At a glance
State laws with “emerging” evidence could have positive impacts, but the quantity and quality of the evidence for public health impact is limited at this time.
Pre-hospital
Includes all emergency medical care provided to the stroke patient prior to the handoff of the patient from Emergency Medical Services (EMS) providers to staff at the acute care facility.
Continuing Education on Stroke for EMS Providers
While most EMS providers will receive some education on stroke in their initial certification or licensure programs, states could encourage ongoing education for EMS providers about the signs and symptoms of stroke and training on stroke protocol.
State law example: The Illinois State Stroke Advisory Subcommittee is required to develop and disseminate to all EMS systems “an evidence-based statewide stroke assessment tool to clinically evaluate potential stroke patients.” With the State EMS Advisory Council, the Subcommittee is also required to “select or develop the educational curriculum for instructing EMS System personnel on the use of the tool.” In addition, each EMS Regional Stroke Advisory Subcommittee must make recommendations to the Region’s EMS Medical Directors Committee for pre-hospital personnel continuing education requirements.
Continuous Quality Improvement (CQI) of EMSS for Stroke
Pilot and grant-funded quality improvement collaboratives have improved the quality of EMS and pre-hospital care in stroke systems. CQI interventions would involve ongoing assessments of the functions performed by all participants in the pre-hospital stroke system that affect the health outcomes of stroke patients.
State law example: The Rhode Island Department of Health must establish and implement a stroke care CQI plan and require stroke centers and EMS agencies to report data for use in a statewide stroke database—built on a nationally recognized platform, such as Get With The Guidelines/Stroke.
In-hospital/post-hospital
Includes the treatment of an acute stroke patient at the appropriate stroke hospital(s) and all the long-term, rehabilitative care received by the patient after discharge from the hospital.
Nationally Recognized Stroke Rehabilitation Facilities
National standards and certification for stroke rehabilitation facilities could assure quality and a commitment to continuous improvement of post-hospital stroke care and services.
State law example: A Florida regulation requires CFCs to ensure that patients meeting acute care rehabilitation admission criteria are transferred to an acute rehabilitation facility accredited by the Commission on Accreditation of Rehabilitation Facilities (CARF) or The Joint Commission (JC).
State Standards for Acute Stroke Ready Hospitals (ASRH)
A state can designate a facility as an ASRH or the equivalent when the facility meets specific standards set by the state.
State law example: In 2016, Georgia required the establishment of at least three levels of stroke centers to serve acute stroke patients. The three levels of stroke centers include CSCs for complex specialized care, PSCs, and remote treatment stroke centers (RTSC) for rural and underserved areas.