2015 -- S 0618 SUBSTITUTE A

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     STATE OF RHODE ISLAND

IN GENERAL ASSEMBLY

JANUARY SESSION, A.D. 2015

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A N   A C T

RELATING TO HEALTH AND SAFETY - STROKE PREVENTION AND TREATMENT

ACT OF 2009

     Introduced By: Senators Doyle, Goodwin, Ottiano, Nesselbush, and Crowley

     Date Introduced: March 05, 2015

     Referred To: Senate Health & Human Services

     It is enacted by the General Assembly as follows:

     SECTION 1. Sections 23-78.1-3, 23-78.1-4, 23-78.1-5 and 23-78.1-6 of the General

Laws in Chapter 23-78.1 entitled "Stroke Prevention and Treatment Act of 2009" are hereby

amended to read as follows:

     23-78.1-3. Designation of Rhode Island primary stroke centers. -- Designation of

Rhode Island comprehensive and primary stroke centers. -- (a) The director of the department

of health shall establish a process to recognize comprehensive and primary stroke centers in

Rhode Island. The joint commission on accreditation of health care organizations and the

American Heart Association/American Stroke Association have collaborated on the development

of certification programs for comprehensive and primary stroke centers that follow the best

practices for stroke care. A hospital shall be designated as a "Rhode Island comprehensive stroke

center" or a "Rhode Island primary stroke center" if it has received a certificate of distinction for

comprehensive or primary stroke centers issued by the joint commission on accreditation of

healthcare organizations (the joint commission); or other nationally recognized certification body,

if a formal process is developed in the future;

      (b) The department of health shall recognize as many hospitals as Rhode Island

comprehensive or primary stroke centers as apply and are awarded certification by the joint

commission (or other nationally recognized certification body, if a formal process is developed in

the future);

      (c) The director of the department of health may suspend or revoke a hospital's state

designation as a Rhode Island comprehensive or primary stroke center, after notice and hearing, if

the department of health determines that the hospital is not in compliance with the requirements

of this chapter.

     23-78.1-4. Acute care hospitals. -- (a) All acute care hospitals shall maintain readiness

to treat stroke patients. This shall include:

      (1) Adherence with American Heart Association/American Stroke Association

guidelines;

      (2) Establishment of written care protocols for the treatment of ischemic and

hemorrhagic stroke patients, including transfer of acute stroke patients to a comprehensive or

primary stroke center as appropriate and medically indicated;

      (3) Participation in Get With The Guidelines/Stroke or other nationally recognized data

set platform to collect nationally recognized stroke measures, and ensure continuous quality

improvement;, and facilitate the transmission of data to the statewide stroke database/registry as

outlined in § 23-78.1-6;

      (4) Participation in the Rhode Island Stroke Task Force and the Stroke Coordinators

Network to provide oversight for the stroke system of care and to share best practices.

     23-78.1-5. Emergency medical services providers; triage and transportation of

stroke patients. -- (a) The department of health, division of EMS and the ambulance service

advisory board shall adopt and distribute a nationally recognized standardized assessment took

tool for stroke. The division of EMS shall post this stroke assessment tool on its website and

provide a copy of the assessment tool to each licensed emergency medical services provider no

later than January 1, 2010. Each licensed emergency medical services provider must use the

stroke-triage assessment tool provided by the department of health, division of EMS;

      (b) The department of health, division of EMS and the ambulance service advisory board

shall establish pre-hospital care protocols related to the assessment, treatment, and transport of

stroke patients by licensed emergency medical services providers in this state. Such protocols

may include plans for the triage and transport of acute stroke patients to the closest

comprehensive or primary stroke center as appropriate and within a specified timeframe of onset

of symptoms;. The stroke pre-hospital care protocols shall be reviewed on an annual basis;

      (c) By June 1 of each year, the department of health, division of emergency medical

services (EMS), shall send the list of comprehensive and primary stroke centers to each licensed

emergency medical services agency in this state and shall post a list of comprehensive and

primary stroke centers on the division of EMS website. For the purposes of this chapter, the

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division of EMS may include comprehensive and primary stroke centers in Massachusetts and

Connecticut that are certified by the joint commission, or are otherwise designated by that state's

department of public health as meeting the criteria for comprehensive or primary stroke centers as

established by the brain attack coalition;

      (d) Each emergency medical services provider must comply with all sections of this

chapter by June 1, 2010.

     23-78.1-6. Continuous improvement of quality of care for individuals with stroke. --

(a) The department of health shall establish and implement a plan for achieving continuous

quality improvement in the quality of care provided under the statewide system for stroke

response and treatment. In implementing this plan, the department of health shall undertake the

following activities:

      (1) Develop incentives and provide assistance for sharing information and data among

health care providers on ways to improve the quality of care;

      (2) Facilitate the communication and analysis of health information and data among the

health care professionals providing care for individuals with stroke;

      (3) Require the application of evidence-based treatment guidelines regarding the

transitioning of patients to community-based follow-up care in hospital outpatient, physician

office and ambulatory clinic settings for ongoing care after hospital discharge following acute

treatment for a stroke;

      (4) Require comprehensive and primary stroke center hospitals and emergency medical

services agencies to report data consistent with nationally recognized guidelines on the treatment

of individuals with confirmed stroke within the statewide system for stroke response and

treatment;

      (5) Analyze data generated by the statewide system on stroke response and treatment;

and

      (6) The department of health shall maintain a statewide stroke database that compiles

information and statistics on stroke care that align with the stroke consensus metrics developed

and approved by the American Heart Association/American Stroke Association, Centers for

Disease Control and Prevention and The Joint Commission. The department of health shall utilize

Get With The Guidelines Stroke as the stroke registry data platform or another nationally

recognized data set platform with confidentiality standards no less secure. To every extent

possible, the department of health shall coordinate with national voluntary health organizations

involved in stroke quality improvement to avoid duplication and redundancy. The department of

health shall establish reporting requirements and specifications to ensure the uniformity and

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integrity of data submitted to the statewide database/registry.

      (b) Except to the extent necessary to address continuity of care issues, health care

information shall not be provided in a format that contains individually-identifiable information

about a patient. The sharing of health care information containing individually-identifiable

information about patients shall be limited to that information necessary to address continuity of

care issues, and shall otherwise be released in accordance with chapter 37.3 of title 5 and subject

to the confidentiality provisions required by that chapter and by other relevant state and federal

law.

      (c) Annual reports. - On June 1 after enactment of this chapter and annually thereafter,

the department of health and the Rhode Island stroke task force shall report to the general

assembly on statewide progress toward improving quality of care and patient outcomes under the

statewide system for stroke response and treatment.

     SECTION 2. This act shall take effect upon passage.

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EXPLANATION

BY THE LEGISLATIVE COUNCIL

OF

A N   A C T

RELATING TO HEALTH AND SAFETY - STROKE PREVENTION AND TREATMENT

ACT OF 2009

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     This act would set standards for recognition of comprehensive stroke care centers.

     This act would take effect upon passage.

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