.edu/.../2018/10/EPLP-027-rose-mosaic-virus.pdf · mosaic virus (ApMV), and Arabis mosaic virus (ArMV). These viruses

2020 CONFERENCE ON Rare Gynecologic Tumors · Amanda Nickles-Fader, MD 2:30 Q&A Seoni ss Nadeem R. Abu-Rustum, MD; Samuel Mok, PhD; Amanda Nickles-Fader, MD SARCOMA 2:40 Leiomyosarcoma

2020 CONFERENCE ON Rare Gynecologic Tumors · Amanda Nickles-Fader, MD 2:30 Q&A Seoni ss Nadeem R. Abu-Rustum, MD; Samuel Mok, PhD; Amanda Nickles-Fader, MD SARCOMA 2:40 Leiomyosarcoma

TheBookofTheWatchers(1Enoch1-36): ananti-Mosaic,non-Mosaic ...

TheBookofTheWatchers(1Enoch1-36): ananti-Mosaic,non-Mosaic ...

Mosaic Introduction Mosaic Refills - Ultradent...4802 Mosaic Singles Intro Kit x1 1 x Singles 10pk of each shade: A1, A2, A3, EN, ET 1 x Mosaic Shade Guide 4803 Mosaic Shade Guide

Mosaic Introduction Mosaic Refills - Ultradent...4802 Mosaic Singles Intro Kit x1 1 x Singles 10pk of each shade: A1, A2, A3, EN, ET 1 x Mosaic Shade Guide 4803 Mosaic Shade Guide

Nickles-Stearns Is Not the Market Choice for Health Care Reform, Cato Policy Analysis

Nickles-Stearns Is Not the Market Choice for Health Care Reform, Cato Policy Analysis

Phospholipid bilayer “Mosaic” of proteins The fluid-mosaic model.

Phospholipid bilayer “Mosaic” of proteins The fluid-mosaic model.

Codes for pathogens and pests in vegetable crops€¦ ·  · 2017-10-31Chilli veinal mosaic virus Chilli veinal mosaic ChiVMV Cucumber mosaic virus Cucumber mosaic CMV ... Erwinia

Codes for pathogens and pests in vegetable crops€¦ ·  · 2017-10-31Chilli veinal mosaic virus Chilli veinal mosaic ChiVMV Cucumber mosaic virus Cucumber mosaic CMV ... Erwinia

Mosaic Brochure

Mosaic Brochure

Maintenance of mosaic background wall cp mosaic

Maintenance of mosaic background wall cp mosaic