A Study of primary stroke center policy : recommendations for policy implementation
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A Study of primary stroke center policy : recommendations for policy implementation

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      Stroke is the fourth leading cause of death in the United States. The development of new treatment strategies for stroke has improved the care of hospitalized stroke patients receiving the recommended treatment in the critical early hours following symptom onset. Yet there is still room for improvement. Some states have responded by adopting a certification process and criteria for primary stroke cen-

      ters (PSCs) as part of improving the state’s stroke system of care. A stroke system of care is one that coordinates patient access to a full range of coordinated services necessary for all aspects of stroke management, including prevention, notification and response of emergency medical service (EMS), acute treatment in the hospital emergency department, and rehabilitation.1 PSC hospitals have the infrastructure and organizational elements, including staff, equipment, and protocols, to treat stroke patients quickly and efficiently.2, 3 However, wide variation exists among and within states on procedures for PSC certification and designation, regulatory authority and responsibility, available resources, and quality improvement and assurance initiatives. Some states accept The Joint Commission PSC certifica- tion; others have their own certification process based on American Heart Association/American Stroke Association (AHA/ASA) and Brain Attack Coalition guidelines. Additionally, some states have built levels of certification into their PSC policies.

      A collaborative project by the Centers for Disease Control and Prevention’s Division for Heart Disease and Stroke Prevention, the National Association of Chronic Disease Directors, and the University of Georgia Department of Public Administration and Policy looked at the implementation of PSC policies.4 The project focused on four early adopter states—Florida, Massachusetts, New Mexico, and New York—with varying experience in PSC policy implementation. The project team reviewed a variety of public docu- ments and reports, visited each state, and observed a large meeting of stakeholders or providers in each of the case study states. The project team spoke with a wide range of stakeholders on a broad range of topics relating to acute stroke care. Stakeholders included academics, public health advocates, AHA/ASA representatives, emergency department physicians and nurses, EMS staff and administrators, hospital administrators, insurance payers, neurologists and other medical specialists, hospital stroke coordinators, state health department managers and regulatory representatives, and stroke survivors. Interviewees spoke specifically about their professional interaction in the PSC system of care.

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