Performance Improvement 2013-2014. What Facilitates or Obstructs Implementing Primary Stroke Center Policy and How does Policy Affect Rural Health Systems?


This study looked at the implementation of State policies aimed at the development of primary stroke centers. In 2004, the American Stroke Association developed the Stroke System of Care, a series of recommendations to improve treatment of stroke. One recommendation encouraged states to support legislated or regulated primary stroke center designation and, in some cases, revised EMS transport protocols. Methodology for this study included an analytical scan of a legislative database and relevant websites for policy activity in primary stroke center designation, as well as case study approach profiling four states' primary stroke center policy development and implementation.

The study identified several key components to successful policy adoption and implementation. They include: clarify legislation into regulations and rules; clarify roles and responsibilities of partners, state government and implementers including identifying a lead agency; ensure the availability of resources for implementation and oversight; establish and use advisory groups to ensure current science is reflected; coordinate elements in the overall system of stroke care; clarify implications for insurers, Medicare, and Medicaid; support stroke care in isolated and rural areas such as telemedicine; create policy feedback opportunities; and establish and maintain data for quality improvement. Barriers to policy implementation were also identified which include the lack of a state stroke system of care including disjointed emergency response and hospital communication; controversy around the use of Tissue Plasminogen Activator; financial and regulatory disincentives; and intrastate and interstate barriers to telemedicine.

Report Title: Primary Stroke Center Legislation and Implementation Study
Agency Sponsor: CDC, Centers for Disease Control and Prevention
Federal Contact: Thomas Chapel, 404-639-2116//SUSAN LADD?
Performer: University of Georgia School of International and Public Affairs
Record ID: 9871 (December 31, 2011)

View full report


"PerformanceImprovement2014.pdf" (pdf, 671.65Kb)

Note: Documents in PDF format require the Adobe Acrobat Reader®. If you experience problems with PDF documents, please download the latest version of the Reader®