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SCORE is a quality improvement collaborative that supports Primary Stroke Service designated hospitals in Massachusetts. The Collaborative assists designated hospitals in monitoring and improving the quality of stroke care for acute, inpatient and secondary prevention performance measures. The Collaborative is implemented as a partnership of the Massachusetts Department of Public Health Paul Coverdell National Acute Stroke Registry, the American Stroke Association Get With The Guidelines-Stroke quality improvement program and participating Primary Stroke Service-designated hospitals.
Stroke Collaborative Reaching for Excellence (SCORE) is a quality improvement collaborative that supports Primary Stroke Service designated hospitals in Massachusetts. The Collaborative assists designated hospitals in monitoring and improving the quality of stroke care for acute, inpatient and secondary prevention performance measures. The Collaborative is implemented as a partnership of the Massachusetts Department of Public Health Paul Coverdell National Acute Stroke Registry, the American Stroke Association Get With the Guidelines-Stroke quality improvement program and participating Primary Stroke Service-designated hospitals.
SCORE aims to:
- Improve equity of stroke care by reducing the burden of illness, injury and disability to all patients without bias.
- Improve timeliness of stroke care, particularly in the acute phase of care, to result in an increased number of eligible patients receiving the recommended acute treatment.
- Improve effectiveness of stroke care with systematic use of evidence based practice guidelines for diagnostic tests, intervention, and therapy to avoid both under-use of effective care and overuse of ineffective care.
- Improve patient-centeredness by introducing methods to better inform and involve patients and their families in the care provided and decisions made, and ensuring that accurate information follows the patient through transitions in care including transition from pre-hospital, to the acute care hospital, and at least onto the discharge destination.
- Improve safety by achieving the above.
- Raising standards of care to ensure the appropriate action is taken with all eligible patients.
- Improve efficiency (to get the best value for money spent) by better documenting patient care, reducing medical errors, eliminating double data entry and by identifying treatment overuse.
SCORE has focused on evidence- and guidelines-based performance measures bundled into three tiers:
- Acute Emergency Department Measures – eligible patients receiving lytic treatment, median time from hospital arrival to treatment, hospital arrival to treatment within 60 minutes, and median time from hospital arrival to computed tomography (CT)
- In-patient Measures – dysphagia screening, deep vein thrombosis prophylaxis, performing a lipid panel, and antithrombotics medication within 48 hours of hospitalization
- Discharge Measures – smoking cessation, stroke education, anticoagulation therapy for atrial fibrillation patients, discharged on antithrombotics, appropriate treatment with lipid altering therapy, and a plan for rehabilitation was considered.
Coverdell National Acure Stroke Registry
SCORE, funded in part by the Paul Coverdell National Acute Stroke Registry grant provided by the Centers for Disease Control and Prevention (CDC), is part of a national program to address the treatment and care of acute stroke. Massachusetts has been one of the states involved in the program since its inception in 2001 and is currently one of 7 states participating in the program. The long-term goal of the program is to ensure that all Americans receive the highest quality of acute stroke care that is available to reduce untimely deaths, prevent disability, and avoid recurrent strokes.
Partnership with American Stroke Association
In 2004, the American Stroke Association (ASA) and the Massachusetts Department of Public Health (MDPH) combined two national stroke quality improvement projects, the ASA Get With the Guidelines – Stroke and MDPH Paul Coverdell National Acute Stroke Registry, in order to reduce redundancy, minimize competition, conserve hospital resources, maximize hospital benefits, and create synergies. The joint quality improvement initiative was called the Stroke Collaborative Reaching for Excellence (SCORE).