The Virginia Department of Health (VDH) is the Code-mandated agency responsible for stroke care improvement initiatives within the Commonwealth. These initiatives shall include stroke care data and information collection, information and data sharing, application of evidence-based treatment guidelines, and continuous quality improvement. VDH shall implement systems to collect data and information related to stroke care and develop a process for continuous quality improvement for the delivery of stroke care provided by the statewide system for stroke response and treatment. VDH shall report to the Governor and the General Assembly annually on July 1.

RECOMMENDATIONS

1. Non-certified stroke centers should contribute to the Virginia Stroke Registry as well as to those free-standing emergency departments and post-acute discharge facilities, such as inpatient rehabilitation facilities and skilled nursing facilities.

2. Additional measures should be added to the Virginia Stroke Registry to include special populations such as pregnancy and sickle cell, as well as collection of measures regarding advanced stroke therapies such as thrombectomy and aneurysm repair.

3. The Virginia Stroke Registry should include the collection of “Z" codes (ICD-10 codes for social determinants of health) in order to address disparities of care across Virginia.

4. The Virginia Stroke Registry should make every effort to allow for the collection of data measures and patient outcomes to facilitate the ongoing certification of stroke centers by the three stroke certifying bodies used in Virginia.

5. The Virginia Stroke Registry should be interoperable with additional Virginia data sources, such as the Virginia Vital Events Statistics Program, to comprehensively describe stroke burden and gaps in stroke care along the full continuum of care.

6. The Virginia Hospital and Healthcare Association Collaborative should continue to engage the non-certified stroke hospitals and guide them towards stroke certification, participation in the Virginia Stroke Registry, and quality improvement.

7. Get With The Guidelines participating hospitals should activate the Coverdell layer to submit to Phase 1 of the VDH Stroke Registry.

8. VDH should continue to work on development of Phase 2 of the Virginia Stroke Registry.

9. Hospitals should continue to use Unite Us, or any statewide referral platform, to alleviate the burden on hospital stroke coordinators and care managers of connecting patients to necessary services post-discharge.

10. General Funds should be provided to sustain a statewide referral system for hospitals and community-based organizations annually, with consideration of Community Health Workers as frontline public health workers at the core of the referral system.

11. VDH should release the Virginia Hospital Acute Stroke Survey annually to all stroke hospitals, with updated questions to reflect current trends and process improvement outcomes for stroke care.

12. VDH should release the Virginia EMS Stroke Inventory Surveys annually, with questions targeted to the appropriate recipients to encourage greater EMS response and involvement.

13. VDH should update the EMS Stroke Triage Plan’s protocols to address pre-alerting up to 24 hours to better address those patients who might be a candidate for mechanical thrombectomy.

14. VDH should investigate the barriers for EMS agencies that are transporting suspected stroke patients to non-certified stroke centers or out of state facilities.