THE SENATE

S.B. NO.

1348

TWENTY-SEVENTH LEGISLATURE, 2013

S.D. 1

STATE OF HAWAII

 

 

 

 

 

 

A BILL FOR AN ACT

 

 

RELATING TO HEALTH.

 

 

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF HAWAII:

 


     SECTION 1.  The legislature finds that stroke is the leading cause of chronic disability among adults in the State.  Rapid identification, diagnosis, and treatment of stroke can improve outcomes for stroke patients.

     The legislature finds that Hawaii needs an effective system to support the rapid assessment and triage of stroke patients, provide appropriate stroke treatment in a timely manner, and improve the overall care of stroke patients to increase their chances of survival and decrease the long term disabilities associated with stroke.  A stroke system of care should be established in Hawaii to evaluate, stabilize, and provide emergency and inpatient care to patients with acute stroke.

     The purpose of this Act is to:

     (1)  Establish a stroke system of care in the State by recognizing three levels of care:  level I - comprehensive stroke center; level II - primary stroke center; and level III - stroke support facility.  Recognition will be based on criteria developed and used by the American Heart Association, American Stroke Association, or Brain Attack Coalition; and

     (2)  Establish requirements for the measuring, reporting, and monitoring of stroke care performance through data collection and creation of a stroke database.

     SECTION 2.  Chapter 323, Hawaii Revised Statutes, is amended by adding a new part to be appropriately designated and to read as follows:

"PART    .  TREATMENT OF STROKE

     §323-A  Definitions.  As used in this part:

     "Comprehensive stroke center" means a hospital or health care facility with the necessary personnel, infrastructure, expertise, and programs to diagnose and treat stroke patients who require a high level of medical and surgical care, specialized tests, or interventional therapy.

     "Department" means the department of health.

     "Emergency services provider" means any public employer that employs persons to provide firefighting, water safety, or emergency medical services.

     "Health care facility" shall have the same meaning as in section 323D-2.

     "Hospital" means an institution with an organized medical staff that is regulated under section 321-11(10) and admits patients for inpatient care, diagnosis, observation, and treatment.

     "Primary stroke center" means a hospital or health care facility with a program that stabilizes and provides emergent care to acute stroke patients, transfers patients to a comprehensive stroke center, or admits stroke patients and provides further care depending on the patient's needs and the center's capabilities.

     "Stroke support facility" means a hospital or health care facility that provides timely access to stroke care but that does not meet all the criteria specified for a comprehensive stroke center or a primary stroke center.  Stroke support facilities provide timely access to acute stroke care that would not otherwise be available such as in rural areas where transportation and access are limited and utilize stroke care methods commonly known as "drip and ship" or telemedicine approaches.

     §323-B  Classification and recognition of stroke centers.  (a)  The department shall recognize the following classifications of stroke care programs:

     (1)  Level I comprehensive stroke center.  To qualify as a level I comprehensive stroke center, a hospital or health care facility shall meet the requirements specified by the American Heart Association, American Stroke Association, or Brain Attack Coalition for comprehensive stroke centers.  A comprehensive stroke center may act as a resource center for other facilities by providing expertise about case management, offering guidance for triage, making diagnostic tests or treatments available to patients initially treated at a different stroke center, and being an educational resource for other hospitals and health care professionals;

     (2)  Level II primary stroke center.  To qualify as a level II primary stroke center, a hospital or health care facility shall meet the requirements specified by the American Heart Association, American Stroke Association, or Brain Attack Coalition for primary stroke centers; and

     (3)  Level III stroke support facility.  To qualify as a level III stroke support facility, a hospital or health care facility shall meet the requirements specified by the American Heart Association, American Stroke Association, or Brain Attack Coalition for stroke support facilities, or meet the following requirements:

         (A)  Establish a plan specifying the elements of operation for stroke treatment;

         (B)  Enter into a collaborative written agreement with a level I comprehensive stroke center or a level II primary stroke center to accept stroke patients for whom the level I comprehensive stroke center or level II primary stroke center lacks the capacity to provide treatment; provided that the agreement shall contain the following provisions:

              (i)  Identification of the collaborating level I comprehensive stroke center or level II primary stroke center; and

             (ii)  Written protocols for the transportation of stroke patients; communications between the collaborating level I comprehensive stroke center or level II primary stroke center; administering of thrombolytics or other approved acute stroke treatment therapy; and emergency access and transport plans for stroke care services within ninety minutes of identified need;

         (C)  Require and document emergency department personnel training in stroke care;

         (D)  Designate a stroke director who may be an emergency department physician or non-neurologist physician; and

         (E)  Employ the National Institutes of Health Stroke Scale for the evaluation of acute stroke patients.

     (b)  A hospital or health care facility shall submit an application to the department for recognition pursuant to this section and shall demonstrate to the satisfaction of the department that the hospital meets the applicable criteria in subsection (a).

     (c)  Hospitals or health care facilities that submit documentation showing accreditation or certification from the American Heart Association, American Stroke Association, or Brain Attack Coalition as a comprehensive stroke center, primary stroke center, or stroke support facility shall be presumed to meet the criteria in subsection (a) for recognition as a level I comprehensive stroke center, level II primary stroke center, or level III stroke support facility, as applicable.  The department may accept and consider an accreditation or certification from The Joint Commission or other nationally recognized organizations that use criteria consistent with the American Heart Association, American Stroke Association, or Brain Attack Coalition's criteria in determining whether a hospital or health care facility meets the criteria in subsection (a) for recognition as a level I comprehensive stroke center, level II primary stroke center, or level III stroke support facility.

     (d)  The department shall approve and recognize hospitals or health care facilities that in its determination meet the criteria in subsection (a) for comprehensive stroke centers, primary stroke centers, or stroke support facilities, as applicable.

     (e)  Each hospital or health care facility recognized by the department pursuant to this section shall submit annually an affidavit by its chief executive officer attesting that the organization continues to meet the criteria for recognition required by subsection (a).  If a hospital or health care facility fails to meet the criteria for recognition for more than six weeks or chooses not to maintain its recognition, the hospital or health care facility shall immediately notify the department by certified mail return receipt.

     §323-C  Publication of recognition.  (a)  The department shall publish and maintain on its website a list of hospitals or health care facilities that meet state-approved criteria and are recognized pursuant to this section together with the hospital or health care facility's applicable state level recognition.

     (b)  If a hospital or health care facility has been recognized by the department pursuant to section 323-B, the hospital or health care facility may advertise to the public its state-approved status and state level recognition.  A level I comprehensive stroke center may use the words, "Hawaii-approved Level I Comprehensive Stroke Center".  A level II primary stroke center may use the words, "Hawaii-approved Level II Primary Stroke Center".  A level III stroke support facility may use the words "Hawaii-approved Level III Stroke Support Facility".

     (c)  If the hospital or health care facility fails to meet the criteria for recognition for more than six weeks or chooses not to maintain its recognition, it shall immediately cease advertising to the public that it is state-approved and recognized and, where feasible, remove all such advertisements from public distribution.  To the extent that immediate removal of an advertisement is not feasible, any automatic renewal of such advertisement shall be canceled immediately.

     §323-D  Pre-hospital stroke-triage assessment.  The department shall adopt standardized pre-hospital stroke-triage assessment guidelines for use by recognized stroke centers and emergency medical services and publish the guidelines on its website.

     §323-E  Continuous improvement of quality of care for stroke patients.  (a)  The department shall require all recognized stroke centers and emergency medical services to demonstrate effective use of recommendations and clinical practice guidelines to manage care and maintain a quality assurance program that includes performance measurements and improvement activities.

     (b)  Performance measurements shall be reported to the department using a standardized stroke measure set containing data that is consistent with nationally recognized guidelines on the treatment of individuals with confirmed stroke within the State such as the American Heart Association's "Get With The Guidelines - Stroke" or The Joint Commission's "Stroke Performance Measurement Implementation Guide".

     §323-F  Data collection.  (a)  The department shall establish and maintain a statewide stroke database that contains compiled stroke care information and statistics.

     (b)  The department shall:

     (1)  Obtain and utilize periodic regional level reports containing aggregated state provider data with or without national benchmark or comparisons for the standardized stroke care measures; and

     (2)  Require reporting regarding the transitioning of patients to community-based follow-up care in hospital-outpatient, physician-office, and ambulatory-clinic settings for ongoing care after discharge from a hospital or health care facility following acute treatment for stroke.

     All hospitals and health care facilities shall be afforded access to the department's database.

     §323-G  Reporting requirements.  The department shall submit a report to the governor and legislature no later than twenty days prior to the convening of each regular session.  The report shall summarize the data collected pursuant to sections 323-E and 323-F, evaluate progress made toward improving quality of care and outcomes for stroke patients, and make recommendations to further improve the quality of care and outcomes for stroke patients.  The department shall also publish the report on its website.

     §323-H  Rules.  The department may adopt rules, pursuant to chapter 91, to effectuate the purposes of this part.

     §323-I  Enforcement; penalties.  If the department determines that any person has violated or is violating this part or any rule adopted pursuant to this part, the department may take enforcement action and impose penalties as provided in section 321-20.  In any proceeding pursuant to this section, the person subject to the proceeding shall be given notice and the opportunity for a hearing in accordance with chapter 91.

     §323-J  Interpretation.  (a)  This part is not a medical practice guideline and shall not be construed to restrict the authority of a hospital or health care facility to provide services for which it holds a license under state law.  This part is intended to effectuate patient care based on the needs and circumstances of the individual patient.

     (b)  Nothing in this part shall be construed to require disclosure of any confidential health information or data protected by the Health Insurance Portability and Accountability Act of 1996, Public Law 104-191, and its related regulations, as amended; chapter 323B; or any other law prohibiting the disclosure of confidential health information or data."

     SECTION 3.  In codifying the new sections added by section 2 of this Act, the revisor of statutes shall substitute appropriate section numbers for the letters used in designating the new sections in this Act.

     SECTION 4.  This Act shall take effect upon its approval; provided that this Act shall be fully implemented by July 1, 2015.

 


 



 

Report Title:

Stroke; Hospitals; Health Care Facilities; Recognition; Advertising; Stroke Data Collection and Reporting

 

Description:

Requires the department of health to classify and recognize qualified hospitals and health care facilities that provide care to stroke patients.  Allows hospitals and health care facilities to publicly advertise their recognition.  Requires hospitals and health care facilities to report data to the department.  Requires the department to create guidelines for pre-hospital stroke-triage assessment and maintain a statewide stroke database.  Requires the department to provide an annual report to the governor and legislature.  Takes effect on approval; provided that this Act is fully implemented by 7/1/15.  (SD1)

 

 

 

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