The S.C. Legislature
passed the Stroke Prevention Act of 2011 in June that will establish a
network of hospitals for stroke patients similar to the network that
exists for trauma patients where all hospitals are rated based on their
capabilities. The new law is expected to save lives and prevent
permanent disabilities by getting stroke patients the most appropriate
level of care in the shortest amount of time. The following are
reactions from Edward Jauch, M.D., and Robert J. Adams, M.D., two
influential advocates for the law.
MUSC Emergency Medicine and stroke
researcher Dr. Edward Jauch, left, with state Sen. Darrell Jackson,
center, and MUSC Stroke Center Director Dr. Robert Adams in Columbia.
was your reaction to it finally getting passed?
Relief and appreciation for all the hard work so many people expended
making this happen. Numerous members of the MUSC family
contributed to the creation and passage of this bill, often behind
the scenes. It is just the beginning of a long important process in
changing the way stroke is prevented and cared for. It requires an
incredible amount of effort to even begin to change the system. Soon
people will be able to find out where to go for expert stroke care in
has the journey entailed getting to this point?
Three years of planning and working with numerous stakeholders
throughout the state. It started as a multidisciplinary working
group of stakeholders from across S.C. that led to the creation of the
first stroke bill, which created the South Carolina Stroke Systems of
Care Study Committee. It was critically important to add necessary
direction and formality by placing the responsibility of success within
the Department of Health so that we knew the frequent trips to Columbia
would pay off.
This group worked
aggressively for more than a year to identify the stroke needs of the
state and create a statement of need for the legislature through the
stroke bill. After working to move the bill through subcommittees
within the senate and house, and later through the full senate and
house, and overriding the governor's veto, the bill became law on June
this mean for S.C. residents?
This is the first step in organizing health care resources within the
state to address the significant burden of stroke. It will help
build systems of care within regions to ensure EMS agencies are aware
of hospital stroke capabilities within their region and that potential
stroke patients are taken to the most appropriate hospital capable
of treating acute stroke.
Further, it will foster
collaboration among hospitals in the state to provide the best stroke
care for patients. Additionally, the bill will fund a registry
maintained by DHEC to better determine the occurrence of stroke within
the state and provide guidance for future stroke intervention and
prevention efforts. From a practical point of view, the bill increases
chances that patients with stroke will be taken to the most appropriate
stroke hospital as quickly as possible. It does not guarantee this will
occur, but improves the chance. The bill also ensures that through DHEC
we will continue to populate and update the map of South Carolina
hospitals with stroke capable sites as the first step.
is it necessary to have a task force to maintain and track a stroke
patient database, and is it worth the $500,000 price tag?
The cost came in part from additional staff that will be needed to deal
with hospital certification issues. Granted registries are expensive
and must be done correctly to be of any value. If done correctly, they
can be a significant help in planning for service delivery and
prevention. For instance, if Robert and I wanted to identify the
counties with the greatest need for stroke education, improved access
to tPA (a stroke drug), etc., we currently would not be able to obtain
the necessary data. Most hospitalization data come from documents
created for financial reasons and not medical reasons, so many
important medical aspects are left out.
does our state rank among the highest with stroke and mortality rates?
South Carolina experiences a disproportionately high prevalence of
major risk factors for stroke and cardiovascular disease—diabetes,
hypertension, smoking, obesity, etc. Lack of stroke resources at
most hospitals in S.C. may also play a role. While this may explain the
overall severity of the problem, what it doesn't describe is the
disproportionate burden of stroke in younger patients, likely due to
these risk factors occurring earlier in S.C .and not being treated as
aggressively in S.C.
does our state have such a high stroke/mortality rate and what do you
see MUSC's role in changing that for the future?
First, MUSC is clearly the fundamental medical biological resource for
stroke in the state. While there are others, we need to be the leaders.
We need to not only lead in the exploratory biology of stroke, but also
in the application of the current knowledge, type 2 translational
research, to ensure the best practices are carried out throughout the
state and to export our good care, knowledge, and passion to improve
care throughout the state. Examples of this are telemedicine efforts in
stroke, sepsis and trauma. As a leading academic emergency department
(ED) in the state, we also have the opportunity and obligation to
improve the rapid triage and care for stroke patients in the ED and our
coordination with EMS within the region.
does the future hold?
We hope we are involved in the resulting stroke advisory council, a
committee convened by DHEC to see this work implemented and extended to
make a bigger difference with stroke.
Our MUSC lobbyists also
worked hard and were key to making this happen even though MUSC has
nothing to directly gain from the passage of this bill. The South
Carolina Hospital Association (SCHA) also was crucially important,
especially Rick Foster, M.D., because legislation like this cannot be
passed or be effective unless the SCHA is on board. We are and will
continue to make progress against stroke.