Abstract WP321: Enhancing Stroke Systems of Care in the United States through Evidence-Informed State Policy Interventions

Abstract

In the United States (US), a stroke occurs every 40 seconds. Stroke care policies vary across federal, state, and local levels. Differences in health outcomes could be addressed through adoption of evidence-informed stroke policies. We examined early evidence to identify state policy interventions that may improve quality of stroke care. The US Centers for Disease Control and Prevention (CDC) examined the evidence base for stroke systems of care policy interventions enacted by the US state governments. We assessed 16 policy interventions impacting the entire continuum of stroke care, including those in the pre-, in-, and post-hospital settings. An expert group representing CDC, state stroke programs, and the American Heart Association informed the assessment. Over 460 items were assessed using the Quality and Impact of Component Evidence Assessment methodology for effectiveness, equity, reach, efficiency, and transferability. Each policy intervention’s evidence base was assigned to one of four levels: “best,” “promising potential public health impact,” “promising quality,” or “emerging.” Of the policy interventions assessed thus far, eight had “best” evidence, one had “promising potential public health impact” evidence, one had “promising quality” evidence, and six had “emerging” evidence (see Table). State laws addressing policy interventions with “best” evidence, such as pre-notification of receiving facilities by emergency medical service providers or telestroke to initiate treatment on-site, are expected to have the greatest potential for positive impact. A greater focus on policy evaluation research could help policymakers understand their options for implementing and scaling up stroke policies with emerging and promising evidence bases in their state. States may improve population health and economic outcomes by strengthening health care delivery using policy interventions with “best” available evidence.