Organization and Implementation of a Stroke Center in Panamá, a Model for Implementation of Stroke Centers in Low and Middle Income Countries

Abstract

Background: Stroke is the second leading cause of death and disability worldwide. Stroke centers have become a central component of modern stroke services in many high-income countries, but their feasibility and efficacy in low, middle, and emerging high-income countries are less clear. Also, despite the availability of international guidelines, many hospitals worldwide do not have organized clinical stroke care. We present a methodology to help hospitals develop stroke centers and review quality data after implementation.Objectives: To describe and compare demographics, performance, and clinical outcomes of the Pacífica Salud, Hospital Punta Pacífica (PSHPP) stroke center during its first 3 years 2017–2019.Methods: Pacífica Salud, Hospital Punta Pacífica was organized to implement protocols of care based on the best practices by international guidelines and a quality improvement process. The methodology for implementation adapts a model for translating evidence into practice for implementation of evidence-based practices in medicine. This is a retrospective study of prospectively collected quality data between March of 2017 to December of 2019 for patients admitted to PSHPP with primary diagnosis stroke. Data collected include demographics, clinical data organized per the Joint Commission's STK Performance Measures, door to needle, door to groin puncture, 90 day modified Rankin Score, and hemorrhagic complications from IV thrombolysis and mechanical thrombectomy (MT). Primary outcome: year over year proficiency in documenting performance measures. Secondary outcome: year over year improvement.Results: A total of 143 patients were admitted for acute ischemic stroke, TIA, or hemorrhagic stroke. Of these, 36 were admitted in 2017, 50 in 2018, and 57 in 2019. Performance measure proficiency increased in the year-over-year analysis as did the total number of patients and the number of patients treated with IV thrombolysis and MT.Conclusions: We present the methodology and results of a stroke program implementation in Panamá. This program is the first in the country and in Central America to achieve Joint Commission International (JCI) certification as a Primary Stroke Center (PSC). We postulate that the dissemination of management guidelines is not sufficient to encourage the development of stroke centers. The application of a methodology for translation of evidence into practice with mentorship facilitated the success of this program.

Mechanical Thrombectomy Global Access For Stroke (MT-GLASS): A Mission Thrombectomy (MT-2020 Plus) Study

“…71–73 For countries that lack a system of local or national MT center certification, collaboration with an international organization or a certifying body could facilitate this process. 74…”

Prehospital Stroke Care Part 1: Emergency Medical Services and the Stroke Systems of Care

“…54,55 Finally, globally, stroke center certification is more established in high-income countries and regions compared with low- and middle-income countries. 56,57…”

Advances in Stroke: Quality Improvement

“…6 Likewise, the first stroke program in Central America was implemented in Panamá using an evidence-based 7 step process that could serve as a model for program development and implementation across the spectrum of resource availability contexts (eg, emerging high-income countries). 7…”

“…6 Likewise, the first stroke program in Central America was implemented in Panamá using an evidence-based 7 step process that could serve as a model for program development and across the spectrum of resource availability contexts (eg, emerging high-income countries). 7 Prehospital Care QI Six QI studies reported ambulance and emergency department processes to improve systems of prehospital care. A study from 4 hospitals in Houston, TX, examined an integrated stroke system of care model.…”

“…Studies sought to understand or support existing stroke system of care in the United States 2 and Canada 3 and to develop new stroke systems of care in China, 4,5 Chile, 6 and Panamá. 7 For example, Zusevics et al 2 used development evaluation to examine the stroke system of care for the Wisconsin Coverdell Stroke Program. Through process mapping and stakeholder interviews, quality practices were identified, including areas requiring improvement.…”