SYSTEMS OF CARE. 12/15/ , American Heart Association 2

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2 SYSTEMS OF CARE 12/15/ , American Heart Association 2

3 EMS Update EMS Grant Awards 12/15/ , American Heart Association 3

4 EMS Update - Applications 12/15/ , American Heart Association 4

5 EMS Education Classes completed Sanborn Jewell Fonda Hartley Sergeant Bluff Estherville Kingsley Battle Creek Fayette Preston Lyon Co. New Sharon Mapleton Belmond State Center Clarence Lansing Prairie City Pierson Primghar Whittemore Hopkinton 12/15/ , American Heart Association 5

6 What s the Big Idea? More lives saved Improved outcomes Shorter recovery Fewer hospitalizations Decreased cost Improved quality of life Healthier community Healthier state 12/15/ , American Heart Association 6

7 12/15/ , American Heart Association 7

8 12/15/ , American Heart Association 8

9 12/15/ , American Heart Association 9

10 12/15/ , American Heart Association 10

11 Hospital Funding. St Anthony Regional Hospital Crawford County Memorial Hospital Sioux Center Health Manning Regional Healthcare Center CAH Audubon County Memorial Hospital Floyd Valley Hospital Hegg Memorial Hospital Orange City Area Health System Waverly Health Center Mercy Medical Center New Hampton Sanford Sheldon Medical Center Jackson County Regional Health Center Greene County Medical Center CAH Pella Regional Health Center CAH Cherokee Regional Medical Center Sanford Rock Rapids Medical Center Boone County Hospital Avera Holy Family Hospital Baum Harmon Mercy Hospital Osceola Community Hospital Horn Memorial Hospital Community Memorial Hospital Medical Center Burgess Health Center Palmer Lutheran Health Center Mercy Medical Center Centerville Van Buren County Hospital Veterans Memorial Hospital Knoxville Hospital & Clinics 12/15/ , American Heart Association 11

12 Things to consider: Rural health disparities Lack of participation Formalized regional work Lack of resources, structure in EMS to increase the use of 12-Lead Bottom Line thinking Healthcare providers as advocates for their communities Collaboration and resource optimization 12/15/ , American Heart Association 12

13 How are we doing this? Iowa has rural areas with limited EMS services, and long transports to hospitals with Primary PCI capabilities. Mortality is still worse, the farther away you are from a Cath Lab that performs primary PCI. The Metro Areas, and other areas with good ALS EMS presence close to Cath Labs, do not have as much need as some other rural areas. This project aims to improve care in the rural areas that have traditionally not had as much support or success with STEMI care. 12/15/ , American Heart Association 13

14 How are we doing this? Funding for the PCI Hospitals Funding for EMS Services. Funding for Non-PCI Hospitals. Task Force and Committee meetings. Education for EMS and Hospitals. Data Collection and review Public Awareness campaign 12/15/ , American Heart Association 14

15 What has happened in Iowa since the start? 16 PCI Centers funded 22 Iowa PCI Centers reporting to ARG 70 EMS Services funded 28 Non-PCI Hospitals funded 3 STEMI Conferences EMS 12-Lead ECG Courses & Hospital education 4 Quarters of Data Collection 14 Task Force Meetings Quality Meetings, EMS Advisory and Hospital Advisory Meetings Regional work: outreach, stakeholder meetings Hospital & EMS Guidelines 12/15/ , American Heart Association 15

16 What has happened in Iowa since the start? Statewide STEMI Guidelines have been approved in both Iowa and Nebraska. The introduction letter signed by members of Interventional Cardiology Steering Committees in each state. Representing 14 Cardiology groups in Nebraska and 20 Cardiology groups in Iowa. This sends a very powerful message on the need for standardized statewide guidelines and willingness to utilize best practice and evidence based recommendations. 12/15/ , American Heart Association 16

17 Build The TEAM! 12/15/ , American Heart Association 17

18 The Science. 12/15/ , American Heart Association 18

19 The Science. 12/15/ , American Heart Association 19

20 Early Identification 12-Lead ECG paves the way! 12/15/ , American Heart Association 20

21 The Science I IIa IIb III I IIa IIb III All communities should create and maintain a regional system of STEMI care that includes assessment and continuous quality improvement of EMS and hospitalbased activities. Performance can be facilitated by participating in programs such as Mission: Lifeline and the D2B Alliance. Performance of a 12-lead ECG by EMS personnel at the site of FMC is recommended in patients with symptoms consistent with STEMI. 12/15/ , American Heart Association 21

22 Statewide Report 12/15/ , American Heart Association 22

23 Statewide Report 12/15/ , American Heart Association 23

24 Statewide Report 12/15/ , American Heart Association 24

25 Statewide Report 12/15/ , American Heart Association 25

26 Statewide Report 12/15/ , American Heart Association 26

27 Statewide Report 12/15/ , American Heart Association 27

28 Build The TEAM! 12/15/ , American Heart Association 28

29 The Data 100 Median time FMC-Device Q Q Q Q Q Q Q Q Q Series Series /15/2016 Series1 Series2 Linear (Series1) 2010, American Heart Association 29

30 The Data 100% Prehospital 12-Lead Acquisition: Rural vs Urban 90% 80% 80% 81% 82% 83% 73% 77% 78% 84% 80% 70% 68% 60% 50% 40% 42% 42% 44% 35% 47% 45% 46% 40% 30% 20% 19% 25% Iowa Avg. = 8 min. Nation Avg. = 6 min. 10% 0% Q Q Q Q Q /15/ , American Heart Association 30 Series1 Series2 Series3 Series4

31 The Data If you thought you were having a heart attack, would you call 911? About 10% said no 32 people in our sample 48,449 adults living in rural Iowa 12/15/ , American Heart Association 31

32 The Data 90% 80% 77% Patients Arriving by Personally Owned Vehicle 82% 76% 75% 81% 70% 60% 50% 44% 45% 48% 48% 50% 40% 30% 20% 10% 0% Q Q Q Q Q Rural Urban 12/15/ , American Heart Association 32

33 The Data [If no] Why wouldn t you call 911? Check all that apply. 1. Faster to drive myself (63%) 2. Cost (31%) 12/15/ , American Heart Association 33

34 The Data To the best of your knowledge, which of the following can be signs/symptoms of a heart attack? Check all that apply. Least recognized were neck discomfort/tightness (73%) and nausea/vomiting (74%) 12/15/ , American Heart Association 34

35 The Data 25% ELIGIBLE PATIENTS RECEIVING FIBRINOLYSIS 20% 19% 19% 19% 19% 20% 20% 21% 21% 20% 15% 14% 15% 15% 14% 12% 10% 9% 8% 7% 6% 5% 0% Q Q Q Q Q Q Q Q Q /15/2016 State Nation Linear (State) 2010, American Heart Association 35

36 The Data Median Length of Stay at Referral Facility Q Q Q Q Q Q Q Q Q /15/2016 State National Linear (State) 2010, American Heart Association 36

37 The Data Unadjusted Mortality Rate Lower is better!! 2 How low can we go?! 1 0 Q Q Q Q Q Q Q Q Q Series Series Series1 Series2 Linear (Series1) 12/15/ , American Heart Association 37

38 Public Awareness 12/15/ , American Heart Association 38

39 Public Awareness What can you do? Churches Community Groups Health Fairs Senior Centers Fundraisers Fairs/Festivals Community Events School Events Local Newspapers Talk with your family and friends! 12/15/ , American Heart Association 39

40 State & Nationwide Best Practices Use the transfer sheet as our documentation Bypass the hospital if the patient is stable Quarterly outreach with referral hospitals Sending out feedback forms on every STEMI patient Monthly STEMI meeting with multidisciplinary regional/city team STEMI drills Utilizing a common clinical registry Data sharing Multistate collaboration Putting aside the politics for the best work for the patient Implementing the statewide guideline as the new protocol 12/15/ , American Heart Association 40

41 Collaboration Project What is working in your area? What has changed in the past year? What do you think is necessary in your region to make M:L work better? How can you foster collaboration in your area? What are the challenges? What do you need from Cardiology? What do you need from ED Providers? What do you need from IDPH or County Health Departments? What can YOU do to make a difference? 12/15/ , American Heart Association 41

42 Can one little thing make a big impact? Ask a mosquito! 12/15/ , American Heart Association 42

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