BILL ANALYSIS �
SENATE HEALTH
COMMITTEE ANALYSIS
Senator Ed Hernandez, O.D., Chair
BILL NO: AB 861
A
AUTHOR: Hill and Nestande
B
AMENDED: May 27, 2011
HEARING DATE: July 6, 2011
8
CONSULTANT:
6
Orr
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SUBJECT
California Stroke Registry
SUMMARY
Establishes the California Stroke Registry (CSR) within the
California Department of Public Health (CDPH) to serve as a
centralized repository for stroke data to promote quality
improvement for acute stroke treatment. Requires that CSR
only be implemented to the extent funds from federal or
private sources are made available for this purpose.
CHANGES TO EXISTING LAW
Existing law:
Requires CDPH to administer the California Heart Disease
and Stroke Prevention (CHDSP) Program.
Establishes the Heart Disease and Stroke Prevention and
Treatment Task Force (Task Force) within CDPH to create
California's Master Plan for Heart Disease and Stroke
Prevention and Treatment (Master Plan) to reduce the
morbidity, mortality, and economic burden of heart disease
and stroke in the state.
Continued---
STAFF ANALYSIS OF ASSEMBLY BILL 861 (Hill and Nestande)
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This bill:
Establishes the CSR in the CHDSP Program to serve as a
centralized repository for stroke data to promote quality
improvement for acute stroke treatment. Requires the 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. Provides that data will be
submitted voluntarily and encompass all areas of the state
for which stroke data are available.
Authorizes CDPH to contract with an agency or a nonprofit
professional association, representing a designated
reporting region for the purposes of collecting and
collating acute stroke data. Authorizes CDPH to provide
grant awards to implement public health activities to
fulfill required funding award objectives.
Requires the CHDSP director to:
Maintain a statewide stroke database that compiles
information and statistics voluntarily reported on
stroke care;
Recommend the voluntary reporting of case-specific
data on the treatment of individuals with suspected
acute stroke by hospitals and emergency medical
services agencies;
Encourage sharing of information and data among
health care providers to improve the quality of care
for stroke, and facilitate the communication and
analysis of information and data among the health care
professionals providing care for individuals with
stroke;
Consult with the Stroke Advisory Committee;
Specifies that information collected under this bill be
confidential. Authorizes persons with valid scientific
interest in the collected confidential information, who
meet specified criteria and who undergo specified processes
to obtain approval, to access the information for research
purposes. Specifies that disclosures authorized by this
bill include only the information necessary for the stated
purpose of the requested disclosure, used for the approved
purpose, and not be further disclosed. Excludes
confidential information from being available or disclosed
STAFF ANALYSIS OF ASSEMBLY BILL 861 (Hill and Nestande)
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for specified legal proceedings, unless otherwise allowed
by law.
Allows the publication of reports and statistical
compilations using this information, provided no individual
cases or institutional or individual sources of information
are disclosed.
Allows an individual to whom the information pertains to
have access to his or her own information.
Requires CDPH to maintain a record of persons who are given
access to confidential information.
Provides that this bill be implemented only to the extent
funds from federal or private sources are made available
for this purpose.
Excludes contracts with the program's fiscal intermediary
from specified provisions of the Public Contract Code.
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.
FISCAL IMPACT
The Assembly Appropriations Committee analysis estimates
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 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.
BACKGROUND AND DISCUSSION
AB 861 establishes a voluntary California Stroke Registry
within CDPH to collect data on stroke as a means to improve
treatment. The author asserts that the establishment of a
STAFF ANALYSIS OF ASSEMBLY BILL 861 (Hill and Nestande)
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stroke registry in statute will improve the potential for
California to receive and accept federal grants through the
CDC and the Paul Coverdell National Acute Stroke Registry
(Coverdell Registry). A voluntary stroke registry was
established by CDPH in 2007 and approximately 42 hospitals
across the state have participated so far. According to
the author, increasing the amount of information that can
be collected on strokes, the types of treatment stroke
patients receive, and the impacts of those treatments will
provide medical professionals with a roadmap to improved
care. The author believes that codifying the voluntary
registry will likely lead to a much greater rate of
participation. In addition, a second round of CDC funding
is forthcoming in 2012 but absent a stroke registry in
statute, the author claims that California will be
ineligible to receive funds.
Stroke prevalence in the U.S.
A stroke occurs when the blood supply to part of the brain
is suddenly blocked (ischemic stroke) or when a blood
vessel in the brain bursts, spilling blood into the spaces
surrounding brain cells (hemorrhagic stroke). 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
severe narrowing of an artery in or leading to the brain,
called stenosis. When there is sudden bleeding into or
around the brain or when brain cells no longer receive
oxygen and nutrients from the blood, the brain cells die.
Stroke can cause death or significant disability, such as
paralysis, speech difficulties, and emotional problems.
According to the CDC, about 137,000 Americans die of stroke
every year, making stroke the third leading cause of death
in the U.S. More than 795,000 Americans suffer from a
stroke each year, and 15-30 percent remain permanently
disabled. The AHA estimates the total cost from heart
disease and stroke in the U.S. for 2007 (including health
expenditures and lost productivity) was $286 billion.
Federal funding for stroke prevention
While evidence-based medical guidelines for stroke care
have been developed, as well as new and improved diagnostic
and treatment tools, the CDC reports that many hospitals
STAFF ANALYSIS OF ASSEMBLY BILL 861 (Hill and Nestande)
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still do not have the organization, staff, and equipment to
effectively diagnose and treat stroke patients. In response
to this need, Congress provided funding in 2001 to the CDC
to implement state-based registries that measure, track,
and improve the delivery and quality of stroke care, and
named the project after the late U.S. Senator Paul
Coverdell of Georgia who suffered a fatal stroke in 2000
while serving in Congress. The main goals of the Coverdell
Registry are to:
Measure, track, and improve the quality of care for
acute stroke patients;
Decrease the rate of premature death and disability
from acute stroke through secondary prevention;
Increase public awareness of stroke treatment and
prevention; and
Reduce disparities in acute stroke care by
providing underserved populations with better access
to care.
Under the Coverdell Registry program, the CDC piloted eight
prototype registry projects, led by academic and medical
institutions across the country, to test models for
measuring the quality of care delivered to stroke patients.
California participated in the second phase of this
project, receiving funding in 2002 to gather data
concerning each step of emergency and hospital care for
stroke patients, from emergency response to the patients'
eventual discharge from a hospital. At the end of the
three-year pilot period, the results showed that large gaps
existed between generally recommended guidelines for
treating stroke patients and actual hospital practices.
In 2004, the CDC funded four state health departments to
establish statewide Coverdell Registries, and expanded
funding to three more states in 2007.
California's Master Plan for Heart Disease and Stroke
Prevention and Treatment
In 2003, the state of California took the lead in
coordinating and focusing statewide efforts on heart
disease and stroke. The California Legislature passed AB
1220 (Berg), Chapter 395, Statutes of 2003, which
established a 12-member Task Force to develop California's
Master Plan for Heart Disease and Stroke Prevention and
Treatment (Master Plan) for 2007 to 2015. The Master Plan
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establishes goals such as decreasing death and disability
from heart disease and stroke through early detection,
treatment, and management of acute events, through
education of the public and health professionals, improving
the quantity and quality of research, and expanding data
acquisition and surveillance of cardiovascular disease,
including the evaluation of programs targeting heart
disease, stroke, and related risk factors.
The CHDSP Program is housed within CDPH 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, established in 2007
with 42 hospitals participating. Similar programs that
CDPH also administers include the Birth Defects Monitoring
Program, the Parkinson's Disease Registry, the immunization
registry and the Ken Maddy California Cancer Registry.
Related bills
AB 1329 (Davis) would authorize CDPH to establish a
competitive process to receive applications for, and issue,
the award of a grant to an agency to operate the statewide
cancer reporting system. Authorizes CDPH to also issue
grants to other agencies representing designated cancer
reporting regions for the purposes of collecting and
collating cancer incidence data. Would exempt the award of
these grants from the State Contract Act. AB 1329 is set
for hearing on July 6, 2011 in the Senate Health Committee.
Prior legislation
AB 1220 (Berg) Chapter 395, Statutes of 2003, establishes a
12-member Heart Disease and Stroke Prevention and Treatment
Task Force to develop a Master Plan for California.
Arguments in support
The AHA believes that providing explicit statutory
authority for a stroke registry is necessary to improve
California's ability to access federal funds for a
permanent, long-term registry. AHA believes that the
centralized stroke data will enable the state 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. Other
supporters believe that a registry will provide important
data and lead to improvements in quality patient care that
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will result in cost savings for the state. They attest to
the need for rapid intervention for stroke patients and
immediate diagnosis as a means to minimize the damage of a
stroke. They believe that the collection of data resulting
from the registry will help identify effective treatments
and standardize care.
PRIOR ACTIONS
Assembly Health: 16- 0
Assembly Appropriations:17- 0
Assembly Floor: 75- 0
COMMENTS
1. Federal funding. The CDC will be issuing competitive
grants for state stroke registries in 2012. It is unclear
that codifying the program will influence California's
chances of receiving these grant funds. The Assembly
Appropriations Committee analysis suggests that codifying
this program without the clear assurance of a funding
source can create cost pressure on the General Fund.
2. Increased participation. It is unclear if codifying the
existing voluntary registry will actually lead to increased
participation by hospitals, especially in the potential
absence of funding for registry activities.
3. Stroke Advisory Committee. Page 3 line 24 requires the
CHDSP Director to consult with the Stroke Advisory
Committee, yet no such committee is named in statute. CDPH
developed the Task Force in 2006 to create California's
Master Plan. The Task Force then established three work
groups in 2007 to develop implementation strategies for a
stroke system of care and to provide continuing guidance as
the system is developed in California. The author may wish
to amend the bill to replace the Stroke Advisory Committee
with either the Task Force or the one of the work groups.
4. Public Contract Code (PCC) exemption. The PCC is
intended to provide fair and competitive bidding
opportunities for public contracts, including ensuring that
a fair proportion of the total number of contracts or
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subcontracts are awarded to minority, women, and disabled
veteran business enterprises, and to also protect the
public from the misuse of public funds. The PCC is enforced
by the state Department of General Services (DGS). AB 861
excludes contracts with the program's fiscal intermediary
from specified provisions of the PCC. It is unclear why the
provisions of this bill need to be exempted from the PCC
provisions. It is also unclear what process CDPH uses to
ensure its contracts are as competitive as those awarded by
DGS.
POSITIONS
Support: American Heart Association (co-sponsor)
American Stroke Association (co-sponsor)
Adelante Media Group
California Medical Association
California Pacific Medical Center
San Mateo County EMS Agency
San Ramon Regional Medical Center
11 individuals
Oppose:None received.
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