Frequently Asked Questions

For more than 25 years heart disease, stroke, and unintentional injury have been the top five leading causes of death in the state.¹  As stated in the Whitepaper A Statewide System of Care for Time Sensitive Emergencies The Integration of Stroke and STEMI Care into the Regional Trauma System “Stroke, STEMI and trauma patients require timely EMS triage, informed diagnosis, and definitive treatment by a multidisciplinary team of healthcare providers, supported by appropriate resources, in order to reduce the risk of death or serious disability.”¹ The paper also notes that “An effective system of care includes specialized, independently verified, state designated treatment centers that support an integrated approach to increasing public awareness of initial symptom recognition, reduce the impact of trauma, stroke, and STEMI occurrence through evidence based standard treatment regimens and ongoing quality improvement.”¹

Experts in the field have long recognized that a systems approach can have a positive impact on patient outcomes. Research demonstrates that a standardized approach to systems of care has led to a 15% relative reduction in 30-day in-hospital mortality in acute stroke.² Patients who receive care at a Level I or Level II trauma facility (verified resources to care for seriously injured) had a 25% reduction in mortality.³

Michigan is developing a regional system of care for time-sensitive emergencies which includes stroke, ST-elevation myocardial infarction (STEMI), and traumatic injuries. This organized, coordinated effort within a geographic area will deliver a comprehensive range of patient care integrated into the existing trauma system.  These systems of care will capitalize on the experience and gains made by developing the trauma system, enhance efficiencies and further collaboration with a variety of disparate healthcare components into a formal structure that is established, supported, and supervised within statute, administrative rules, and policy.

Administrative Rules outline how systems are operationalized. The Rules for stroke and STEMI systems were drafted with the understanding that stroke and STEMI would be integrated into the existing trauma system. While stroke and STEMI have some language specific to their service lines both were intentionally written to mirror concepts like trauma (data collection, accreditation/certification, organizational structure, and advisory committees). Stakeholders, partners, and advisory bodies advise on policies, procedures, and inform timeline development.

Stakeholders, partners, and advisory bodies advise on policies, procedures, and inform timeline development. Systems require time, thoughtful input from stakeholders and a formal plan that builds in a stepwise manner to implement the system. The trauma system, with its many components (125 hospitals, 800 EMS transporting agencies and 29,000 providers, and more than 600 subject matter experts) took almost twelve years to be fully operational. SOC for stroke and STEMI will capitalize on the work already done related to processes, policies, procedures, and organizational structures in place to move expeditiously to set up and operationalize the system. 

Stroke Administrative Rules
STEMI Administrative Rules

The following is an outline of the steps needed to operationalize the system. Of note, some steps require inputs not necessarily in the full control of the Section i.e., when a registry vendor contract will be finalized.

Data Collection

• The department is drafting a timeline of when the system components should be developed and/or in place. A limiting element has been the system registry contract. The original trauma registry contract has expired and contracting for a new registry that encompasses trauma, stroke and STEMI is in "Request for Proposal" status. 
  
  • Once that contract is executed more formal timelines will be developed. Projected timelines will be added to the FAQs as they become available. 

• An early step to determining a baseline for the system has been to develop and analyze facility survey/assessment related to readiness/needs for system participation in development to establish baseline and priority needs.
  • The assessment was developed and disseminated to stakeholders in the first quarter of 2024 and has provided insights about where programs are.
  •  Equally important has been the establishment of a comprehensive contact list for partners and stakeholders which has been used to develop a listserv for communication. Updated program contact information should be sent to Katelyn Schaible at schaiblek2@michigan.gov
  • Communication tolls and updates are being planned i.e., routine updates to FAQ's quarterly emails, etc. A one-page description of System of Care in Michigan designed to inform program Administrators is in development.

  Advisory Bodies

  • The Administrative Rules outline the role of advisory bodies for systems of care at both the regional and state level. The Statewide Stroke Advisory Subcommittee and the Statewide STEMI Advisory Subcommittee will act as the departments subject matter experts for the clinical and operational components of stroke and STEMI care.
  • Applications were requested from stakeholders and partners to sit on the SOC Advisory Committees for a three-year term. There was a very robust response to that request and the inaugural Advisory Bodies have been seated. The first meeting will be held January 21, 2025.
  •  Information about the committees and meeting links will be posted to the committees section of the SOC website as it becomes available.

• Attend SOC Office Hours to learn more about the progress in system development. See the schedule for updated programming. 
• Contact List: Please make sure the Division of EMS and Systems of Care SOC Section has current information that includes: physicians, specialists, program managers/coordinators, data managers etc. who are working in stroke/STEMI or both. This will assist when reaching out to stakeholders when necessary. Reach out to Katelyn Schaible, Department Manager, Stroke and STEMI SOC SchaibleK2@michigan.gov to confirm your contact information is on file.
• Check in at the SOC website Frequently Asked Questions Section to get updates on the discussion and implementation plan https://www.michigan.gov/mdhhs/doing-business/trauma/stroke-stemi
• Please note there is no required work, meeting or activity that needs to take place immediately. The Department is planning a variety of communication modalities to ensure that all our partners and stakeholders are up to date on the implementation plans.

No, the Systems of Care initiative for stroke and STEMI, like the trauma system, is voluntary and all-inclusive regardless of hospital size or geographical location. Facilities should consider and plan to participate in the system at a level that meets their current resources. Of course, all systems are most effective if a majority of stakeholders participate. 

Yes, Michigan Systems of Care integrate the time-sensitive emergencies of stroke and STEMI into the existing regional trauma system. The rule language describes a system that when operationalized fully would expand the Regional Trauma Network into a Regional System of Care Network, with three branches: trauma, stroke, and STEMI.

The projected timeline and steps that need to be in place for designation is outlined below.  This is based on current information and is likely to change as more insight into primary inputs is achieved. 

• 2025 – The advisory bodies with input from the requisite subject matter experts will develop minimum data sets (each service line) and a data dictionary for the SOC registry.
• Internal development of the Designation application process including timelines, clarification around the Michigan Criteria (language specific to stroke and STEMI regional work). The process will be pilot tested with a sample of content experts to ensure there are no issues or questions.
• 2026 – The Designation Packet will be published.  The System of Care staff will host office hours, webinars, and educations opportunities to support programs in preparing for initial designation status. Programs will have the opportunity to build and refine their programs before submitting their application for Designation.
• 2027 – Initial designation applications will be accepted. Application cycles will be defined by the accrediting/certifying bodies cycle as each accrediting organization may have different timeframes for their accreditation

Michigan STEMI care facilities that have obtained accreditation by a nationally recognized professional certifying and accrediting organization and have met state requirements (these details have not been finalized) will apply to the state to be designated at that accredited level. The processes, forms, policies, and procedures for STEMI certification/accreditation will not be finalized until later in the development plan and is registry dependent. The advisory bodies will advise and assist in outlining this process more completely.

Please note the following Administrative Rule language. The terms used are specific and slightly different from the Rule language in the Stroke rules, (equivalent) to department approved nationally recognized professional certifying and accrediting organizations that have equivalent certification standards to the organizations noted below and will be presented to the STEMI advisory subcommittee for consideration:

A STEMI receiving center shall provide evidence of current certification or accreditation by a department-approved nationally recognized professional certifying and accrediting organization that the healthcare facility has the resources required to be certified as meeting all the criteria for a certified STEMI receiving center equivalent to a TJC-AHA comprehensive STEMI center or TJC-AHA primary heart attack center or an ACC chest pain center with PCI or a Corazon PCI/Catheterization program, or subsequent equivalent certification or accreditation as approved by the department with the advice of the STEMI advisory subcommittee.

A STEMI referral facility shall provide evidence of current certification or accreditation by a department-approved nationally recognized professional certifying and accrediting organization that the healthcare facility has the resources required to be certified as meeting all the criteria for a certified STEMI referral facility equivalent to a TJC-AHA acute heart attack ready center or an ACC non-PCI chest pain center or a Corazon chest pain center or subsequent equivalent certification or accreditation as approved by the department with the advice of the STEMI advisory subcommittee.
 For more information regarding accrediting bodies and the levels of care, follow the links provided below.

The Joint Commission (Advanced Cardiac) Cardiac Certification | The Joint Commission

Comprehensive Cardiac Center
Comprehensive Heart Attack Center
Primary Heart Attack Center
Acute Heart Attack Ready Center

American College of Cardiology (ACC) Chest Pain Center Accreditation

Chest Pain Center Certification
Chest Pain Center with Primary PCI
Chest Pain Center Primary PCI and Resuscitation

Corazon Cardiovascular Program Accreditation

Chest Pain Center
Cath/PCI

The Department recognizes that there may be additional certification and accreditation organizations that wish to be recognized as “Department Approved.” Please note the following Administrative Rule language. The terms used are specific and slightly different in each rule set.

The STEMI Rules describe organizations as (equivalent) to department approved nationally recognized professional certifying and accrediting organizations that have equivalent certification standards to the organizations noted below and will be presented to the STEMI advisory subcommittee for consideration:

• (a) A STEMI receiving center shall provide evidence of current certification or accreditation by a department-approved nationally recognized professional certifying and accrediting organization  that the healthcare facility has the resources required to be certified as meeting all the criteria for a certified STEMI receiving center equivalent to a TJC-AHA comprehensive STEMI center or TJC-AHA primary heart attack center or an ACC chest pain center with PCI or a Corazon PCI/Catheterization program, or subsequent equivalent certification or accreditation as approved by the department with the advice of the STEMI advisory subcommittee.
• (b) A STEMI referral facility shall provide evidence of current certification or accreditation by a department-approved nationally recognized professional certifying and accrediting organization that the healthcare facility has the resources required to be certified as meeting all the criteria for a certified STEMI referral facility equivalent to a TJC-AHA acute heart attack ready center or an ACC non-PCI chest pain center or a Corazon chest pain center or subsequent equivalent certification or accreditation as approved by the department with the advice of the STEMI advisory subcommittee.

The Stroke Rules describe subsequent equivalent certification as approved by the department with the advice of the stroke advisory subcommittee as listed below.

• (a) A level I or comprehensive stroke center shall provide evidence of current certification by a department-approved, CMS-recognized professional certifying organization that the healthcare facility has the resources required to be certified as meeting all the criteria, or subsequent equivalent certification as approved by the department, with the advice of the stroke advisory subcommittee, for an accredited comprehensive stroke center under R 330.254(1)(e).
• (b) A level II or thrombectomy capable stroke center shall provide evidence of current certification by a department-approved, CMS-recognized professional certifying organization that the healthcare facility has the resources required to be certified as meeting all the criteria, or subsequent equivalent certification as approved by the department with the advice of the stroke advisory subcommittee, for a certified thrombectomy capable stroke center under R 330.254
• (c) A level III or primary stroke center shall provide current certification by a department approved, CMS-recognized professional certifying organization that the healthcare facility has the resources required to be certified as meeting all the criteria, or subsequent equivalent certification as approved by the department with the advice of the stroke advisory subcommittee, for a certified primary stroke center under R 330.254(1)(e)
• (d) A level IV or acute stroke ready hospital stroke center shall provide current certification by a department-approved, CMS-recognized professional certifying organization that the healthcare facility has the resources required to be certified as meeting all the criteria, or subsequent equivalent certification as approved by the department with the advice of stroke advisory subcommittee, for a certified acute stroke ready hospital under R 330.254(1)(e)

The Department will work with the Advisory Committees to develop a process for review of requests to become “Department Approved.”  More information will made available in the later part of 2025.

Michigan Trauma System - MDHHS - Michigan Statewide Trauma System
Michigan Systems of Care - MDHHS - Michigan Systems of Care Stroke and STEMI
Systems of Care Recommendations - SYSTEMS OF CARE FOR TIME SENSITIVE EMERGENCIES (michigan.gov)
Systems of Care White paper - A Statewide System (michigan.gov)
American Heart Association - Systems of Care for STEMI: AHA Policy Statement - American College of Cardiology (acc.org)
American Heart Association - Recommendations for the Establishment of Stroke Systems of Care: A 2019 Update | Stroke (ahajournals.org)

STEMI Certification/Accreditation Links:
American College of Cardiology (ACC) links:

Chest Pain Center - Chest Pain Center Accreditation

American Heart Association/TJC: Heart Attack Center (AHA/TJC) - Heart Attack Center Certifications | American Heart Association

Corazon, Inc - Accreditation

Stroke Certification Links:
The Joint Commission (TJC) - Stroke Certification | The Joint Commission
Accreditation Commission for Health Care (ACHC/HFAP) - Stroke Certification – ACHC (hfap.org)
Det Norske Veritas (DNV) - DNV Healthcare