Miller School Neurologists Lead Florida Stroke Registry’s Stakeholders Meeting

The organization’s work is devoted to developing an effective, consistent and statewide system of stroke care.

A coordinated approach is essential to addressing Florida’s high rate of stroke mortality, according to participants at the Florida Stroke Registry’s 11th annual stakeholders meeting.

Jose G. Romano, M.D., speaks at the Florida Stroke Registry annual meeting.

Led by a dedicated team of stroke neurologists and researchers from the University of Miami Miller School of Medicine, the August 24–25 session in Jacksonville brought together professionals and community representatives involved in all aspects of stroke care.

“We must continue to integrate the process of improving the quality of care for stroke, which affects minorities disproportionately, and improve stroke outcomes for everyone,” said Jose G. Romano, M.D., the registry’s executive director, interim chair of the Department of Neurology at the Miller School and chief of neurology at UM/Jackson Memorial Health System.

The Registry’s Grassroots Work

More than 130 stakeholders attended the meeting, which included educational, networking and brainstorming sessions related to stroke certification, quality metrics, policy issues, health systems, hospitals, communities and patients.

“Along with stroke experts such as critical care physicians and nurses, the registry meeting drew community health workers, emergency medical service professionals and paramedics,” said Carolina M. Gutierrez, Ph.D., the registry’s associate director and research assistant professor of neurology. “From the time someone experiences a stroke and calls 911, through hospital treatment and post-hospital and discharge care, these professionals all play vital roles in stroke systems of care.”

Over the years, health providers have formed regional stroke coalitions that include a medical director and EMS workers who share best practices to improve care in their communities.

From left: Dr. Mitchell Elkinds, Dr. Tatjana Rundek, Dr. Jose Romano and Dr. Carolina Gutierrez.

“This is an important, grassroots initiative to improve the process of providing rapid and effective care for stroke patients,” Dr. Gutierrez explained.

“The Florida Stroke Registry works with stroke coalitions by creating reports of stroke performance metrics at the regional level, benchmarks them, and ensures data transparency so that coalitions can drive improvements based on local resources,” said Sebastian Koch, M.D., registry executive committee member, stroke director at University of Miami Hospital and interim chief of stroke at the Miller School. “We have seen better acute stroke performance in hospitals that belong to stroke coalitions.”

Creating a Statewide System of Stroke Care

Nearly all of the state’s approximately 175 stroke centers are participating in the registry. In addition, many participate in the Florida Coverdell program, which received three years of funding in 2022 from the U.S. Centers for Disease Control and Prevention in the Paul Coverdell National Acute Stroke Program.

“As a Coverdell stroke registry, our goal is to drive an efficient Florida stroke system of care,” added Dr. Gutierrez.

In the past year, the registry’s team, led by registry education core director Gillian Gordon Perue, M.B.B.S., D.M., developed a hospital inventory survey examining various aspects of stroke program infrastructure, including stroke coordinator roles and responsibilities, and challenges in accomplishing quality improvement initiatives.

While hospital-based measures of stroke quality of care have improved, hospital readmission rates after discharge remain high.

“With almost one in eight patients returning to hospital within a month after stroke hospitalization, it is critical to understand the factors that drive poor transition of care from hospital to home,” said Tatjana Rundek, M.D., Ph.D., founding member of the registry executive committee and principal investigator, with Dr. Romano, of the registry-affiliated Transitions of Care Stroke Disparities Study funded by the National Institutes of Health.

Dr. Gutierrez noted that the registry revealed disparities in stroke treatment due to race, ethnicity and gender.

“We also know that social determinants of health, including location, income, language barriers and access to transportation, may limit a stroke patient’s ability to seek follow-up care,” she said.  “We are still scratching the surface in addressing health disparities in stroke care and mitigating risk factors.”

Using Data to Identify Disparities

The Florida Stroke Registry began in 2012 as an NIH-funded Miller School program under the direction of the late Dr. Ralph L. Sacco, and looked to reduce health disparities in acute stroke treatment and improve stroke care in Florida and Puerto Rico.

Since then, the registry has continuously collected data, analyzed the findings and provided reports that outline best practices in stroke care, said Dr. Romano. The registry was one of the first U.S. initiatives to provide data-driven perspectives of race, ethnicity, sex and geographic stroke disparities.

Florida has seen continuous and dramatic improvements in stroke care since the registry has been operating. In the past decade, rapid administration of clot-busting agents (thrombolytics) within 45 minutes of hospital arrival increased from 6% to 80%, and defect-free care during stroke hospitalization improved from 9% to 85% statewide.

“This year’s meeting has helped us maintain and strengthen the path that Dr. Sacco started — to build a complete system of stroke care that includes all the essential professionals as well as community stakeholders,” Dr. Gutierrez said. “With Florida’s overall growth, including a large aging population, our statewide, interdisciplinary stroke registry is more valuable than ever.”

Tags: Dr. Carolina Gutierrez, Dr. Jose G. Romano, stroke outcomes