BILL ANALYSIS �
AB 861
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Date of Hearing: March 29, 2011
ASSEMBLY COMMITTEE ON HEALTH
William W. Monning, Chair
AB 861 (Hill and Nestande) - As Introduced: February 17, 2011
SUBJECT : California Stroke Registry.
SUMMARY : Establishes the California Stroke Registry (CSR)
within the Department of Public Health (DPH) to serve as a
centralized repository for stroke data to promote quality
improvement for acute stroke treatment. Requires 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 establish a statewide CSR to serve as a
centralized repository for stroke data to promote quality
improvement for acute stroke treatment.
2)Requires CSR to align with the stroke consensus metrics
developed by national health organizations such as the federal
Centers for Disease Control and Prevention (CDC), the Joint
Commission, the American Heart Association (AHA), and the
American Stroke Association (ASA).
3)Requires the acquisition of data for CSR to encompass all
areas of the state for which stroke data are available.
4)Requires CSR to be under the direction of the Director of DPH
and housed within DPH's California Heart Disease and Stroke
Prevention Program (CHDSP) and permits CHDSP to accept, on
behalf of the state, grants of public or private funds for
CSR.
5)Permits DPH to contract with an agency, including, but not
limited to, a health systems agency, single county health
department, multicounty health department groupings, or
nonprofit professional associations, representing a designated
reporting region for the purposes of collecting and collating
acute stroke data.
6)Permits DPH to contract, or provide grant awards, to implement
public health activities to fulfill required funding award
objectives.
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7)Requires the Director of DPH, in establishing the CSR, to do
the following:
a) Maintain a statewide stroke database that compiles
information and statistics on stroke care. Requires DPH,
to the extent possible, to coordinate with the CDC, the
Joint Commission, AHA and ASA to avoid duplication and
redundancy;
b) Recommend that hospitals and emergency medical services
agencies report case-specific data on the treatment of
individuals with suspected acute stroke to the
representative of DPH, or any individual, agency, or
organization designated to cooperate with that
representative;
c) Encourage sharing of information and data among health
care providers to improve the quality of care for stroke;
d) Facilitate the communication and analysis of health
information and data among the health care professionals
providing care for individuals with stroke; and,
e) Consult with the Stroke Advisory Committee of the ASA
regarding ways in which to improve the quality of stroke
care and delivery in California.
8)Requires all information collected for the CSR to be
confidential. Requires DPH, or its designee, to use this
information to evaluate measures designed to improve the
quality of acute stroke treatment.
9)Authorizes persons with a valid scientific interest who are
engaged in demographic, epidemiological, or other similar
studies related to health, and who meet qualifications as
determined by DPH, and who agree, in writing, to maintain
confidentiality, to have access to confidential information.
Requires, before confidential information is disclosed for
study, researchers to do both of the following:
a) Obtain approval of their committee for the protection of
human subjects established in accordance with existing law;
and,
b) Provide documentation to DPH that demonstrates to DPH's
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satisfaction that the entity has established the procedures
and ability to maintain the confidentiality of the
information.
10)Requires any disclosure authorized by this bill to include
only the information necessary for the stated purpose of the
requested disclosure, used for the approved purpose, and not
to be further disclosed.
11)Requires that the furnishing of confidential information to
DPH or its authorized representative, in accordance with this
bill, to not expose any person, agency, or entity furnishing
information to liability, and is prohibited from being
considered a waiver of any privilege or a violation of a
confidential relationship.
12)Requires DPH to maintain an accurate record of all persons
who are given access to confidential information. Requires
the record to include the name of the person authorizing
access; name, title, address, and organizational affiliation
of persons given access; dates of access; and, the specific
purpose for which information is to be used. Requires the
record of access to be open to public inspection during normal
operating hours of DPH.
13)Prohibits any part of the confidential information from being
available for subpoena, from being disclosed, discoverable, or
compelled to be produced in any civil, criminal,
administrative, or other proceeding, or from being deemed
admissible as evidence in any civil, criminal, administrative,
or other tribunal or court for any reason.
14)Requires that this bill not prohibit the publication by DPH
of reports and statistical compilations that do not in any way
identify individual cases or individual sources of
information.
15)Requires that the individual to whom the information pertains
have access to his or her own information in accordance with
existing law.
16)Makes the following definitions:
a) Ischemic stroke means an occlusion of a blood vessel
that blocks blood flow to the brain, depriving the brain of
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oxygen, and resulting in brain tissue death. This
definition includes transient ischemic attacks, defined as
stoke-like symptoms for less than 24 hours; and,
b) Hemorrhagic stroke means as a rupture of a blood vessel,
resulting in bleeding into or around the brain.
17)Prohibits this bill from preempting the authority of
facilities or individuals providing diagnostic or treatment
services to patients with stroke to maintain their own
facility-based stroke registries.
18)Prohibits this bill from being construed as a medical
practice guideline and from being used to restrict the
authority of a hospital to provide services for which it has
received a license under state law.
19)Requires this bill to be implemented only to the extent funds
from federal or private sources are made available for this
purpose.
20)Makes various finding and declarations regarding the
prevalence of stroke in California and the importance of rapid
identification, diagnosis, and treatment of stroke to save
lives.
EXISTING LAW :
1)Permits DPH to do all of the following in order to protect,
preserve, and advance public health: a) studies; b)
demonstrations of innovative methods; c) evaluations of
existing projects; d) provisions of training programs; and, e)
dissemination of information.
2)Permits DPH, in performing activities listed in 2) above, to
do all of the following: a) perform the activity directly; b)
enter into contracts, cooperative agreements, or other
agreements for the performance of the activity; and, c) award
grants for the performance of the activity.
FISCAL EFFECT : This bill has not yet been heard by a fiscal
committee.
COMMENTS :
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1)PURPOSE OF THIS BILL . According to the author, a voluntary
stroke registry was established in 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 participation and
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 CDC. The author asserts that
the CDC has been tasked with implementing state-based
registries to measure and track acute stroke care. According
to the author, a second round of CDC funding is forthcoming
but absent a stroke registry in statute, California will be
ineligible to receive those federal funds.
2)BACKGROUND . According to the National Institute of
Neurological Disorders and Stroke (NINDS), a stroke, or "brain
attack," occurs when blood circulation to the brain fails.
Brain cells can die from decreased blood flow and the
resulting lack of oxygen. NINDS states that there are two
broad categories of stroke: those caused by a blockage of
blood flow and those caused by bleeding. While not usually
fatal, a blockage of a blood vessel in the brain or neck,
called an ischemic stroke (PRONOUNCED i-skee-meek), is the
most frequent cause of stroke and is responsible for about 80%
of strokes. These blockages stem from three conditions: the
formation of a clot within a blood vessel of the brain or
neck, called thrombosis; the movement of a clot from another
part of the body such as the heart to the neck or brain,
called embolism; or, a sever narrowing of an artery in or
leading to the brain, called stenosis. Bleeding into the
brain or the spaces surrounding the brain causes the second
type of stroke, called hemorrhagic stroke.
Stroke occurs in all age groups, in both sexes, and in all
races. In African Americans, stroke is more common, and more
deadly - even in young and middle-aged adults - than for any
ethnic or other racial group in the United States. Scientists
have found more and more severe risk factors in some minority
groups and continue to look for patterns of stroke in these
groups. Some of the most important treatable risk factors for
stroke are: high blood pressure; cigarette smoking; heart
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disease; history of stroke; and, diabetes.
According to AHA and ASA, stroke is the third leading cause of
death in California. Each year stroke kills approximately
15,585 Californians and accounts for almost 200,000
hospitalizations. Stroke is the leading cause of severe,
long-term disability in California. While 50-70% of stroke
survivors regain functional independence, 15-30% are
permanently disabled and 20% of stroke survivors require
institutional care at three months after the onset. According
to the CDC, the estimated direct and indirect costs in 2010 of
stroke in the United States was $73.3 billion.
3)PAUL COVERDALE 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. Congress named the registry
the Paul Coverdale National Acute Stroke Registry (PCNASR)
after the late U.S. Senator Paul Coverdell of Georgia, who
suffered a fatal stroke in 2000 while serving in Congress.
The goals of PCNASR include: to measure, track, and improve
the quality of care and access to care for stroke patients;
decrease rate of premature death and disability; eliminate
disparities in care; support the development of stroke systems
of care that emphasize quality of care; improve access to
rehabilitation and opportunities for recovery; and, increase
the workforce and scientific knowledge for stroke surveillance
within stroke systems of care. In June 2004, the CDC funded
the state health departments of Georgia, Illinois,
Massachusetts, and North Carolina to establish statewide
stroke registries to improve acute care in hospitals.
According to the CDC, by the end of the three-year project
period, over 180 hospitals were participating and over 45,000
stroke patients benefited from hospital participation. In
July of 2007, CDC awarded funds to Georgia, Massachusetts,
Michigan, Minnesota, North Carolina, and Ohio to continue to
improve this work. According to the author, explicit
statutory authority is needed for California to be eligible
for the CDC funds.
4)STATE ACTIVITY . In 2003, the state of California recognized
the need to take the lead in coordinating and focusing the
statewide assault on heart disease and stroke. The California
Legislature passed AB 1220 (Berg), Chapter 395, Statutes of
2003, which established a 12-member Heart Disease and Stroke
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Prevention and Treatment Task Force to develop California's
Master Plan for Heart Disease and Stroke Prevention and
Treatment for 2007-2015 to reduce the morbidity, mortality,
and economic burden of heart disease and stroke in the state.
Establishment of a stroke registry is consistent with the
recommendations contained in the Mater Plan.
CHDSP is housed within DPH and was established to reduce
premature death and disability from heart disease and stroke
among Californians. CHDSP currently administers the state's
voluntary stroke registry. DPH also administers a Birth
Defects Monitoring Program, a Parkinson's Disease Registry and
the Ken Maddy California Cancer Registry.
5)SUPPORT . According to the sponsors of this bill, AHA and ASA,
by centralizing stroke data, the state will be able to
identify geographic areas that are doing well and what their
best practices are which can then be implemented statewide and
improve the care and treatment of stroke victims. All other
supporters attest to the need for immediate diagnosis and
treatment of stroke to save lives as well as to significantly
reduce long term disability such as neurological damage,
paralysis, and speech and language difficulties. Supporters
write that by providing vital information on stroke care, this
bill will improve quality of patient care and contribute to a
substantial cost savings to the state.
6)RELATED LEGISLATION . ACR 8 (Butler and Bonnie Lowenthal),
Resolution Chapter 2, Statutes of 2011 recognizes the Month of
February 2011 as American Heart Month in California, and
February 4, 2011, as Wear Red Day in California in order to
raise awareness of the importance of the ongoing fight against
heart disease and stroke; and urges public support for Go Red
for Women events.
7)PREVIOUS LEGISLATION . AB 1220 (Berg), Chapter 395, Statutes
of 2003, established a 12-member Heart Disease and Stroke
Prevention and Treatment Task Force to develop a Master Plan
for California.
REGISTERED SUPPORT / OPPOSITION :
Support
American Health Association (co-sponsor)
American Stroke Association (co-sponsor)
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Adelante Media Group
California Pacific Medical Center
San Mateo County Health System
University of California, Los Angeles
Numerous Individuals
Opposition
None on file.
Analysis Prepared by : Tanya Robinson-Taylor / HEALTH / (916)
319-2097