Office of Care Integration

The Office of Care Integration (OCI) follows COMAR regulations to designate hospital specialty centers. OCI provides on-site verification to programs to ensure they operate per their designation (e.g., Level 1, Level 2, Level 3) and have met the criteria necessary to maintain their designations. Designation and verification processes for trauma and specialty referral centers require continuing evaluation of designated centers for compliance with the regulations and standards set forth in COMAR 30.08 et seq., and ensure ongoing quality monitoring of Maryland’s trauma/specialty care system.

The Office of Care Integration staff manage and coordinate quality monitoring activities for the trauma/specialty care system. Key components of the ongoing monitoring activities are the trauma registry data analysis, monthly meetings with the Maryland Trauma and Specialty Care Quality Improvement Committee, and case-specific follow-up on consumer complaints.

Kenny Barajas
Chief, Office of Care Integration /
Designated Stroke Centers 
410-706-3930 |

Katie Hall
Director, Cardiac Intervention Centers
410-706-4740 |

Elizabeth Wooster
Director, Trauma & Injury Specialty Care Program
443-467-7361 |

Abby Butler
Director, Perinatal and Neonatal Referral Centers
443-531-3311 |

For more information:


The Maryland Trauma System

The Maryland trauma system is regionalized and tiered, ensuring prompt and appropriate care of trauma patients throughout Maryland. A complete list of facilities within the Maryland trauma system, including out-of-state hospitals that receive Maryland trauma patients, appears on page 32. MIEMSS is responsible for oversight of the Maryland trauma system, consisting of nine Maryland-designated adult trauma centers and five categories of specialty referrals, including two pediatric trauma centers, adult and pediatric burn, neurotrauma, eye, and hand/upper extremity facilities.
Trauma and Specialty Referral Centers Page

Adult trauma centers are designated at one of four levels of care (Primary Adult Resource Center, Level I, Level II, and Level III), which provides for the appropriate resources necessary to care for injured patients across the state. Memorandums of understanding are in place with three out-of-state hospitals (MedStar Washington Hospital Center, Children’s National Hospital, and ChristianaCare) to facilitate trauma services for injured patients requiring a higher level of care in outlying areas of the state.

Since 2015, all Maryland adult and pediatric trauma centers have been required to submit data to the National Trauma Data Bank (NTDB). This data is used to assist trauma centers with comparative data that allows each to benchmark their trauma center on a national scale. The Office of Care Integration (OCI) collaborates with each of the 14 trauma centers in Maryland and uses NTDB data to provide a statewide comparison that measures qualities between Maryland trauma centers and national trauma centers.

The Maryland Trauma Quality Improvement Committee (TQIC) is composed of trauma program managers and directors, trauma performance improvement staff, trauma registrars, and injury prevention and education staff. This group applies a trauma quality scorecard to review, monitor, and trend statewide compliance using metrics such as emergency department documentation of patients’ Glasgow Coma Scale, emergency department documentation of patients’ pain assessment, unplanned visits to the operating room, trauma bypass hours per month, and eight other criteria.

In FY 2023, in collaboration and support of ESO Solutions, Inc., trauma registries were successfully moved to the GEN6 Trauma Registry platform for Trauma, Eye Trauma, and Hand and Upper Extremity Trauma Registries. These registries link EMS documents to the patient’s Trauma Registry documentation. The Maryland Burn Collaborative meets to analyze and interpret “burn data submissions”, “standard audit indicators”, and “performance improvement”. A Maryland burn center scorecard is used to monitor and trend statewide compliance using quality indicators such as Burn Total Body Surface (TBSA) greater than 10% of patients admitted within six hours from the scene, Burn TBSA greater than 10% of patients admitted within six hours from interhospital transfer, and Deaths less than 10% TBSA, as well as four additional criteria.

Designated Stroke Centers

Maryland’s statewide regional system approach to stroke care continues to evolve with the publication of new research findings on stroke care. In FY 2023, the Stroke Quality Improvement Committee (Stroke QIC), consisting of Maryland hospitals’ stroke program coordinators and stroke program medical directors, focused on ongoing initiatives for improving stroke care in Maryland.

Following the promulgated and enacted revision and updates to the COMAR regulations for Primary Stroke Center (PSC) and Comprehensive Stroke Center (CSC) in FY 2022, two additional stroke center designations were promulgated and enacted for the improvement of the regional system of care approach. The two types of center designations are the Acute Stroke Ready Hospital Center (ASRHC) and the Thrombectomy-Capable Primary Stroke Center (TCPSC). All stroke centers maintain their designations for up to five years. In FY 2023, two PSCs achieved an initial designation as a TCPSC, and six PSCs designations were renewed. Currently, Maryland has designated 32 Primary Stroke Centers, three Comprehensive Stroke Centers, and four Thrombectomy-Capable Primary Stroke Centers.

Each stroke center submits data monthly to the American Heart Association’s (AHA) Get with the Guidelines® (GWTG) – Stroke registry. The Office of Care Integration (OCI) uses the registry data on a monthly basis to monitor compliance standards Core Measure CY 2017 CY 2018 CY 2019 CY 2020 CY 2022 Percent of ischemic stroke patients who arrive at the hospital within 2 hours of time last known well and for whom IV t-PA is initiated within 3 hours of time last known well 93.2% 93.3% 92.7% 91.8% 91.2% Percent of patients with ischemic stroke or TIA who receive antithrombotic therapy by the end of hospital day two 98.6% 98.2% 98.3% 97.7% 97.5% Percent of patients with an ischemic stroke, or hemorrhagic stroke, who receive VTE prophylaxis the day of or the day after hospital admission 98.2% 98.0% 97.5% 97.3% 97.6% Percent of patients with an ischemic stroke or TIA prescribed antithrombotic therapy at discharge 99.5% 99.6% 99.7% 99.4% 99.6% Percent of patients with an ischemic stroke or TIA with atrial fibrillation/flutter discharged on anticoagulation therapy 98.2% 97.7% 98.9% 97.8% 98.5% Percent of patients with ischemic or hemorrhagic stroke, or TIA with a history of smoking cigarettes, who are, or whose caregivers are, given smoking cessation advice or counseling during hospital stay 99.0% 99.0% 99.1% 98.6% 99.1% Percent of ischemic stroke or TIA patients with a cholesterol LDL level=100, or LDL not measured, or on cholesterol-reducer prior to admission who are discharged on statin medication 98.5% 99.1% 99.0% 99.0% 99.3% Percent of stroke patients who undergo screening for dysphagia (difficulty swallowing) with an evidence-based bedside testing protocol approved by the hospital before being given any food, fluids, or medication by mouth 89.1% 89.0% 91.0% 89.8% 90.0% Percent of patients with stroke or TIA, or their caregivers, who were given education and/or educational materials during the hospital stay addressing all of the following: personal risk factors for stroke, warning signs for stroke, activation of emergency medical system, the need for follow-up after discharge, and medications prescribed 97.5% 96.9% 96.7% 96.8% 96.4% Percent of patients with stroke who were assessed for rehabilitation services 99.3% 99.1% 99.5% 99.4% 99.6% Source: Get With the Guidelines-Stroke Registry IV t-PA = Intravenous Tissue Plasminogen Activator VTE = Venous Thromboembolism LDL = Low Density Lipoprotein (bad cholesterol) TIA = Transient Ischemic Attack Stroke Core Measures (5-Year Comparison) 15 established by the AHA and American Stroke Association (ASA) (see above). Using core performance measures for standards of care, OCI evaluates the data to benchmark Maryland’s compliance rate and compares the results to national compliance measures. Compliance to the AHA and ASA standards has improved patient outcomes. The annual state aggregate data for CY 2022 revealed Maryland had a compliance rate of 92% or greater for each of the core performance measures, significantly higher than the AHA/ASA minimal compliance rate of 80%.

Maryland stroke centers use GWTG data to support changes to their stroke alert protocols, improve their response times, and to share best practices and processes. In FY 2023, stroke centers used GWTG data to improve door-to Intravenous tissue Plasminogen Activator (IV t-PA) times. It has been well-established that improved patient outcomes are documented when patients are treated sooner with the clot-busting fibrinolytic t-PA. The minimum compliance standard determined by the AHA/ASA Target Stroke Program stipulates that 75% of stroke patients eligible for t-PA should receive t-PA within 60 minutes of arrival at the hospital “door”. For CY 2022, Maryland’s median door-to-PA time was 45 minutes. Additionally, 83.7% of all acute ischemic stroke patients eligible to receive t-PA had a door-to-t-PA time that met the standard of 60 minutes or less.
Designated Stroke Centers Page

Perinatal and Neonatal Programs

The Maryland perinatal and neonatal systems are modeled after American College of Obstetrics and Gynecologists (ACOG) and the American Academy of Pediatrics (AAP) standards of care. These standards range from Level I (basic perinatal and neonatal care) to Level IV (high-risk perinatal and neonatal care). MIEMSS is responsible for oversight of the Level III and IV Maryland perinatal and neonatal referral centers, which include 15 hospitals offering obstetric services. Of these 15 hospitals, 13 are Level III perinatal and neonatal centers, and two are Level IV centers. 
Perinatal and Neonatal Page

Hospitals participating in the Maryland perinatal system submit patient care data to the Maryland Department of Health (MDH) and MIEMSS, as appropriate, for system and quality management. All Level III and IV perinatal referral centers submit an annual perinatal indicator report that provides statistics beyond mortality data and focuses on striving for clinical excellence, patient safety, and reliability. Perinatal centers strive to reach a goal of zero adverse outcomes when the cases are preventable. Perinatal and neonatal programs use both regional and national data to provide database elements and indicators including variables related to maternal and infant health. The MIEMSS Perinatal Advisory Committee uses this database to identify areas for improvement and best practices.

MIEMSS Perinatal Programs work to reduce the number of maternal morbidity and mortality rates in Maryland. Maryland is currently ranked 25th in the U.S. for adverse perinatal outcomes. In response to the data and our goal of reducing the number of preventable deaths in Maryland, Perinatal Programs has developed EMS specific education around culturally responsive care for Maryland’s diverse maternal population. Fifty percent of preventable maternal deaths occur post-delivery and after leaving the hospital. EMS clinicians, who become primary care providers to this population, have the potential to have the greatest impact in combating the barriers to attaining effective and life-saving care.

Maryland STEMI System

Hospitals that comply with state standards for receiving patients experiencing the most common type of heart attack, ST-Elevation Myocardial Infarction (STEMI), are designated as Cardiac Intervention Centers (CIC). MIEMSS has designated 28 hospitals in Maryland and four out-of-state hospitals that serve Maryland patients as CICs. Primary percutaneous coronary intervention (pPCI), recognized by the American College of Cardiology and the American Heart Association (AHA) as the treatment of choice, is generally associated with fewer complications and better outcomes than other forms of treatment. Sooner treatment to relieve the blockage causing the STEMI increases the likelihood that the patient’s heart muscle will recover. All CICs submit data quarterly to AHA’s Get with the Guidelines® (GWTG) – Coronary Artery Disease (CAD) registry. MIEMSS measures care for STEMI patients in Maryland and compares that data to national data from participating hospitals. The goal for First Medical Contact (FMC) intervention using the cardiac catheterization lab (“device”) is 90 minutes or less. Registry data indicated that, for the rolling four quarters of CY 2022, Maryland’s FMC-to-device in less than 90 minutes was achieved in 72.9% of STEMI patients transported by EMS, with a median time of 85 minutes.
Designated Cardiac Intervention Centers page

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