Local Health Systems Collaborate on Pilot Program to Prevent, Treat Stroke

Mar. 15, 2012
Greater Rochester Health Foundation supports cooperative program to unify care
A brain scan after a stroke, showing permanent damage on the right side.

Rochester’s three health systems are collaborating to improve stroke care through creation of the Stroke Treatment Alliance of Rochester (STAR), funded by an $800,000 grant from the Greater Rochester Health Foundation. The initiative brings stroke teams from Highland, Rochester General, Strong Memorial and Unity hospitals together to provide consistent and immediate care for a condition that requires fast action for long-term survival and meaningful quality of life.

The grant, the largest to date issued by GRFH, was written by neurologist Curtis Benesch, M.D., M.P.H., and neurosurgeon Babak Jahromi, M.D., Ph.D., of the University of Rochester Medical Center. The program includes a consortium of vascular neurologists and neurosurgeons who provide around-the-clock emergency support and consultation for each hospital. While each local hospital has a state Department of Health-designated Primary Stroke Center, inconsistencies among the institutions persist.

“The Foundation recognizes that stroke is a significant health issue for our community with nearly 2,500 people admitted to area hospitals each year for stroke or TIA (transient ischemic attack sometimes referred to as a mini-stroke),” said John Urban, president and CEO of the Foundation. “Many people do not recognize the symptoms of stroke and therefore fail to receive care within the optimal time frame. Locally, more than 70 percent of people were not able to receive optimal care which makes stroke a significant health issue for our community. The $800,000 we have awarded to STAR over three years is the largest single grant in our five year history. We are proud to fund this collaborative effort which will have such a positive impact on the health of our community.”

According to the Centers for Disease Control, the Rochester region has one of the highest stroke rates in New York, affecting 14 people per 1,000.

“Communitywide teamwork is necessary to provide timely, comprehensive and effective care to each patient who suffers a stroke in the Rochester area,” said Webster H. Pilcher, M.D., Ph.D., Neurosurgery chair at URMC and one of the early proponents of the communitywide efforts. “The key is getting physicians in the community who care for stroke patients all working together to improve care. Enhancing the delivery of care for patients at each hospital is essential for improving survival and quality of life.”

Benesch, associate professor of Neurology, and Jahromi, assistant professor of Neurosurgery, Imaging Sciences and Neurology, are leading the STAR initiative, working closely with Chris Burke, M.D., medical director of the stroke center at Unity, David Rempe, M.D., and Richard Constantino, M.D., at RGH, and Adam Kelly, M.D., at Highland.

"Patients everywhere benefit from the seamless cooperation of the dedicated physicians and institutions involved with STAR program. Rochester General Hospital has been fully behind this program from the start. Its participation has been critical to the success of spreading first-class stroke treatment throughout the community,” said Richard L Barbano, M.D., Ph.D., chief of Neurology at RGH.

In addition to improving care, the consortium will develop a broad, community education campaign about the risk factors and warning signs for strokes. Failure to recognize the symptoms often results in a delay in getting emergency care. Stroke care is needed immediately to improve the chances for survival and minimize the long-term effects.

Recent studies show that only 28 percent of all people who suffered a stroke were transported to a hospital within an hour. Doctors encourage patients to get to the hospital quickly to receive essential treatment with a clot-busting drug called tissue plasminogen activator (tPA), within four hours of the onset of symptoms. That means that more than 70 percent of people were not able to receive optimal care.

"We've been working hard to pull all of this together over the last several months and we're thrilled to be a part of this valuable collaboration," said Mary Dombovy, M.D. vice president of Unity Neurosciences. "This initiative will improve stroke care in our community and provide better outcomes for our patients."

“Our academic and community hospitals have both strengths and opportunities for improvement in terms of care provided to stroke patients,” said Adam Kelly, M.D., director of the stroke center at Highland Hospital. “This network will allow us to share best ideas and practices across these different settings and improve overall care throughout the Rochester community.”

A stroke can have a devastating toll on individuals, their families and the community, considering the estimated $230 million spent on treatment, rehabilitation and lost productivity. Experts estimate approximately 3,000 Rochester area people are hospitalized in Rochester each year following a stroke or transient ischemic attack (TIA), a mini-stroke. In addition, many patients require sometimes lengthy rehabilitation in specialized facilities and nursing homes.

Through the collaborative effort, physicians estimate the program could save the community $1.6 million per year by improving care to allow more stroke patients to return home without additional medical services.

STAR is a natural extension of URMC’s Rochester Neurosurgery Partners, which provides neurosurgical support and care at the community’s four acute-care hospitals. This group performs a wide range of neurosurgical procedures and staff track patient outcomes and work to improve care.

URMC’s Neurosurgery and Neurology departments have a long history of leadership in providing high quality, innovative care, and is included in the US News & World Report’s list of the “2011-12 Best Hospitals in America.” The combined programs are ranked 48th after an extensive review of survival rates, patient safety scores, volume and reputation.