BILL ANALYSIS Ó
AB 861
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Date of Hearing: April 6, 2011
ASSEMBLY COMMITTEE ON APPROPRIATIONS
Felipe Fuentes, Chair
AB 861 (Hill and Nestande) - As Introduced: February 17, 2011
Policy Committee: HealthVote:16-0
Urgency: No State Mandated Local Program:
No Reimbursable: No
SUMMARY
This bill establishes the California Stroke Registry within the
Department of Public Health (DPH) to serve as a centralized
repository for stroke data to promote quality improvement for
acute stroke treatment. It also states that the program will
only be implemented to the extent funds from federal or private
sources are made available for this purpose. Specifically, this
bill:
1) Requires DPH to create the registry, and specifies
operating details including: where the program is housed,
which national organizations must inform the effort, and
that DPH may contract out the registry function.
2) Assigns responsibility to the director of DPH to carry
out various activities related to maintenance of the
registry, outreach, communication with stakeholders, and
improvement in the quality of stroke care.
3) Provides for access to stroke registry data for
scientific and epidemiological purposes, and specifies how
confidential data is to be protected.
4) Prohibits the provisions of the bill from being
construed as a medical practice guideline, and specifies
that it does not preempt the authority of facilities to
maintain their own stroke registries.
FISCAL EFFECT
One-time start-up costs, likely in the range of $200,000 to
$400,000, and ongoing costs of around $800,000 annually to fund
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stroke registry operations. Although a federal grant program
exists to fund state stroke registries, only six states have
received funding through this program. If federal or private
funds are not identified, the establishment in statute of an
unfunded program would result in cost pressure to the General
Fund.
COMMENTS
1)Rationale. According to the author, a voluntary stroke
registry was established at DPH in 2007 and approximately 42
hospitals across the state have participated. The author
maintains that codifying the voluntary registry will likely
lead to a much greater rate of participation and that
increasing the amount of information that can be collected on
strokes, the types of treatment victims receive, and the
impacts of those treatments will provide medical professionals
with a roadmap to improved care. Additionally, the author
maintains that establishment of a stroke registry in statute
will improve the potential for California to receive and
accept federal grants through the Center for Disease Control
(CDC). According to the author, a new round of CDC funding is
forthcoming but absent a stroke registry in statute,
California will be ineligible to receive those federal funds.
2)Stroke is a Significant Population Health Problem, But Stroke
Care Needs Improvement . According to the CDC, a stroke, or
"brain attack," occurs when the blood supply to part of the
brain is blocked or when a blood vessel in the brain bursts.
In either case, parts of the brain become damaged or die when
blood circulation to brain cells fails. A significant
percentage of stroke victims are permanently disabled by the
stroke incident. DPH reports that approximately 20,000
Californians die of stroke annually, and stroke accounts for
approximately 200,000 hospital discharges per year. CDC notes
that while evidence-based medical guidelines for stroke care
have been developed, as well as new and improved diagnostic
and treatment tools, many hospitals still do not have the
organization, staff, and equipment to effectively diagnose and
treat acute stroke patients.
3)Paul Coverdell National Acute Stroke Registry . In 2001,
Congress charged CDC with implementing state-based registries
to track acute stroke care and to use data from the registries
to improve the quality of care. The purpose of a stroke
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registry is to develop and implement systems for collecting
data on acute stroke care provided to patients, analyze the
collected data, and use the results of those analyses to guide
quality improvement interventions at the hospital level
through partnerships with hospitals, doctors, stroke-care
teams, and administrators. In 2001 and 2002, CDC funded
prototype projects in several states, including California.
These projects showed that large gaps existed between
generally recommended guidelines for treating stroke patients
and actual hospital practices. In 2004, four states were
awarded funds to implement and operate stroke registries, and
in 2007, six states received funding for this purpose.
Analysis Prepared by : Lisa Murawski / APPR. / (916) 319-2081