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Paul Coverdell National Acute Stroke Registry logo

Each year more than 795,000 Americans suffer from a stroke, and 15-30% remain permanently disabled. More than 1 million Americans and their families live with the disabling effects of stroke. The estimated direct and indirect costs of stroke were $53.9 billion in 2010. To help reduce the nation's stroke burden, in addition to efforts to prevent strokes, we need to improve the quality of care provided to patients with acute stroke and thus reduce death and disability from these events. A major challenge is that while evidence-based medical guidelines for stroke care have been developed, as well as new and improved diagnostic and treatment tools, many hospitals still do not have the organization, staff, and equipment to effectively diagnose and treat acute stroke patients.

The Mission of the Paul Coverdell National Acute Stroke Registry

Measure, track, and improve the quality of care and access to care for stroke patients from onset of stroke symptoms through rehabilitation and recovery.
Decrease rate of premature death and disability from acute stroke.
Eliminate disparities in care.
Support development of stroke systems of care that emphasize quality of care.
Improve access to rehabilitation and opportunities for recovery after stroke.
Increase the workforce capacity and scientific knowledge for stroke surveillance within stroke systems of care.

History of the Program

In 2001, Congress charged CDC with implementing state-based registries that measure and track acute stroke care and to use data from the registries in efforts to improve the quality of that care. Congress further directed that this project be named the Paul Coverdell National Acute Stroke Registry, after the late U.S. Senator Paul Coverdell of Georgia, who suffered a fatal stroke in 2000 while serving in Congress.

CDC, in consultation with stroke experts and organizations, piloted eight prototype registry projects, led by academic and medical institutions across the country, to test models for measuring the quality of care delivered to stroke patients. "Wave I" projects, funded in 2001, were located in Georgia, Massachusetts, Michigan, and Ohio. "Wave II" projects, funded in 2002, were located in California, Illinois, North Carolina, and Oregon. These prototype projects gathered data concerning each step of emergency and hospital care for stroke patients, from emergency response to the patients' eventual discharge from a hospital. At the end of the 3–year pilot period, the results showed that large gaps existed between generally recommended guidelines for treating stroke patients and actual hospital practices. Intensive quality improvement efforts are needed to close those gaps.

In June 2004, CDC provided funds to the state health departments of Georgia, Illinois, Massachusetts, and North Carolina to establish statewide Coverdell stroke registries for acute care hospitals in their states. The purpose of these registries was to develop and implement systems for collecting data on acute stroke care provided to patients, analyzing the collected data, and using the results of those analyses to guide quality improvement interventions at the hospital level through partnerships with hospital doctors, stroke-care teams, and administrators. All acute care hospitals serving the general population in participating states were eligible for the program.

In the first year of program activities states established partnerships with leading medical experts, various hospital associations, local affiliates of the American Hospital Association, and other groups interested in improving health care for stroke patients; developed strategies for identifying and recruiting eligible hospitals; selected and implemented customized Web-based data-collection systems for hospital use; and recruited hospitals to participate in the registry. In the second and third years, states reviewed collected data to identify specific areas of need for quality improvement, worked with hospitals to implement quality improvement interventions to improve care, and evaluated progress toward improving statewide acute stroke care and promoting long-term systemic changes in how that care is provided. By the end of the 2004–2007 project period, more than 180 hospitals were participating in a stroke registry and the percentages of total statewide stroke admissions treated by participating hospitals ranged from 40% to 79% among the four states.

In June 2007, CDC expanded funding to six state health departments in Georgia, Massachusetts, Michigan, Minnesota, Ohio, and North Carolina for the Paul Coverdell National Acute Stroke Registry for a new 5-year funding period. Illinois will continue to participate in stroke quality improvement activities and provide information to CDC on its progress. In 2007, CDC also came to an agreement with The Joint Commission’s Primary Stroke Center Certification program and with the American Heart Association/American Stroke Association’s Get With The Guidelines-Stroke program to jointly release a set of standardized stroke performance measures for use by all three programs. This effort will reduce duplication, increase collaboration, and encourage hospitals to participate in one or more of the programs. The National Quality Forum endorsed eight of these performance measures in 2008.

The near-term goals of the Paul Coverdell National Acute Stroke Registry program are to

Increase the number of states with Coverdell stroke registries.
Develop and disseminate best practices in hospital recruitment and training, data collection, and quality improvement based on lessons learned.
Encourage the development of statewide systems of care for stroke patients through coordination with emergency medical services and collaboration among statewide partners.
Communicate with major stakeholders in stroke care to ensure ongoing improvement in the quality of that care.

The long-term goal of this program is to ensure that all Americans receive the highest quality of acute stroke care currently available and to reduce the number of untimely deaths attributable to stroke, prevent stroke-related disability, and prevent stroke patients from suffering recurrent strokes.

Paul Coverdell National Acute Registry States, 2009

Paul Coverdell National Acute Stroke Registry states in 2009 are Georgia, Massachusetts, Michigan, Minnesota, Ohio, and North Carolina.

Paul Coverdell National Acute Stroke Registry Brochure

Time Lost is Brain Lost

Download this brochure created for the Stroke Registry outlining the Registry's mission, facts about stroke, and performance measures.

Paul Coverdell National Acute Stroke Registry Brochure [PDF–1.1M]

Related Information

Funding Opportunity Announcement-Paul Coverdell National Acute Stroke Program

American Heart Association/American Stroke Association &Centers for Disease Control and Prevention Announcement of Continued and Ongoing Collaboration around Acute Stroke Care and Quality Improvement [PDF-197K]

Morbidity and Mortality Weekly Report (MMWR)

Paul Coverdell National Acute Stroke Registry Surveillance—Four States, 2005–2007
November, 2009

Paul Coverdell National Acute Stroke Registry—Strategies from the Field

Strategies from the Field cover. Each Coverdell-funded state has identified unique ways to meet the goals and objectives of the Coverdell program. This document outlines creative approaches developed by states and highlights lessons learned. These strategies from the field are intended to illustrate the ways in which Coverdell states are addressing stroke care. The information can be used by Coverdell-funded states as well as states that are not funded by Coverdell but are interested in implementing a stroke registry.

Strategies from the Field [PDF–457K]

Paul Coverdell National Acute Stroke Registry Infoshare Conference Call

Stroke Coding Issues
Barry Libman, MS, RHIA, CCS, CCS-P
President, Barry Libman, Inc.
Conference call held Thursday, May 21, 2009, 10:00–11:00 am EST

Topic: Coders and other medical professionals requiring an understanding of the rules specific to the coding of stroke care will benefit from this presentation discussing

How coding captures an episode of medical care.
Coding rules and guidance that determine the reporting of diagnoses.
Coding rules specific to stroke.
Present on admission indicators.
The future of coding: ICD-10-CM/PCS.

Listen to the call HERE [MP3–8M]. The written transcript of the call can be accessed HERE [Word–81K]. The PowerPoint slides used in the conference call can be accessed at www.barrylibmaninc.com.