Implementing M:L in South Dakota Darrin Smith, Senior Director of Advocacy and State Health Alliances.

Implementing M:LImplementing M:Linin

South DakotaSouth Dakota

Darrin Smith, Senior Director of Advocacy Darrin Smith, Senior Director of Advocacy and State Health Alliancesand State Health Alliances

What is Mission: Lifeline?What is Mission: Lifeline?

Mission: Lifeline is the American Heart Association's Mission: Lifeline is the American Heart Association's national initiative to advance the systems of care for national initiative to advance the systems of care for patients with ST-segment elevation myocardial patients with ST-segment elevation myocardial infarction (STEMI). The overarching goal of the infarction (STEMI). The overarching goal of the initiative is to reduce mortality and morbidity for initiative is to reduce mortality and morbidity for STEMI patients and to improve their overall quality of STEMI patients and to improve their overall quality of care.care.

The NeedThe Need• 1.4 million people will suffer a heart attack1.4 million people will suffer a heart attack

• Approximately 400,000 of those will experience STEMIApproximately 400,000 of those will experience STEMI

• 30% of STEMI patients do not receive any form of treatment to restore 30% of STEMI patients do not receive any form of treatment to restore blood flow, whether through clot-busting drugs or percutaneous blood flow, whether through clot-busting drugs or percutaneous coronary intervention (PCI), the latter being the preferred therapy which coronary intervention (PCI), the latter being the preferred therapy which uses mechanical means such as stents, balloon angioplasty or surgery.uses mechanical means such as stents, balloon angioplasty or surgery.

Time is muscle. The outcome of STEMI events depends greatly on the Time is muscle. The outcome of STEMI events depends greatly on the care patients receive and the timeframe in which they receive it. care patients receive and the timeframe in which they receive it. Through Mission: Lifeline, the American Heart Association wants to Through Mission: Lifeline, the American Heart Association wants to ensure that healthcare systems are able to deliver prompt and ensure that healthcare systems are able to deliver prompt and appropriate care to STEMI patients during the critical "golden hour" appropriate care to STEMI patients during the critical "golden hour" following their heart attack.following their heart attack.

The Need, cont…The Need, cont…

According to the Centers for Disease Control, South Dakota is in the Class According to the Centers for Disease Control, South Dakota is in the Class 5 category for STEMI death rates, making it one of the states with the 5 category for STEMI death rates, making it one of the states with the highest STEMI death rates in the nationhighest STEMI death rates in the nation. To make timely and . To make timely and appropriate care for STEMI patients the standard across this country, appropriate care for STEMI patients the standard across this country, Mission: Lifeline has identified a number of complex challenges that Mission: Lifeline has identified a number of complex challenges that must be overcome:must be overcome:

• Public/Patient EducationPublic/Patient Education• Enhancing Emergency Medical ServicesEnhancing Emergency Medical Services• Enhancing Hospital ServicesEnhancing Hospital Services• Quality Data TrackingQuality Data Tracking• ProtocolsProtocols

The GoalThe GoalTo meet the overarching goal, Mission: Lifeline will bring together the To meet the overarching goal, Mission: Lifeline will bring together the

necessary partnerships between:necessary partnerships between:

• Patients and care giversPatients and care givers• EMSEMS• Physicians, nurses and other providersPhysicians, nurses and other providers• PCI-Referring hospitals (Non-PCI capable)PCI-Referring hospitals (Non-PCI capable)• PCI-Receiving hospitals (PCI capable)PCI-Receiving hospitals (PCI capable)• Department of HealthDepartment of Health• Office of EMSOffice of EMS• Office of Rural Health Office of Rural Health • Quality Improvement OrganizationsQuality Improvement Organizations• State and local policymakersState and local policymakers• Third-party payersThird-party payers• Health SystemsHealth Systems

South Dakota TodaySouth Dakota Today

• Hospital/EMS MapHospital/EMS Map

• M:L Hospital Survey resultsM:L Hospital Survey results

• ML EMS Survey results (next slide)ML EMS Survey results (next slide)

SD M:L EMS SurveySD M:L EMS Survey

• ALS complete = 8 (6%)ALS complete = 8 (6%)

• ALS complete w/o transmsn = 19 (14.3%)ALS complete w/o transmsn = 19 (14.3%)

• ALS not complete = 22 (16.5%)ALS not complete = 22 (16.5%)

• BLS w/12-Lead = 3 (2.3%)BLS w/12-Lead = 3 (2.3%)

• BLS w/o 12-Lead = 81 (60.9%) BLS w/o 12-Lead = 81 (60.9%)

SD M:L ProjectSD M:L Project• $9M+ three year project funded by an $8.4M grant from $9M+ three year project funded by an $8.4M grant from

the Helmsley Charitable Trustthe Helmsley Charitable Trust

• This is the 2This is the 2ndnd largest grant the American Heart largest grant the American Heart Association has ever received on any level – national, Association has ever received on any level – national, regional, or localregional, or local

• This project will impact literally This project will impact literally everyevery licensed licensed ambulance service and licensed hospital in the state of ambulance service and licensed hospital in the state of South DakotaSouth Dakota

SD M:L Project, cont…..SD M:L Project, cont…..

• This will revolutionize heart attack patient care in SD – This will revolutionize heart attack patient care in SD – we currently have one of the highest 10 STEMI death we currently have one of the highest 10 STEMI death rates according to the CDCrates according to the CDC

• This project is designed to produce a “model system” This project is designed to produce a “model system” that can then be implemented across the Midwest and that can then be implemented across the Midwest and nation, making SD a leader in heart attack systems of nation, making SD a leader in heart attack systems of carecare

What it means to SD?What it means to SD?Successful implementation of Mission: Lifeline will mean that South Dakota Successful implementation of Mission: Lifeline will mean that South Dakota

will have:will have:

• One of the most advanced, if not One of the most advanced, if not the the most advanced, coordinated heart most advanced, coordinated heart attack systems of care in the United Statesattack systems of care in the United States

• The highest percentage of ambulance services in the nation equipped The highest percentage of ambulance services in the nation equipped with 12-lead ECGswith 12-lead ECGs

• The highest percentage of 12-lead ECG-trained emergency medical The highest percentage of 12-lead ECG-trained emergency medical technicians in the nationtechnicians in the nation

• The highest percentage of ambulance services transmitting 12- lead The highest percentage of ambulance services transmitting 12- lead ECG results in the nationECG results in the nation

What it means to SD, cont….What it means to SD, cont….• The highest percentage of hospitals with 12-lead ECG-The highest percentage of hospitals with 12-lead ECG-

receiving station software in the nationreceiving station software in the nation

• The highest percentage of hospitals in the nation The highest percentage of hospitals in the nation utilizing the ACTION Registry-Get WithThe Guidelines utilizing the ACTION Registry-Get WithThe Guidelines (GWTG) data collection tool(GWTG) data collection tool

• One of the states with the highest percentage of One of the states with the highest percentage of hospitals in the nation with written STEMI patient hospitals in the nation with written STEMI patient treatment and transport protocols.treatment and transport protocols.

Implementation StrategiesImplementation Strategies• Aggressive public education and awareness campaigns will be Aggressive public education and awareness campaigns will be

executed to raise awareness and knowledge levels with respect to executed to raise awareness and knowledge levels with respect to signs and symptoms of heart attack and the need to activate the 9-1-1 signs and symptoms of heart attack and the need to activate the 9-1-1 system immediatelysystem immediately

• Aggressive medical provider education and awareness efforts will be Aggressive medical provider education and awareness efforts will be executed to recruit medical professionals as partners in educating their executed to recruit medical professionals as partners in educating their patients about heart attack warning signs and symptoms, and the need patients about heart attack warning signs and symptoms, and the need to call 9-1-1 immediatelyto call 9-1-1 immediately

• Assistance to Assistance to everyevery ambulance service in South Dakota in acquiring the ambulance service in South Dakota in acquiring the most up-to-date 12-lead ECG equipmentmost up-to-date 12-lead ECG equipment

• Implementation of a robust, comprehensive 12-lead ECG training Implementation of a robust, comprehensive 12-lead ECG training program and ensuring that program and ensuring that everyevery ambulance service in South Dakota ambulance service in South Dakota has access to quality 12-lead ECG training;has access to quality 12-lead ECG training;

Implementation Strategies….Implementation Strategies….

• Assurance that 12-lead ECGs in South Dakota Assurance that 12-lead ECGs in South Dakota ambulance services are transmitting results to medical ambulance services are transmitting results to medical facilities that are equipped to receive those facilities that are equipped to receive those transmissionstransmissions

• Through work with our stakeholders, assurance that Through work with our stakeholders, assurance that emergency department staff in emergency department staff in everyevery South Dakota South Dakota hospital are trained to properly administer fibrinolytic hospital are trained to properly administer fibrinolytic therapytherapy

Implementation Strategies….Implementation Strategies….• Assurance that appropriate protocols are in place for EMS and Assurance that appropriate protocols are in place for EMS and

hospital personnel to provide for the most appropriate care for hospital personnel to provide for the most appropriate care for each STEMI patienteach STEMI patient

• Establishment of the first of its kind “real time” evaluation tool Establishment of the first of its kind “real time” evaluation tool with the American Heart Association/American College of with the American Heart Association/American College of Cardiology jointly developed quality improvement program, Cardiology jointly developed quality improvement program, Action Registry-Get With The Guidelines, which will track Action Registry-Get With The Guidelines, which will track patient data and information throughout the entire continuum patient data and information throughout the entire continuum of STEMI system care and allow us to evaluate and monitor on of STEMI system care and allow us to evaluate and monitor on a regular basis the improvements being made and the need for a regular basis the improvements being made and the need for improvement in other areas of each systemimprovement in other areas of each system

Project Budget HighlightsProject Budget Highlights

• EMS: $4MEMS: $4M

– $3.5M for 12-Leads$3.5M for 12-Leads– $225K for transmission$225K for transmission– $300K for training & materials$300K for training & materials

Project Budget Highlights….Project Budget Highlights….

• Hospitals: $3MHospitals: $3M

– $775K for 12-Lead receiving station software$775K for 12-Lead receiving station software– $2M for ACTION Registry GWTG$2M for ACTION Registry GWTG– $75K for Lytics Training$75K for Lytics Training

Project Budget Highlights….Project Budget Highlights….• Other highlights:Other highlights:

– Full Time SD M:L DirectorFull Time SD M:L Director

– Annual Conferences in SF & RCAnnual Conferences in SF & RC

– Public/Provider EducationPublic/Provider Education

– EvaluationEvaluation

– Positioning SD as a leaderPositioning SD as a leader

MiscellaneousMiscellaneous

• Register your systemRegister your system

• www.americanheart.org/missionlifelinesd

LUNCHLUNCH

The Plan & The BudgetThe Plan & The Budget

• $9M+ over 3 years$9M+ over 3 years

““Human Resources”Human Resources”

• ML DirectorML Director

• Travel BudgetTravel Budget

• Lobbyist/Regulatory ConsultantLobbyist/Regulatory Consultant

EMSEMS

• 12-Lead ECG’s12-Lead ECG’s• 12-Lead Modem’s12-Lead Modem’s• 12-Lead subscription12-Lead subscription• 12-Lead Transmission12-Lead Transmission• Hands On TrainingHands On Training• Training MaterialsTraining Materials

12-Lead ECG’s12-Lead ECG’s

• 181 12-Lead ECG’s placed181 12-Lead ECG’s placed• All 127 licensed ground servicesAll 127 licensed ground services• 135 placed @ 100%135 placed @ 100%• 46 placed @ 75% (16 services)46 placed @ 75% (16 services)

• Grant-like application processGrant-like application process

12-Lead ECG’s12-Lead ECG’s

• Modems placed in all 12-Lead’s Modems placed in all 12-Lead’s (where applicable)(where applicable)

• 3 year subscription provided (when 3 year subscription provided (when necessary)necessary)

12-Lead ECG’s12-Lead ECG’s

• All units will transmitAll units will transmit

• Transmission data plan providedTransmission data plan provided

EMS Training & MaterialsEMS Training & Materials

• Hands on TrainingHands on Training• Learn: Rapid STEMI ID online toolLearn: Rapid STEMI ID online tool• STEMI Provider ManualSTEMI Provider Manual• Every SD Ambulance ServiceEvery SD Ambulance Service• Every EMTEvery EMT

HospitalsHospitals

• 12-Lead ECG Receiving capability12-Lead ECG Receiving capability

• Action Registry – Get with the Action Registry – Get with the Guidelines (ARG)Guidelines (ARG)

• Fibrinolytic Therapy TrainingFibrinolytic Therapy Training

12-Lead Receiving Capability12-Lead Receiving Capability

• 50 Hospitals50 Hospitals

• Receiving capabilities/formatsReceiving capabilities/formats

ACTION – Registry GWTGACTION – Registry GWTG

• Data Collection Tool developed by Data Collection Tool developed by AHA/ACC AHA/ACC

• Focused on entire continuum of Focused on entire continuum of carecare

• QI Staff & WebinarsQI Staff & Webinars• 50 Hospitals – 3 Funding Tiers50 Hospitals – 3 Funding Tiers

ACTION – Registry GWTGACTION – Registry GWTG

• PCI Receiving Centers:PCI Receiving Centers:

– Year 1: 6 receiving centers, 90% of $75,000 Year 1: 6 receiving centers, 90% of $75,000 FTEFTE

– Year 2: 6 receiving centers, 70% of $75,000 Year 2: 6 receiving centers, 70% of $75,000 FTE, 1 new center at 90% of $75,000 FTEFTE, 1 new center at 90% of $75,000 FTE

– Year 3: 6 receiving centers at 50% of Year 3: 6 receiving centers at 50% of $75,000, 1 center at 70%, 2 new centers at $75,000, 1 center at 70%, 2 new centers at 90% of $75,000 FTE90% of $75,000 FTE

ACTION – Registry GWTGACTION – Registry GWTG

• Referring FTE Reimbursement TIER 1:Referring FTE Reimbursement TIER 1:

– Year 1: 5 largest PCI-referring facilities - 70% Year 1: 5 largest PCI-referring facilities - 70% of $50,000 FTEof $50,000 FTE

– Year 2: 4 PCI-referring facilities - 50% of Year 2: 4 PCI-referring facilities - 50% of $50,000 FTE$50,000 FTE

– Year 3: 2 PCI-referring facilities - 30% of Year 3: 2 PCI-referring facilities - 30% of $50,000 FTE$50,000 FTE

ACTION – Registry GWTGACTION – Registry GWTG

• Referring FTE Reimbursement TIER 2:Referring FTE Reimbursement TIER 2:

• Remaining PCI-referring facilities – to be Remaining PCI-referring facilities – to be divided accordingly, total FTE reimbursement divided accordingly, total FTE reimbursement incentive of $195,000incentive of $195,000

Fibrinolytic Therapy Training Fibrinolytic Therapy Training

• 50 Hospitals50 Hospitals

• $75K budgeted over 3 years$75K budgeted over 3 years

• Hands-On or Online/CD based?Hands-On or Online/CD based?

Public Awareness/EducationPublic Awareness/Education

• $85K annually for 3 years$85K annually for 3 years

• Campaign TBDCampaign TBD

EvaluationEvaluation

• Public Awareness – Years 1 & 3Public Awareness – Years 1 & 3

• Project Evaluation – 1 manuscript Project Evaluation – 1 manuscript in Year 1; 2 manuscripts in Years 2 in Year 1; 2 manuscripts in Years 2 & 3& 3

M:L Model SharingM:L Model Sharing

Sharing the SD system model:Sharing the SD system model:

• 4 Trips in Year 24 Trips in Year 2

• 8 Trips in Year 38 Trips in Year 3

QUESTIONS???QUESTIONS???

Annual ConferencesAnnual Conferences

• 2 Annually2 Annually

• 1 East River – Sioux Falls1 East River – Sioux Falls

• 1 West River – Rapid City1 West River – Rapid City

Annual ConferencesAnnual Conferences

• 150 Attendees East River150 Attendees East River

• 100 Attendees West River100 Attendees West River

• 1 Paid Speaker per event1 Paid Speaker per event

Annual ConferencesAnnual Conferences

• Similar Topics/SchedulesSimilar Topics/Schedules

• Dates (November 3Dates (November 3rdrd or 4 or 4thth))

• Format/Topics???Format/Topics???

Policy IssuesPolicy Issues

• EMS ProtocolsEMS Protocols

• Hospital DesignationHospital Designation

Other Items/Open DiscussionOther Items/Open Discussion

Next Task Force MeetingNext Task Force Meeting

ADJOURN!!!ADJOURN!!!