Abstract 19: Assessing The Impact Of Stroke Systems Of Care Policies On Stroke-related Outcomes

Abstract

Introduction: Stroke systems of care (SSOC) laws have been adopted across the US as early as 2002 to improve access to time- sensitive, life-saving treatments and care for stroke patients. However, the impact of these laws on stroke care delivery and patient outcomes remains largely unknown. The study goal was to determine whether the policy interventions are associated with improved stroke outcomes by examining SSOC laws implemented by states. Methods: We developed a policy surveillance dataset of the 50 states and D.C. SSOC laws in effect at any time from 2002-2018. A stakeholder group of federal, state, and local SSOC experts informed the study. Based on an evidence-informed conceptual model, the study linked the policy surveillance dataset with three state-level outcomes: 1) age-adjusted overall stroke mortality rates; 2) percentage of hospitals certified as primary stroke centers (PSC); and 3) percentage of patients who received brain scan results within 45 minutes of arrival at a stroke center. To estimate policy effectiveness, we used Bayesian Additive Regression Trees to predict outcomes as if no policies were in effect and compared them to the actual observed outcomes in each state that put at least one policy into effect. For each modeled outcome, we controlled for state-level contextual factors such as stroke prevalence, percent rural population, non-white population, density of hospital closure, Paul Coverdell National Acute Stroke Program participation, and Medicaid expansion status. Results: Results identified 38 states with at least one SSOC law in effect during the study period. Of these states, 11 states had lower and 3 had higher overall stroke mortality rates than predicted; 9 states had a higher and 4 had a lower proportion of PSCs than predicted; and 12 states had higher and 2 had lower brain scan rates within 45 minutes than predicted. Conclusion: Having one or more SSOC laws in effect is associated with improved stroke outcomes. This information can inform national chronic disease organizations and state decisionmaker efforts to improve SSOC at state and regional levels.