The Virginia Department of Health (VDH) is the agency responsible for stroke care improvement initiatives within the Commonwealth. Per Virginia Code § 32.1-111.15:1, VDH is tasked with overseeing four primary stroke care initiatives:

1. Implementing systems to collect data and information about stroke care in the Commonwealth

2. Facilitating information and data sharing and collaboration among hospitals and health care providers to improve the quality of stroke care in the Commonwealth

3. Applying evidence-based treatment guidelines for transitioning patients to community-based follow-up care following acute treatment for stroke

4. Establishing a process for continuous quality improvement for the delivery of stroke care by the statewide system for stroke response and treatment

VDH is required to provide an annual report to the Governor and General Assembly on stroke care improvement initiatives undertaken in accordance with this Code section, and to include a summary report of the data collected pursuant to this section. This report serves to fulfill this requirement for 2025.

RECOMMENDATIONS

Virginia Code § 32.1-111.15:1 (3)(C) requires VDH to develop recommendations for the improvement of stroke care throughout the Commonwealth, and Chapter 198 of the 2018 Acts of Assembly requires VDH to convene the VSCQI to advise on the implementation of the provisions of § 32.1-111.15:1. Pursuant to these requirements, the VSCQI worked in partnership with VDH to develop the following recommendations for improving stroke care initiatives in the Commonwealth, which are based upon the four primary stroke care initiatives as listed in Virginia Code § 32.1-111.15:1. These recommendations remain largely the same as in 2024, due to lack of funding particularly for the Stroke Registry, which inhibited progress on implementation of many of the recommendations.

Implement Systems to Collect Data and Information about Stroke Care

1. Non-certified stroke centers, as well as free-standing emergency departments and post-acute discharge facilities, such as inpatient rehabilitation facilities and skilled nursing facilities, should contribute data to the Virginia Stroke Registry. VDH is currently establishing the Virginia Stroke Registry to serve as the statewide system for collecting data and information on stroke care in the Commonwealth, as required by Virginia Code § 32.1-111.15:1.

2. The Virginia Stroke Registry should collect additional data elements related to specific populations of interest, including pregnancy status and sickle cell status. The Registry should also collect data elements regarding patients who have been treated using advanced stroke therapies.

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 serve as a resource to hospitals and free-standing emergency departments to implement quality improvement efforts, including ongoing stroke certification processes.

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. Facilitate Data Sharing and Collaboration

7. The Virginia Hospital and Healthcare Association (VHHA) 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.

8. Hospital participating in the American Heart Association’s (AHA) Get With The Guidelines ®-Stroke program should activate the Coverdell layer, a nationally recognized data set. This means that those hospitals would be extracting additional data from patient records and submitting that data to the Registry, following AHA’s national best practices for the kind of data hospitals should collect and report on stroke incidences.

Apply Guidelines for Transitioning Patients to Community-Based Follow-Up Care

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. Establish a Process for Continuous Quality Improvement

11. VDH Office of Family Health Services (OFHS) should continue the re-abstraction project in partnership with hospitals that submit data through the American Heart Association’s Get With the Guidelines® (AHA GWTG®) program. Of the possible variables for re-abstraction, at least one should be related to EMS. This information can be used by participating hospitals to evaluate or select an area for quality improvement.