APPLICATION INFORMATION

Please respond to the five items below. Please be brief and concise, as the application should be limited to five pages.

Please be sure to complete the coversheet (Appendix A) and mail or e-mail the coversheet and application to:

Wayne D. Rosamond, Ph.D.
Professor
Department of Epidemiology
School of Public Health
137 East Franklin St .
Suite 306 Bank of America Building
Chapel Hill , NC 27514

OR EMAIL: wayne_rosamond@unc.edu

Please write "Stroke Registry RFP" in the subject of any e-mails sent to the above address.

If you have any questions regarding the above information, please contact:

Carol Murphy
Email: cmurphy@unc.edu
Telephone: 919-966-1402

APPLICATION NARRATIVE

1) Hospital Characteristics

Describe your hospital in terms of location, size, type (public/private, academic/non-academic), and number of stroke patients treated per year.

2) Resources

Describe the resources your site has to accomplish the following:

1. Provide a local contact person to lead the registry program on-site, champion the registry's cause and participate in the state-wide steering committee. This person will be responsible for designating other registry staff and ensuring the success at the registry site.
2. Designate and release appropriate hospital staff to participate in training in relation to adherence to registry protocols.

3) Monitoring

Briefly describe how your hospital would approach fulfilling the following objectives:

1. Identify and collect data on all adult patients with acute stroke at your hospital for a 6 month period each year.
2. Collect data on quality of care indicators concurrent with patient care and transmit these data to a centralized, web-based registry. Examples of key data elements to be captured include:

• Consideration of thrombolytic therapy
• Use of anticoagulant therapy for patients with atrial fibrillation
• Use of DVT prophylaxis
• Symptom onset time
• Brain imaging time
• Stroke education
• Lipid management
• Discharge on antithrombotics

4) Technology

Describe your site's capacity to access and utilize a registry-specific, web-based data entry system in your emergency department, neurology service, or other appropriate service.

5) Quality Improvement

Describe your site's capacity to implement and engage in quality improvement initiatives for stroke care.

*** Please Download Request for Participation Cover Sheet Here - Download