The History of the MOSAIC Program

Michigan Acute Stroke Overview & Treatment Surveillance logo


MiSRQIP was in operation between 2007 and 2012


Michigan stroke surveillance work has been using MOSAIC since 2012


Michigan's current work in improving the quality of care for stroke patients started at the turn of this century with a national program.

In 2000, in recognition of the growing need to assess and improve the acute care given to stroke patients, the U.S. Congress earmarked funding to establish prototype, state-based registries to measure and track such care.

Paul Coverdell National Acute Stroke Program logoIn 2001, Congress asked the Centers for Disease Control and Prevention (CDC) to implement the project and determine how best to use the resulting data to improve the quality of care. Congress named the new project the Paul Coverdell National Acute Stroke Registry (PCNASR) in honor of the late U.S. Senator Paul Coverdell of Georgia, who had suffered a fatal stroke in 2000 while serving in Congress.

During the initial three-year PCNASR funding period (2001-2004), eight prototype registries won competitive grant funding to establish and test models to measure the quality of acute stroke care. Michigan's program - the Michigan Acute Stroke Care Overview and Treatment Surveillance System (MASCOTS) - was one of the first projects to receive PCNASR funding.1

In 2007, the Michigan Department of Community Health (MDCH), along with its agency counterparts in five other states, was awarded a new, five-year (2007-2012) PCNASR implementation grant. MDCH, in partnership with the American Heart and Stroke Association and other partners,2 used the new funding to launch the Michigan Stroke Registry and Quality Improvement Program (MiSRQIP).

Thirty-six hospitals signed on to MiSRQIP and began using the American Heart Association's Get with the Guidelines-Stroke Patient Management Tool to track and report their delivery of acute stroke care. Together, MiSRQIP and the participating hospitals focused on improving a total of 10 stated measures of quality for stroke care. Their efforts were successful. By the end of the project, the hospitals were able to show statistically significant improvements in seven of the 10 targeted quality care measures.

In 2012, the CDC awarded MDCH an additional three years of funding (2012-2015) to continue its work to improve the quality of stroke care. The result was the establishment of Michigan's Ongoing Stroke Registry to Accelerate the Improvement of Care (MOSAIC), which extended Michigan's previous efforts into a pilot project to assess and improve stroke-related, post-hospital discharge practices in five Michigan hospitals.

Current Work

In 2015, MDCH (now the Michigan Department of Health and Human Services, or MDHHS) received notice that it had won a fourth round of competitive PCNASR funding (July 1, 2015 - June 30, 2020) for MOSAIC.

With the current grant funding, MOSAIC and its partners are continuing their focus on improving the work of the hospital-based registry and the post-hospital discharge pilot program, as well as expanding their efforts to develop a coordinated system of care that can help ensure delivery of appropriate, effective treatment for stroke patients.

To that end, MOSAIC has established the necessary relationships to access and build the capacity to link current silos of stroke care data together, creating an improved, integrated statewide comprehensive system of care for stroke patients.

In addition, MOSAIC and its partners are working to assess and improve emergency medical services (EMS) pre‐hospital care for stroke and to establish and build concerted quality improvement efforts between EMS and hospitals. They also are expanding their work into the transition period that exists between the patient's discharge from the hospital and his/her return home with the goal of identifying services needed in that post‐discharge period and improving access to them.

Long-Term Goal

In future projects, MOSAIC and its partners will coordinate with other heart disease and stroke programs to assess and improve community awareness regarding the signs and symptoms of stroke and the importance of calling 9‐1‐1, and assess and improve access to services for patients with common stroke risk factors, such as hypertension and/or high cholesterol. They also will work to reduce disparities in stroke care and the overall burden of stroke on individuals, families, communities, and businesses.

Stroke systems of care include pre-event, event, and post-event components. The focus of the MOSAIC grant for 2015-2020 includes the following components: stroke systems of care, community awareness, EMS, QI, transition of care post-discharge, and statewide stroke system of care.

Learn More

For more information, contact MOSAIC Program Coordinator and Registry Manager Adrienne Nickles, MPH at 517-335-9649 (e-mail:



1 "Wave I" projects, funded in 2001, included pilots in Michigan, Georgia, Massachusetts, and Ohio. "Wave II" pilot projects, funded in 2002, were located in California, Illinois, North Carolina, and Oregon.

2 MDCH partners included the American Heart Association / American Stroke Association; the Michigan Stroke Initiative; the Great Lakes Regional Stroke Network; the Michigan Public Health Institute; the Department of Epidemiology at the University of Michigan School of Public Health; and the Department of Epidemiology at the Michigan State University College of Human Medicine.