Stroke Systems of Care: Policy Evidence Assessment Reports (PEAR)

Background

Stroke is a leading cause of death and serious disability in the United States.1 There are life-saving treatments for stroke, but patients must receive them in a timely manner.

State and regional stroke systems of care coordinate and promote timely patient access to the full range of activities and services associated with stroke prevention, treatment, and rehabilitation.2 Stroke systems of care improve patient care and support throughout their health care journey—from the first symptoms of stroke, EMS transport, and hospital care, to follow-up with outpatient providers.

Stroke pre-notification of receiving facility by emergency medical service (EMS) providers.

Stroke policy interventions with best evidence

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Emergency medical service (EMS) triage and transport to most appropriate stroke facility.

Stroke policy interventions with best evidence

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Air medical transport to most appropriate stroke facility.

Stroke policy interventions with best evidence

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Inter-facility transfer to most appropriate stroke facility.

Stroke policy interventions with best evidence

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Telestroke to initiate treatment on-site.

Stroke policy interventions with best evidence

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State-level continuous quality improvement (CQI) registry.

Stroke policy interventions with best evidence

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Nationally certified primary stroke centers (PSCs)

Stroke policy interventions with best evidence

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State standards for primary stroke centers (PSCs).

Stroke policy interventions with best evidence

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About the Reports

In May 2017, the Centers for Disease Control and Prevention (CDC) Division for Heart Disease and Stroke Prevention (DHDSP) assessed the best available evidence for seven different policy interventions to improve pre-hospital stroke care, addressed in state law. Pre-hospital stroke care includes all emergency medical care provided to the stroke patient prior to the handoff of the patient from EMS providers to staff at the acute care facility.

Between May and August 2018, DHDSP assessed the best available evidence for nine additional policy interventions to improve acute-care hospital and post-hospital stroke care. This includes all care provided to the stroke patient at an acute care facility by hospital staff and their consulting specialists before a patient is discharged, and all long-term, rehabilitative care received by the stroke patient after they have been discharged from the acute care facility.

The reports prioritize the stroke policy interventions by these evidence levels: best, promising quality, promising impact, or emerging.

  • State laws that address the policy interventions with best evidence are expected to have the greatest potential for a positive health impact and an associated economic impact. Examples of positive health outcomes include improved patient access to appropriate stroke treatment and improved neurological outcomes and mortality rates. Economic impacts may include such factors as shorter hospital stays, cost savings, and cost effectiveness.
  • Those with promising or emerging evidence could also have positive impacts, but the quantity and quality of the evidence for public health impact is limited at this time.

Each report provides evidence summaries for the stroke policy interventions included in the assessment, which include a full reference list and positive outcomes observed in intervention studies, as well the specific states in which these outcomes were found. These summaries are designed to help state decision makers and public health organizations determine which policy interventions may be useful in their state.

View a summary of policy interventions by evidence level or download the full reports to learn more about the methods used.

Using the Reports

Results of these policy evidence assessments offer decision makers real-world, evidence-informed options for supporting stroke systems of care.

  • State decision makers and public health organizations may consider presenting the reports, along with facts about stroke rates and existing stroke policies and programs, to state stroke task forces and collaboratives, state and local public health agencies, Emergency Medical Services directors, health care providers and payers, and others interested in improving stroke outcomes.
  • State and private sector decision makers may refer to the reports as they consider planning for a state stroke policy that addresses multiple evidence-informed policy interventions to improve stroke care.
  • State and local health agencies and their partners, state legislators, and task forces can use these reports to help drive stroke policy development.
  • Researchers may consider reviewing these reports for evidence gaps to be addressed in future studies.

Download the Reports

References

  1. Stroke Facts. 2017.
  2. Schwamm LH, Pancioli A, Acker JE, et al. Recommendations for the Establishment of Stroke Systems of Care. Recommendations From the American Stroke Association’s Task Force on the Development of Stroke SystemsExternal. 2005;36(3):690-703.

 

Disclaimer: The findings and conclusions of these reports are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention. Furthermore, these reports are not intended to promote any particular legislative, regulatory, or other action.