When it comes to treating strokes, hospitals are increasingly under the gun to develop more aggressive internal initiatives that reduce the time it takes to provide the latest
life-saving care. Of the more than 700,000 new or recurrent stroke cases diagnosed annually, it is estimated that 80% could be effectively treated if the clot-busting drug, tPA,
is used within the required three-hour timeframe, according to the American Heart Association.
A group of more than 75 VHA (Voluntary Hospital Administration) hospitals is showing substantial progress in racing the clock to improve the care delivered to stroke patients -
reducing its response times by almost 50%. Early physician input is critical to its success.
The hospitals are participating in VHA's Clinical Advantage program. The program uses regional workshops and a national symposium to promote collaborative ways healthcare
professionals can break down clinical barriers to delivering expedited stroke care.
Earning system-wide physician buy-in for the program is a top objective of VHA's corporate marketing department. The internal communication tactics that work best with
physicians, who tend to have an empirical "prove it" attitude, are those that rely on evidence-based medicine, says Scott Dahl, director of product management for VHA's clinical
affairs. The marketing team is relying on an arsenal of clinical case studies and white papers to demonstrate how rapid-response stroke teams deliver improved patient
outcomes.
Going After Early Adopters
When the campaign launched six months ago, its initial focus was identifying and recruiting clinical leaders who would champion the program's goals on the local level. Clinical
improvement officers and medical directors at VHA's 18 regional offices were considered early adopters and targeted through email efforts, the intranet and direct mail. To
generate an urgent call to action, the campaign highlighted disturbing stroke statistics. For example, every 53 seconds someone in the U.S. suffers a stroke; approximately 600,000
Americans will have a stroke this year and 160,000 of them will die.
It also was important to distribute white papers and case studies on how time-sensitive protocols and multidisciplinary team approaches are the best clinical tools for
improving stroke care. A study by the American Heart Association drives this point home - less than 34% of hospitals have stroke protocols in place and less than 18% have a rapid
identification system for patients experiencing acute stroke.
Educating healthcare professionals with this kind of evidence-based information helped motivate them to test drive the program's guidelines aimed at shrinking the time spent on
evaluating and treating stroke patients, says Ivy Elkins, marketing manager for Clinical Advantage. The guidelines call for:
- rapidly assessing suspected stroke patients;
- reducing the time to complete and assess a CT scan, the key diagnostic tool used to determine whether tPA treatment is appropriate;
- training of key personnel to work as a rapid response "stroke team" in triaging and diagnosing stroke patients; and
- using Web-based tools to prioritize clinical improvement opportunities, identify potential change leaders, forecast cost reductions and outcomes and design customized clinical
pathways.
Transforming VHA's Image
While the initiative is boasting impressive clinical results - reducing VHA's stroke treatment timeframes by almost 50% on average - the program also is expanding the health
system's image beyond its narrow group purchasing organization identity, says Barry Pound, who heads up VHA corporate communications. Vendors, in particular, are looking at how
the program has established solid collaborative relationships with clinical leaders and are starting to approach VHA about creating co-marketing alliances. "The [Clinical
Advantage] model of clinical coalition-building and information-sharing is being perceived by vendors as a vehicle for improving treatment across our continuum of care." To this
end, VHA is looking at ways it can tweak the program for other initiatives like patient safety, congestive heart failure and end-of-life care.
Within the VHA, the program is commanding increased respect among clinical improvement leaders. More than 250 VHA healthcare professionals are participating in the initiative.
The primary drivers of this widespread support are early physician involvement through regional workshops, intranet-enabled measurement tools and community-specific program
customization.
"The program is not an all-or-nothing proposition, we encourage hospitals to work on what they can and make sure that they are making it relevant to their patient base," says
Dahl.
(VHA, Barry Pound, Ivy Elkins, Scott Dahl, 972/830-6907; American Heart Association, Corliss Hill, 214/706-1285)
Pumping Up Your Stroke Care
Less than 34% of hospitals have stroke protocols, according to the American Heart Association. AHA is lobbying hard for hospitals to coordinate stroke teams of frontline
emergency professionals. Marketers can lend their support by:
- educating hospital and emergency department personnel about their role in treating stroke as a medical emergency;
- providing an assessment tool to help in determining their ability to respond to stroke as an emergency; and
- increasing community awareness of stroke symptoms.