East Texas Stroke Initiative Proves Successful during Past 3 Years

Memorial Medical Center-Lufkin was recently recognized for its innovative East Texas Stroke Initiative by the Texas Council on Cardiovascular Disease and Stroke, in conjunction with the CVD & Stroke Program of the Texas Department of State Health Services.

The Texas Cardiovascular Health Promotion Awards recognize community-based programs, schools, worksites, and health care entities that promote innovative and effective programs and policies for prevention and/or awareness of cardiovascular disease and/or stroke in Texas communities.

Memorial was one of seven hospitals to be recognized, and it was the only hospital in the East Texas region to receive the distinction.

Due to high rates of uninsured and underserved populations coupled with significantly higher risk factors – obesity, diabetes and smoking – Memorial recognized the East Texas region’s need for quality stroke care.

In 2008, Memorial partnered with The Methodist Hospital in Houston to develop the East Texas Stroke Initiative, an overwhelmingly successful program that has saved lives and offered an enhanced quality of life for patients who have suffered from a stroke.

The East Texas Stroke Initiative greatly enhanced awareness of stroke prevention, signs and symptoms, and treatment of stroke in Angelina County. Through the initiative, Memorial’s stroke team educated local industries, schools, retirement centers and community organizations to recognize the signs and symptoms of stroke. More than 13,000 individuals from the community received stroke education between the efforts of the hospital and Angelina County and Cities Health District.

Stroke educators taught members of the community to recognize the multiple signs of stroke including trouble with walking; trouble with speaking and understanding; paralysis or numbness on one side of the body or face; trouble with seeing in one or both eyes; and headache accompanied by vomiting, dizziness or altered consciousness.

In addition to continuing education for the local community, specific goals of the initiative included receiving a Joint Commission Primary Stroke Center certification – a goal that was accomplished four months ahead of schedule. The clinical staff received numerous hours of training both in Lufkin and in Houston. Members of the stroke team have also decreased the length of stay for all stroke patients and increased administration of t-PA, or tissue plasminogen activator, which can be used to treat some people who are having a stroke caused by a blood clot.

The original goal set forth by the initiative required the administration of t-PA to increase from .003% to 1.5% by the end of the second year. However, the administration increased to 5% by the end of the second year. It then increased to 11.5% by the end of the third year.

“For me, the best benefit has been the t-PA administration rate increase,” said Suzanne Monsour, Project Manager for the East Texas Stoke Initiative. “Prior to the initiative t-PA was not frequently administered at Memorial. Since project implementation t-PA has been given more than 40 times, and the value of t-PA is great. We implemented strict guidelines, protocols and criteria to give the drug, which I think gave the physicians the confidence to administer it. It is now the standard of care at Memorial.”

Memorial Medical Center-Lufkin is the only Joint Commission Primary Stroke Center in Lufkin. The certification was attained in August 2010 and re-certification is slated for August 2012.

Additionally, Memorial Medical Center-Lufkin recently received the American Heart Association/American Stroke Association’s Get With The Guidelines^®-Stroke Gold Plus Quality Achievement Award – for the second year in a row – which recognizes the hospital’s commitment and success in implementing excellent care for stroke patients, according to evidence-based guidelines.

As the program continues through the end of 2013, Memorial plans to achieve additional goals through the East Texas Stroke Initiative. Those goals include continuing support for t-PA administration; in-house and community education; providing additional feedback to transferring facilities and EMS; reducing the patient’s length of stay; increase support for neuro interventional radiology options for patients; and strengthening communication and education with all physicians.

The partnership between Memorial and Methodist hospital was funded by the T.L.L. Temple Foundation. Initially, the Temple Foundation funded the initiative for three years at $5.8 million. Due to the resounding success of the program, the grant was extended for an additional two years.

In the most recent data from the Texas Department of State Health Services – Center for Health Statistics, the age adjusted mortality rate for stroke in Angelina County is more than triple the state average.

Located in what is known as the “Stroke Belt” of the United States, residents in Lufkin and the surrounding deep East Texas region suffer from an elevated number of strokes each year. Stroke prevalence, incidence and mortality rates are currently higher than the national average.

A cultural trap of bad habits – smoking, high blood cholesterol and high blood pressure, diabetes and obesity – contribute to the risk factors associated with stroke and cardiovascular disease, according to Monsour. Additionally, the African American population, especially men, have a high prevalence of hypertension that is very difficult to control even with medication. Lower socioeconomic groups, as well as high concentrations of African Americans residing in the south contribute to the rise in stroke prevalence. There are also higher inequities and disparities in healthcare access, leading to more problems in these areas. The East Texas region, along with the Valley region of Texas, represent the highest pockets of uninsured and underinsured. 

Cutline: Stroke Program Education Coordinator Sabrina Lillard (left) explains different types of strokes to Loretta Lenderman (right), of Pollok, a Memorial patient who recently suffered a minor stroke.