# Presentation: 284663

## Stroke Systems of Care Legislation in North Carolina

- Anita Holmes, J.D. M.P.H.
- Executive Director
- Justus-Warren Heart Disease and Stroke Prevention Task Force
- Head, HDSP Branch, NC DHHS-DPH

## Slide 2

## 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 2007
- 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, 2007

## 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 committees

## Original 2005 NC Stroke Systems of Care Bill

- Part of NC ASA’s 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 mandate)

## 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
- AHA/ASA
- 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 Operations
- 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 centers

## Requested Appropriations

- NC Collaborative Stroke Registry support - $400,000
- Stroke awareness campaign - $300,000
- Professional education, with AHEC, OEMS - $150,000
- 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 TF’s 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

## Results

- $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 Paper
- 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 don’t 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

## Slide 26

## 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
- anita.holmes@ncmail.net
- (919) 707-5361
- www.startwithyourheart.com