| Instructions for Paul Coverdell National Acute Stroke Program (PCNASP) Hospital Inventory Data Elements Awardees are to submit de-identified hosptial inventory data from their hospital partners as an electronic Excel file. The "Inventory" tab of this document has the data elements and format for awardees to transmit this hospital inventory data to CDC. Please use the tab "State Created Questions" to include data from inventory questions that states have created for their hospital partners. Sharing collected data from these additional created questions with CDC is optional. Public reporting of this collection of information is estimated to average 8 hours per response, including the time for reviewing instructions and completing and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a current valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to: CDC/ATSDR Reports Clearance Officer, 1600 Clifton Road NE, MS D-74, Atlanta, Georgia 30333; ATTN: PRA (0920-1108) |
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| Section | A. Hospital Infrastructure | B. Acute Stroke Care | C. Emergency Medical Services (EMS) Integration | D. Community Clinical Linkages | E. Certification and Education | F. Data Abstraction | G. Data-Driven Quality Improvement | H. Hospital Retention | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Data Element | Statenam | Year | Hospital | RUCA | HospSize | InptDsch | StkDsch | StkTeam | ISProtcl | ISPtc_1 | ISPtc_2 | ISPtc_3 | ISPtc_4 | HSProtcl | HSPtc_1 | HSPtc_2 | HSPtc_3 | HSPtc_4 | SAHAdmt | SAHAText | ICHPtc | ICHPtc_1 | ICHPtc_2 | ICHPtc_3 | ICHPtc_4 | ICHAdmt | ICHAText | IVtPA | Endovasc | AdmOrd | StkIC | Neurovst | ContECG | Neursurg | Neur_247 | Neur_2hr | Neurint | EMSPlan | EMSPreN | PreNProt | TranProt | EMS_Run | EMSFeed | Feed_FRQ | TOC_S | RefTrack | TOC_res | Partnr_1 | Partnr_2 | Partnr_3 | Partnr_4 | Partnr_5 | CPACHW | CPASOP | CPAComm | CPARefer | NeurRes | StrkCert | TeleStkR | TeleCons | CaseID | HIE | EHR_Use | DataQI_1 | DataQI_2 | DataQI_3 | DataQI_4 | DataQI_5 | DataQI_6 | DataQI_7 | DataQI_8 | DataText | QI_Rslt | QI_Imprv | Reten_1 | Reten_2 | Reten_3 | Reten_4 | Reten_5 | Reten_6 | Reten_7 | Reten_8 | Reten_9 | Reten_10 |
| Response type | XX (GA, CA, etc.) | yyyy | number | number | number | number | 1=Yes 2=No |
1=Yes 2=No |
Select all that apply | 1=Yes 2=No |
Select all that apply | Single-choice | Text | 1=Yes 2=No |
Select all that apply | Single-choice | Text | 1=Yes 2=No |
1=Yes 2=No |
1=Yes 2=No |
1=Yes 2=No |
1=Yes 2=No |
1=Yes 2=No |
1=Yes 2=No |
Single-choice | Single-choice | 1=Yes 2=No |
1=Yes 2=No |
Single-Choice | Single-Choice | Single-Choice | Single-Choice | 1=Yes 2=No |
Single-Choice | Single-choice | Single-choice | 1=Yes 2=No |
Select all that apply - Numeric Response | Open Text | 1=Yes 2=No |
1=Yes 2=No |
1=Yes 2=No |
Single-choice | 1=Yes 2=No |
1=Yes 2=No |
Single-choice | Single-Choice | Single-choice | 1=Yes 2=No |
Single-choice | G2. During the past 12 months, did your hospital conduct data-driven quality improvement initiatives (e.g. the Plan-Do-Study-Act model, small tests of change, lean, six-sigma) related to stroke care to address any of the following? | Text | Single-choice | Single-choice | Select all that apply | |||||||||||||||||||||||||||||
| Hospital Survey Question | State name | Year of survey conducted | A1. Hospital code (as assigned through the PCNASR): | A2. What is your hospital’s Rural-Urban Commuting Area (RUCA) code? | A3. Current hospital size (number of licensed beds): | A4. Total number of inpatient discharges in most recent calendar year: | A5. Total number of acute stroke discharges (primary diagnosis only) in the most recent calendar year | B1. Does your hospital have a designated acute stroke team? | 2. Written protocol or care pathway in place for the following: | B3. Does your hospital have a neuro- intensive care unit? | B4. Do all stroke patients receive continuous ECG monitoring for at least 24 hours during admission? | B5. Does your hospital have neurosurgical services on-staff? | B5 a) If yes to (5), does your hospital have neurosurgical services available 24/7 (may be on-site or at a remote location)? | B5 b) If never to (5a), does your hospital have neurosurgical services available within 2 hours of patient arrival (may be on-site or at a remote location)? | B6. Does your hospital provide neurointerventional treatment/mechanical thrombectomy? | C1. Is there a written plan for receiving patients with suspected stroke via EMS? | C2. How often does pre-notification by EMS regarding a suspected stroke case lead to activation of the stroke team? | C3. How often does pre-notification lead to activation of written stroke care protocols (e.g. notification to pharmacy, “clearing” of CT scanner)? | C4. Does your hospital have written protocols for stroke patients transferred to and from your hospital? | C5. How often does your hospital upload any EMS data (electronically or manually) into stroke patient’s eHR? | C6. Do you have a formal process for data feedback to EMS agencies? | C6 a) How often does your hospital provide feedback to EMS agencies? | D1. How often do you utilize a transition of care summary with stroke patients during discharge? | D2. Has your hospital implemented a system for tracking referrals provided to stroke patients to support their post hospital transition of care? | D3. How often does your hospital utilize an inventory of community resources to make referrals for post-stroke needs, including resources that can meet patients’ medical, social, and functional needs? | D4. Has your hospital established partnerships with any of the following? Please count any that your hospital participates in or provides resources to as a partnership (provide an estimated number next to each): | D5. Does your hospital have a Collaborative Practice Agreement (CPA) in place that includes community health workers (CHWs)? | D5 a) If yes to (5), specific to CHWs, does the CPA include a CHW scope of practice? | D5 b) Does the CPA ensure that CHW scope of practice maintains CHWs’ connections to the community? | D6. How often does your hospital utilize community health workers to refer stroke survivors to resources that can meet their medical, social, and functional needs post-discharge? | E1. Does your hospital have a residency or fellowship programs (neurology or other/residency fellowship)? | E2. Is your hospital currently certified as a Joint Commission Acute Stroke Ready Hospital (JC ASRH), Joint Commission Primary Stroke Center (JC PSC), Joint Commission Comprehensive Stroke Center (JC CSC), Joint Commission thrombectomy capable stroke center (TSC) or other similar organization such as Det Norske Veritas (DNV) or Healthcare Facilities Accreditation Program (HFAP)? | E3. Does your hospital receive stroke consultation services from another hospital via telemedicine? | E4. Does your hospital provide stroke consultation services to other hospitals via telemedicine? | F1. What process is used for case identification? (select one best answer) | 2. Does your hospital contribute data to a state health information exchange (HIE)? | G1. Does your hospital use the EHR system and standardized clinical quality measures to track differences between populations at highest risk for stroke events compared to all stroke patients for any of the following? | Use of Multidisciplinary Teams for Care Management | Electronic Health Record (EHR) and Patient Tracking Systems | Self-Management and Care Management | Clinical Guidelines | Clinical Decision Support and Protocols | Patient Education | Other (please specify) | Did not do any data-driven quality improvement in the past 12 months | Text response for G2. DataQI_7 if “Other” option selected | G3. Did your hospital’s data-driven quality improvement initiatives lead to a change in hospital stroke policies or systems? | G4. Did your hospital’s data-driven quality improvement initiatives lead to an improvement in a performance measure of care (e.g. door-to-needle time, proportion of eligible patients receiving IV tPA)? | H1. What reasons or incentives are most important in your hospital’s decision to participate in (if new) or continue to participate in the Coverdell Stroke Registry? (select the three most important reasons) | |||||||||||||||||||||||||||||||||||
| B2 a) Does your hospital have a written protocol or care pathway in place for: Emergency care of ischemic strokes (including diagnostic imaging and labs)? | i) If yes to (2a), does the written protocol for emergency care for ischemic stroke include: (Select all that apply:) | B2 b) Does your hospital have a written protocol or care pathway in place for: Emergency care of subarachnoid hemorrhagic strokes (including diagnostic imaging and labs) |
i) If yes to (2b), does the written protocol for emergency care for subarachnoid hemorrhagic stroke include (Select all that apply): | ii) Does your hospital admit most subarachnoid hemorrhagic (SAH) stroke patients? | Text response for We admit or transfer depending on staff availability or other factors (please describe) | B2 c) Does your hospital have a written protocol or care pathway in place for: Emergency care of intracerebral hemorrhagic (ICH) strokes (including diagnostic imaging and labs) |
i) If yes to (2c), does the written protocol for emergency care for intracerebral hemorrhagic stroke include: (Select all that apply): | ii) Does your hospital admit most intracerebral hemorrhagic (ICH) stroke patients? | Text response for We admit or transfer depending on staff availability or other factors (please describe) | B2 d) Written protocol or care pathway in place for: IV tPA (alteplase) | B2 e) Written protocol or care pathway in place for: Endovascular therapy | B2 f) Written protocol or care pathway in place for: Admission orders | B3 a) If yes to (3), does your hospital have a neurointensivist to manage care for stroke patients? | State or local stroke coalition | State or local stroke initiatives | State or local professional organizations | National stroke initiatives or organizations | Other (open text – provide number in parenthesis (example: hospital association (2), stroke nurses association (2)) | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Initial stabilization | Diagnostic imaging | Treatment | Labs | Initial stabilization | Diagnostic imaging | Treatment | Labs | Initial stabilization | Diagnostic imaging | Treatment | Labs | Opportunities for professional development/learning (conference calls, journal articles, etc) | Opportunities for networking/information sharing with other hospitals | Desire/Need to enhance the quality of stroke care we provide | Financial incentive / opportunity to compete for additional funds | Allows/facilitates my hospital becoming/maintaining Stroke Center designation | Access to and/or training on the GWTG tool | Request/interest from upper management/administration | Opportunity to benchmark my hospital against others in the state | Hospital recognition | Other: | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| Data Element |
| Response type |
| Hospital Survey Question |
| File Type | application/vnd.openxmlformats-officedocument.spreadsheetml.sheet |
| File Modified | 0000-00-00 |
| File Created | 0000-00-00 |