• In the US and New Mexico (NM), stroke is the fifth leading cause of death and a leading cause of adult disability.
• One way to try to reduce the impact that strokes have on New Mexicans is the development of hospital stroke centers. Hospitals with these certifications will have a dedicated stroke-focused program, staffed by qualified medical professionals with specific stroke care education. The standards that these hospitals meet will help with the provision of the best care possible for patients suffering from a stroke.
• Seven out of 43 acute care hospitals in NM are certified for stroke care.  Currently, six (14%) are designated as primary stroke centers, and one is designated as acute stroke ready. A total of 16% of hospitals in New Mexico are designated to provide stroke specific care to patients.
• Stroke center designation cannot be awarded until stroke data is submitted to a national registry. The Epidemiology and Response Division (ERD) Emergency Medical Systems (EMS) Bureau Stroke Program contacted and met with representatives from these hospitals, communicating the standards, obtaining their commitment, and assisting with the initiation of data submission through the reimbursement of data licensing fees.
• The NMDOH EMS Bureau Stroke Program will perform outreach to primarily rural areas, communicating the standards and steps necessary for hospital stroke center certification, and work with the state’s EMS agencies to improve their stroke care.  Quarterly Systems of Stroke Care Meetings will be further established and refined.
• For FY19 the Program will continue to work with the four hospitals until full certification is achieved.

• New Mexico Department of Health (NMDOH)
• New Mexico Environment Department (NMED), Air Quality Bureau
• Cardiovascular Disease Mortality Health Status Workgroup
• Acute care hospitals
• Emergency Medical Services (EMS) agencies
• American Heart Association (AHA)
• University of New Mexico Telemedicine

• Patients receiving care at primary stroke centers have a higher rate of survival and recovery than those treated in hospitals without this type of specialized care.  
• A hospital obtaining stroke center accreditation and certification has many benefits for the community, including assurance that the hospital adheres to stroke prevention and treatment measures that have been agreed upon by the American Heart and Stroke Associations, the Centers for Disease Control and Prevention, and national accrediting bodies. 
• Adherence to stroke prevention and treatment measures reduces disability and death associated with stroke.  
• Accreditation and certification will help assure that the hospitals are appropriately reimbursed by Medicare, Medicaid, and third-party payers for the improved care delivered to stroke patients.

The NMDOH Epidemiology and Response Division EMS Bureau Stroke Program will work with the current hospitals to maintain or elevate their current accreditation and certification level.  These efforts will be geared at increasing the number of communities with hospitals that have accreditation and certification for stroke care, which provides the benefits of:

• Improving the quality of patient care by reducing variation in clinical processes;
• Creating a dedicated, well-educated, and cohesive clinical stroke team;
• Strengthening community confidence in the quality and safety of care, treatment, and services from their hospital and EMS agencies.

• Q1: Develop a pre-hospital Stroke Care Card (assessment tool to aid in stroke patient identification and the proper destination for care) for EMS personnel to streamline New Mexico’s stroke care system.  Establish relationships with four hospitals who seek initial stroke certifications/accreditations. Complete - The EMS Bureau hired a new Stroke/STEMI Coordinator at the start of FY19.  Relationships with the hospitals who provide stroke care have been re-established by the new coordinator. Four new hospitals (Lovelace Westside-Albuquerque, Gerald Champion Regional Medical Center-Alamogordo, Carlsbad Medical Center-Carlsbad, and Eastern New Mexico Medical Center-Roswell) have been identified as near future participants in the Get With The Guidelines (GWTG) Stroke Data Registry. These hospitals have also been identified to obtain certification/accreditation as either a Primary Stroke Center or as an Acute Stroke Ready Hospital. The New Mexico Systems of Care Quarterly Stroke Meetings have become the responsibility of the EMS Bureau to coordinate.
• Q2: Implement the Stroke Care Card with EMS agencies across New Mexico. 
• Q3: Confirm each hospital’s entry into the appropriate AHA-GWTG Stroke data registry.  Confirm each hospital’s appropriate stroke certification/accreditation is achieved. 
• Q4: Assess the need for more Primary Stroke Centers and Acute Stroke Ready Hospitals based on the current participation status in New Mexico’s hospitals.

Despite setbacks, the Emergency Medical Services (EMS) Bureau Stroke Program was able to achieve half of its milestones and more importantly, currently 7 out of 43 acute care hospitals are stroke certified in New Mexico. There has been outreach specifically to southeast hospitals because this is the region with the highest cardiovascular disease death rates in the state.  With FY18 ending and FY19 starting, the Stroke Program is continually engaged in identifying and working with other hospitals toward stroke certification.