Interactive Maps to Improve Stroke Systems of Care in Wisconsin

Stroke is the fifth leading cause of death in the US (1). In 2017, stroke accounted for more than 11,000 hospitalizations in Wisconsin (2). Minimizing the total time from onset of symptoms to delivery of treatment appropriate for the level of stroke complexity is critical to improving outcomes for stroke patients (3). Prehospital time — from recognition of symptoms to arrival at a local hospital — accounts for some delays in care. However, because patients are often transferred from local hospitals without substantial stroke-specific resources to larger hospitals capable of treating complex stroke patients, interhospital travel time is also important (4).

The Wisconsin Coverdell Stroke Program sought to learn more about barriers to ensuring that, when needed, stroke patients in all parts of the state receive advanced care without delay. As a partner in the CDC Paul Coverdell National Acute Stroke Program since 2012, The Wisconsin Coverdell Stroke Program aims to improve patient outcomes through stroke systems of care (5). The stroke systems of care framework entails increasing the quality of care and support for stroke patients across the continuum of care through close collaboration across emergency medical services agencies, hospitals, health care facilities, and statewide partners.

In 2020, with the help of the Get With The Guidelines–Stroke (GWTG) registry, the Wisconsin Coverdell Stroke Program determined that 24.6% of stroke patients in Wisconsin were transferred between hospitals to access advanced care or resources (6). In early 2021, the program administered surveys to 8 stroke coordinators across 5 public health regions to identify the facilities most frequently involved in stroke transfers (7). The program initially set out to create static maps depicting these transfers: one for the entire state and insets for 2 metropolitan areas (Milwaukee and Madison). During user testing, however, stroke coordinators indicated they wanted to be able to visualize the entire state and zoom in on areas warranting further investigation. In response, the program embarked on an effort to develop interactive maps that empower the user to visualize gaps in access to advanced stroke care throughout the state.