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Successes of STAR-NY

  • Provided the first complete snapshot of current stroke care practice, intervention rates and discharge outcomes in Rochester, NY STAR-NY has created the first ever mechanism for data/outcomes collection, sharing and comparative analysis across multiple healthcare institutions.

Current Results

  • Established a trajectory of increasing rates of acute intervention for acute stroke across the community (11.2% at baseline to 15.2% over entire intervention phase).
  • Increase in rate of patient discharge to home (53% in baseline to 61% by end of 2012) without change in median length of in-hospital stay for acute ischemic stroke and TIA.
  • STAR-NY has created a renewed focus in the community for increasing secondary stroke prevention rates for patients after first stroke/TIA.

Current & Future Efforts

  • Expand focus from care processes to include physician practice patterns.
  • Target populations for increased intervention (IV and/or IA):
    • Patients arriving within tPA window but excluded based upon historically relative contraindications (which the AHA has now recognized as reasonable to treat - 2013 recommendations - primarily focusing on patients with low stroke severity and rapid improvement in stroke symptoms) - could account for 6% potential increase in acute intervention rates.
    • Patients who are eligible candidates for endovascular treatment; those arriving within 4.5 hours but not eligible for IV tPa (7.0%), those arriving outside tPA window (>4.5 hours) but less than 8 hours of onset (8.3%) and those arriving with an unknown time of onset (4.4% assuming 10% of these patients are eligible based on imaging) = could account for potential 19% increase in acute intervention rates.

The following tables and graphs represent the most up to date STAR-NY results.

                               Acute Intervention Rates

Door to Times  - Process Measures for Monroe county