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Stroke Systems of Care Legislation in North Carolina


Senate Appropriations Committee on HHS. Fiscal Research Division ... Health Appropriations Committee hearings attended, addressed by SAC members ... – PowerPoint PPT presentation

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Title: Stroke Systems of Care Legislation in North Carolina

Stroke Systems of Care Legislation in North
  • Anita Holmes, J.D. M.P.H.
  • Executive Director
  • Justus-Warren Heart Disease and Stroke Prevention
    Task Force
  • Head, HDSP Branch, NC DHHS-DPH

(No Transcript)
The Justus-Warren Heart Disease and Stroke
Prevention Task Force
  • Established by NC General Assembly in August 1995
  • First action step in a preliminary Health
    Department plan to prevent CVD
  • Supported by 25 key partner organizations,
    especially AHA
  • 100,000 appropriated
  • Two positions established and placed in Division
    of Public Health, NC-DHHS

Three TF Charges.
  • Develop a profile of the burden of CVD in NC -
    documents published 1997 2006, update on web in
  • Publicize that burden and its preventability -
    two campaigns on-going since 1997
  • Develop a comprehensive statewide plan to prevent
    CVD - published 1999, updated for 2005-2010

Task Force Structure and Organization
  • Four standing Committees
  • Prevention
  • Management (risk factors and diseases)
  • Public Awareness
  • Legislative
  • New in August, 2006 - Task Force directed by
    General Assembly to establish a Stroke Advisory
    Council - report recommendations by February 15,

Task Force Membership
  • 27 Members appointed by General Assembly as
    recommended by
  • 1/3 - Speaker of the House
  • 1/3 - President Pro Tempore of Senate
  • 1/3 - Governor
  • Includes
  • 6 legislators
  • Representatives of partner organizations and
    stakeholder groups
  • Supported by staff and resource persons to

Original 2005 NC Stroke Systems of Care Bill
  • Part of NC ASAs work to implement
    recommendations of February 2005 White Paper -
    Recommendations for the Establishment of Stroke
    Systems of Care
  • ASA Task Force member and lead author Dr. Larry
    Goldstein, Director of Stroke Center at Duke,
    developed bill with NC AHA Senior VP for Advocacy

Introduced in April, 2005
  • Press conference to announce bill
  • Immediate concerns from HDSP Task Force members
    and others (E.g.,
  • Task Force involvement
  • Call for every hospital to have a plan for stroke
    patients seen as burdensome and an unfunded

Support Opposition
  • Supporters included
  • Many stroke stakeholders
  • AHA/ASA staff, lobbyist, volunteers
  • Two key legislative leaders recruited by Dr.
    Goldstein and bill sponsor at February 2005
    Legislative Heart Health Day
  • Opponents

Origination of Stroke Advisory Council
  • Original bill stuck in Health Committees April
    2005-August 2006
  • TF Chair, Sen. Bill Purcell, MD, also chair of
    Senate Appropriations Comm. for HHS
  • TF meeting Feb. 2006 included presentations on
    stroke issues from all key groups
  • Discussion, no resolution or action proposed
  • At end of 2006 Short Session, only agreement was
    to refer issues to Task Force

August 2006 - House Bill 1860
  • Directed TF to establish and maintain Stroke
    Advisory Council regarding development of
    statewide system of stroke care
  • Specified members to include
  • 4 physicians - representing NCMS, Old North State
    Medical Society, NC College of Emergency
    Physicians and a stroke specialist

SAC Members, continued
  • Representatives of
  • NC Hospital Association
  • NC Association of Rescue and EMS
  • Area Health Education Centers
  • Other relevant experts TF deemed beneficial to
    achieve goals of SAC
  • (Total number of Council members 17)

House Bill 1860, continued
  • Not later than February 15, 2007, Task Force to
    report findings and recommendations to
  • Joint Legislative Commission on Government
  • House Appropriations Subcommittee on HHS
  • Senate Appropriations Committee on HHS
  • Fiscal Research Division
  • (Bill language proscribed spending any existing
    funds on travel, meetings, etc.)

Operational Highlights
  • HDSP Staff solicited nominations, developed web
    page for communications
  • August 30, 2006 Task Force Operational Management
    Group approved
  • List of appointed members including chair - Karen
    McCall, Stroke Survivor on TF
  • Date, place for first meeting - September 22,
    2006 at NC Hospital Association
  • Lunch courtesy of AHA

First Meeting goals
  • Agree on process for working together - strive
    for consensus
  • Review and discuss charge to SAC
  • Given time and resource limitations and
    prescribed membership, initial focus to be on
    acute care issues
  • Hear presentations on history of the legislation
    and some current efforts to improve stroke care
  • Agree on next steps

Subsequent SAC meetings
  • October 23 - Adopted charge, heard presentations
    on the developing regional eastern NC Stroke
    Network and on NC EMS
  • November 20 - presentations re status of Stroke
    Systems in NC, NC GIS Stroke maps, began
    discussion of recommendations
  • December 11 - Discussion and Adoption of
    recommendations to be brought to TF for review
    and approval on January 17, 2007

Stroke Advisory Council Recommendations
  • JW HDSP TF will work with providers across state
    to establish system of regionally distributed and
    locally determined stroke care networks
  • SAC to continue deliberations in 2008 to develop
    comprehensive plan, including identifying and
    disseminating information re primary stroke

Requested Appropriations
  • NC Collaborative Stroke Registry support -
  • Stroke awareness campaign - 300,000
  • Professional education, with AHEC, OEMS -
  • Follow-up hospital survey, with AHA - 10,000
  • Continue SAC Operations - 50,000

Legislative Process
  • Report and recommendations approved by Task Force
    January 17, 2007
  • Presented to GA February 14, 2007 at TFs sixth
    Legislative Heart Health Day
  • Special meeting of Eastern Delegation convened by
    TF Vice Chair
  • Health Appropriations Committee hearings
    attended, addressed by SAC members
  • Op Ed piece in Raleigh paper by SAC Chair
  • Lobbying support from AHA, NCHA, NCMS

Legislative Heart Health Day
Legislative Heart Health Day
  • 900,000 appropriated to the HDSP Branch of NC
    DPH as follows
  • 390,000 recurring for NCCSR
  • 150,000 recurring for professional education
  • 300,000 non-recurring for stroke awareness
  • 50,000 non-recurring to continue SAC operations
  • 10,000 non-recurring for hospital survey
  • (Key message for legislators was the fact that
    the total amount requested was less than NC
    spends each day to treat acute strokes)

Expected Outcomes
  • State support boosts ongoing CDC-funded efforts
    to develop regional stroke networks in
    partnership with ASA
  • NCCSR funding helps retain participating
    hospitals and recruit new ones into Registry (51
    hospital sites in FY 2007)
  • Professional education is provided along stroke
    care continuum working with NCCSR, AHEC, OEMS

Expected Outcomes, cont.
  • 2008 signs and symptoms awareness campaign built
    on earlier efforts, delivered to high stroke, low
    resource markets
  • SAC completes Comprehensive Plan to address all
    components listed in White Paper
  • Plan includes Progress Markers from new ASA White
  • Hospital survey and gap analysis completed,
    results disseminated

Lessons learned
  • It is important to involve key stakeholders
    (including likely opponents) before introducing
    any bill
  • You can get a lot more accomplished if you dont
    care who gets the credit - but credit should
    always be given to legislators and funders
  • Timing and opportunity are critical - legislature
    directed TF to provide recommendations
  • TF had the advantage of a 12 year history of
    working with the legislature to develop
    relationships of credibility and trust

(No Transcript)
HDSP Funding
  • Total Funding FY 07-08 3,452,057
  • NC 2006 Population 8,860,341
  • Per Capita HDSP Funding 0.39

Contact Information
  • Anita Holmes
  • (919) 707-5361