ANN ARBOR, MI - The University of Michigan Health System's Stroke Program has earned a national certification for the high quality of its care, becoming one of only two hospitals in southeast Michigan to be recognized with a “gold seal of approval” from the same national organization that accredits hospitals.

Meanwhile, researchers from the program recently returned from the International Stroke Conference in New Orleans, where they presented a range of research results relating to the nation's third leading cause of death. And the program has recently added new specialists and new expertise in stroke care and research, and opened several new clinical trials and clinical services.

The certification of U-M as a Primary Stroke Center by the Joint Commission on Accreditation of Healthcare Organizations, or JCAHO, means that U-M cares for stroke patients in a coordinated, high-quality way that gives the best chance of a good outcome. There are 88 JCAHO-certified primary stroke centers in 28 states.

Only four other Michigan hospitals have earned this designation, which is based on an intensive review of a hospital's stroke care and standards set by the Brain Attack Coalition and the American Stroke Association. U-M is also participating in the ASA's “Get With the Guidelines” program for quality stroke care. Recent national research shows that patients treated at JCAHO-certified stroke centers receive proven tests and treatments more quickly, and have better results, than those treated elsewhere.

U-M's stroke program is based on close cooperation among emergency medicine, radiology, neurology, cardiovascular and neurosurgery physicians and nurses, which helps ensure rapid delivery of proven treatments.

“We've built a team that can offer some of the most advanced stroke care in the entire Midwest, and this JCAHO certification shows it,” says Lewis Morgenstern, M.D., director of the U-M Stroke Program and an associate professor of neurology, emergency medicine and neurosurgery at the U-M Medical School.

The U-M team also conducts a wide range of research into better stroke treatments and improving both the delivery of stroke care and the public's awareness of stroke.

One of the biggest issues in stroke care is the low rate of use of tPA, a very effective treatment for strokes caused by blocked blood vessels in the brain. Used within three hours of the start of a stroke, tPA can save a patient's life and prevent permanent disability. But it also carries a risk of causing brain bleeding if not used correctly. U-M researchers presented new research results about factors that affect physicians' use of tPA at the recent International Stroke Conference.

Neurologist Devin Brown, M.D., reported on a national survey of emergency department physicians conducted by U-M and the American College of Emergency Physicians. The survey found that 40 percent of the 1,105 survey respondents were unlikely to give tPA even in an ideal setting, mainly because of their fear of the risk of bleeding (intracranial hemorrhage). It also showed what physicians consider an “acceptable risk” for bleeding, and what level of patient improvement they feel would justify taking the risk of causing bleeding. The results may help lead to improved use of tPA and next-generation treatments that don't carry as big a risk.

At the same meeting, U-M stroke researcher Lynda Lisabeth, Ph.D., presented results from a study led by U-M researchers, on the likelihood of strokes and heart problems among stroke survivors. They found that people who had had an ischemic (blockage) stroke were more likely to have another stroke than a heart attack, angioplasty or bypass operation in the two years after their first stroke. This finding could help guide treatment of stroke survivors, to reduce their risk of a second stroke while also managing their risk for a heart problem.

Brown and Lisabeth are two recent additions to the U-M Stroke Program team, which has also added Michael M. Wang, M.D., Ph.D., as Director of Molecular Stroke Research. In April, the team will add a neurointensivist: a neurologist trained to care for stroke patients in intensive care.

Besides the new faculty, the program also features new clinical capabilities, especially in the area of minimally invasive procedures. This approach allows doctors to avoid open-skull surgery when they need to close leaking brain blood vessels or open blocked ones while a stroke is occurring, or to repair brain aneurysms and other blood-vessel problems before they burst.

U-M neurosurgeon Greg Thompson, M.D., who has repaired such problems using open-skull microsurgery techniques for years, recently completed training in the minimally invasive technique, which is called endovascular neurosurgery. He is one of only a few neurosurgeons in Michigan to offer both minimally invasive and traditional microsurgical acute stroke and preventive procedures. U-M's interventional neuroradiologists also offer minimally invasive options.

The U-M Emergency Department is also the site of advanced research in stroke care, through a partnership with St. Joseph Mercy Hospital called the Brain Injury Group. Patients who come to either hospital within the first few hours of a stroke's first symptoms are automatically screened for enrollment in several studies, including the CLEAR, CHANT and SAINT treatment trials.

CLEAR, led locally by U-M emergency physician Phillip Scott, M.D., is testing a combination of tPA and another drug, Integrilin, that is used in heart attack patients to keep blood platelets from sticking together. CHANT and SAINT, led locally by U-M emergency physician Robert Silbergleit, M.D., are studies of a neuroprotective agent that may help stroke survivors keep or regain movement ability. Both studies are being conducted at many sites nationwide; the U-M and St. Joseph Mercy are the only sites in Michigan for CHANT, which is for patients with hemorrhagic stroke, and only two other Michigan hospitals are participating in SAINT, for ischemic stroke.

Also in the U-M Emergency Department, stroke patients may be asked to participate in two studies that are trying to answer questions about stroke symptoms and vulnerability. The Gender and Acute Stroke Presentation Study is looking for any differences between men and women in stroke symptoms, to try to verify the results of a previous study led by Morgenstern. And the GOCHA study is sampling stroke patients' blood to look for genetic factors that may increase the risk of brain bleeding among people who regularly take blood-thinning drugs.

The U-M Stroke Program's JCAHO certification was facilitated by the U-M Medical Management Center, which assures comprehensive disease management through the interventional efforts of six other JCAHO-certified specialty-level disease-specific programs. Currently, the center offers programs for asthma, heart failure, diabetes, coronary artery disease, depression and chronic back pain. The center's goals focus on strengthening patients' self-management skills for a lifetime of successful chronic care management, which often involves care of multiple diseases.

For more on the U-M Stroke Program, visit www.med.umich.edu/stroke.

Written by Kara Gavin

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