State-wide criteria for Stroke Center Certification & Designation
Vallabh Janardhan, MD FSVIN
Chair, SVIN Stroke Center Certification Workshop Founding Board of Director & Treasurer, SVIN
Director, Texas Stroke Institute
Data Safety Monitoring Board Member, Penumbra Pivotal Trial, Penumbra Inc.,
Consultant
Board Member, Insera Therapeutics Inc.,
Stocks/Stock Options
National Science Foundation Grant #0946099
Principal Investigator
FIRST Trial, Penumbra Inc.,
Principal Investigator
Disclosures
Acknowledgements
Chandril Chugh, MD
Tanzila Shams, MD MHA
Stroke Designation 1
Statewide Stroke Legislation
2
Statewide Stroke Certification 3
Overview
Brain attacks: Lessons learned from heart attacks 4
Stroke Designation
1 Ensure high quality care for brain attack patients
3
Provide State oversight of third
party Stroke center certifying bodies
Assist EMS in triaging stroke patients to the appropriate hospital
2
4 Comply with State Legislation for Stroke Designation and Triaging
Stroke Designation: Why do we need it?
Certified Stroke Centers
Hospitals - NOT
Certified
Self Certification by State
Move from Self-certification to embracing third party
Stroke center Certifying bodies (TJC, DNV, HFAP etc.)
Pass appropriate State Legislation mandating Stroke Designation
and Triaging
Stroke Certification & Designation: How do we get there?
Statewide Stroke Legislation
AK
MT
WY ID
WA
OR
NV UT CA
AZ
ND
SD
NE
CO
NM
TX
OK
KS
AR
LA
MO
IA
MN WI
IL IN
KY
TN
MS AL GA
FL
SC
NC
VA WV
OH
MI NY
PA
MD DE NJ
CT RI
MA
ME VT
NH
HI
Stroke Designation: States with Enacted Legislation
14 States have enacted legislation mandating stroke center designation & triaging plans
Enacted Legislation Have supporting legislation Pending legislation
AK
MT
WY ID
WA
OR
NV UT CA
AZ
ND
SD
NE
CO
NM
TX
OK
KS
AR
LA
MO
IA
MN WI
IL IN
KY
TN
MS AL GA
FL
SC
NC
VA WV
OH
MI NY
PA
MD DE NJ
CT RI
MA
ME VT
NH
HI
Stroke Designation: States with Pending Legislation
2 States have pending legislation mandating stroke center designation & triaging plans
Enacted Legislation Have supporting legislation Pending legislation
Stroke Designation: Legislation in House
Robert A. Biggins (R) Illinois (2009)
House Bill 2244
Robert W. Cooper (R) Missouri (2008) House Bill 1790
Conrad James (R) New Mexico (2012)
House Bill 33
Bethany Hall-Long (D) Delaware (2009) House Bill 378
Todd Porter (R) North Dakota (2009)
House Bill 1339
Philip A. Hamilton (R) Virginia (2008) House Bill 479
Kathy Hawken (R) North Dakota (2009)
House Bill 1339
Lois Delmore (D) North Dakota (2009)
House Bill 1339
Eileen S Naughton (D) Rhode Island (2009)
House Bill 5798
Dawn Morrell (D) Washington (2010)
House Bill 2396
Stroke Designation: Legislation in Senate
Dr. Bob Deuell (R) Texas (2005)
Senate Bill 330
Barbara A. Boone (D) New Jersey (2004)
Senate Bill 477
Joseph Carraro (R) New Mexico (2005)
Senate Bill 190
John Sparks (D) Oklahoma (2008) Senate Bill 1420
Dr. Don Thomas (R) Georgia (2008)
Coverdell-Murphy Act
David L. Williams (R) Kentucky (2010)
Senate Bill 1
Mike Fasano (R) Florida (2004)
Senate Bill 1590
State Senators who have enacted legislations for stroke designation
State Senators who have enacted legislations for stroke designation
Daniel A. Wolf (D) Massachusetts
Senate Bill 840 (Pend)
Roman W. Prezioso (D) West Virginia
Senate Bill 581 (Pend)
Pending Stroke legislation
GA Senate Bill 549 Coverdell-Murphy Act
RI House Bill 5798; Stroke Prevention and Treatment Act of 2009
FL Senate Bill 1590 Certified Stroke Center Law
IL House Bill 2244 Primary Stroke Center Act
NJ Senate Bill 477 Stroke Center Act
House or Senate Bills better known as Stroke Acts
AK
MT
WY ID
WA
OR
NV UT CA
AZ
ND
SD
NE
CO
NM
TX
OK
KS
AR
LA
MO
IA
MN WI
IL IN
KY
TN
MS AL GA
FL
SC
NC
VA WV
OH
MI NY
PA
MD DE NJ
CT RI
MA
ME VT
NH
HI
Stroke Designation: States with non-legislative Administrative Policies or Rules related to Stroke
4 States that have not enacted legislation, instead have non-legislative administrative policies
Enacted Legislation Have supporting legislation Pending Legislation Administrative Policy or Rule
AK
MT
WY ID
WA
OR
NV UT CA
AZ
ND
SD
NE
CO
NM
TX
OK
KS
AR
LA
MO
IA
MN WI
IL IN
KY
TN
MS AL GA
FL
SC
NC
VA WV
OH
MI NY
PA
MD DE NJ
CT RI
MA
ME VT
NH
HI
Stroke Designation: States with Supporting Legislation for Cardiovascular disease & Stroke
16 States have supporting legislation but not directly mandating stroke designation & triaging
Enacted Legislation Have supporting legislation Pending legislation
Statewide Stroke Certification
The Joint Commission (TJC)
Det Norske Veritas (DNV) State Certification
Hospital Facilities Accreditation Program
(HFAP)
Stroke Certification: How to get certified?
States with TJC certified Primary Stroke centers
AK
MT
WY ID
WA
OR
NV UT CA
AZ
ND
SD
NE
CO
NM
TX
OK
KS
AR
LA
MO
IA
MN WI
IL IN
KY
TN
MS AL GA
FL
SC
NC
VA WV
OH
MI NY
PA
MD DE NJ
CT RI
MA
ME VT
NH
HI
No TJC Certified Stroke Centers States have TJC Certified Stroke Centers
Source: JCAHO (www.jointcommission.org) ; Last accessed: November 1st, 2014
TJC 1049 certified primary stroke centers in all states except MA
States with TJC certified Comprehensive Stroke Centers
AK
MT
WY ID
WA
OR
NV UT CA
AZ
ND
SD
NE
CO
NM
TX
OK
KS
AR
LA
MO
IA
MN WI
IL IN
KY
TN
MS AL GA
FL
SC
NC
VA WV
OH
MI NY
PA
MD DE NJ
CT RI
MA
ME VT
NH
HI
No TJC Certified Stroke Centers States have TJC Certified Stroke Centers
Source: JCAHO (www.jointcommission.org) ; Last accessed: November 1st, 2014
TJC has 78 certified comprehensive stroke
centers in 28 states
States with DNV certified Primary Stroke Centers
AK
MT
WY ID
WA
OR
NV UT CA
AZ
ND
SD
NE
CO
NM
TX
OK
KS
AR
LA
MO
IA
MN WI
IL IN
KY
TN
MS AL GA
FL
SC
NC
VA WV
OH
MI NY
PA
MD DE NJ
CT RI
MA
ME VT
NH
HI
No DNV Certified Stroke Centers States have DNV Certified Stroke Centers
Source: DNV (www.dnvaccredition.com); Last accessed: November 1st, 2014
DNV has 87 certified primary stroke centers
in 23 states
States with DNV certified Comprehensive Stroke Centers
AK
MT
WY ID
WA
OR
NV UT CA
AZ
ND
SD
NE
CO
NM
TX
OK
KS
AR
LA
MO
IA
MN WI
IL IN
KY
TN
MS AL GA
FL
SC
NC
VA WV
OH
MI NY
PA
MD DE NJ
CT RI
MA
ME VT
NH
HI
No DNV Certified Stroke Centers States have DNV Certified Stroke Centers
Source: DNV (www.dnvaccredition.com); Last accessed: November 1st, 2014
DNV has 14 certified comprehensive stroke
centers in 5 states
States with HFAP certified Primary Stroke Centers
AK
MT
WY ID
WA
OR
NV UT CA
AZ
ND
SD
NE
CO
NM
TX
OK
KS
AR
LA
MO
IA
MN WI
IL IN
KY
TN
MS AL GA
FL
SC
NC
VA WV
OH
MI NY
PA
MD DE NJ
CT RI
MA
ME VT
NH
HI
No HFAP Certified Stroke Centers States have HFAP Certified Stroke Centers
Source: HFAP (www.hfap.org); Last accessed: November 1st, 2014
HFAP has 40 certified primary stroke centers
in 12 states
States with HFAP certified Comprehensive Stroke Centers
AK
MT
WY ID
WA
OR
NV UT CA
AZ
ND
SD
NE
CO
NM
TX
OK
KS
AR
LA
MO
IA
MN WI
IL IN
KY
TN
MS AL GA
FL
SC
NC
VA WV
OH
MI NY
PA
MD DE NJ
CT RI
MA
ME VT
NH
HI
No HFAP Certified Stroke Centers State has HFAP Certified Stroke Center
Source: HFAP (www.hfap.org); Last accessed: November 1st, 2014
HFAP has 1 certified comprehensive stroke
center in 1 state
States with Self-Certification for Primary Stroke Centers
AK
MT
WY ID
WA
OR
NV UT CA
AZ
ND
SD
NE
CO
NM
TX
OK
KS
AR
LA
MO
IA
MN WI
IL IN
KY
TN
MS AL GA
FL
SC
NC
VA WV
OH
MI NY
PA
MD DE NJ
CT RI
MA
ME VT
NH
HI
No State Certified Primary Stroke Centers State Certification for Primary Stroke Centers
211 state certified primary stroke
centers in 4 states (MA, NY, NJ, FL)
Source: State Department of Public Health websites MA: http://www.mass.gov/eohhs/gov/departments/dph/programs/hcq/healthcare-quality/pss-hospitals/ NJ: http://www.nj.gov/health/ems/documents/stroke_centers.pdf NY: http://profiles.health.ny.gov/hospital/designated_centers/Stroke+Center FL: http://ahca.myflorida.com/mchq/Health_Facility_Regulation/Hospital_Outpatient/reports/Primary_Stroke_Centers.pdf Last accessed: November 1st, 2014
States with Self-Certification for Stroke: Massachusetts
States with Self-Certification for Comprehensive Stroke Centers
AK
MT
WY ID
WA
OR
NV UT CA
AZ
ND
SD
NE
CO
NM
TX
OK
KS
AR
LA
MO
IA
MN WI
IL IN
KY
TN
MS AL GA
FL
SC
NC
VA WV
OH
MI NY
PA
MD DE NJ
CT RI
MA
ME VT
NH
HI
No State Certified Comprehensive Stroke Centers State Certification for Comprehensive Stroke Centers
43 state certified comprehensive stroke
centers in 2 states Source: State Department of Public Health websites NJ: http://www.nj.gov/health/ems/documents/stroke_centers.pdf FL: http://ahca.myflorida.com/mchq/Health_Facility_Regulation/Hospital_Outpatient/reports/Primary_Stroke_Centers.pdf Last accessed: November 1st, 2014
States with Self-Certification for Stroke: Florida
Brain attacks: Lessons learned from heart attacks
Non-PCI capable Hospital: IV Fibrinolysis
PCI Capable Hospital: Balloon Angioplasty
& Stenting
Primary Stroke Center: IV r-tPA
Comprehensive Stroke Center:
Clot Retrieval
Stroke Center Certification mirrors Cardiac Centers
1. Major Heart Attacks (STEMI’s): ~ 275,000 (Approx. 30% of all 915,000 myocardial infarctions) 2. Major Brain Attacks (LVO’s - Large
Vessel Occlusions): ~318,159 (Approx. 46% of all 691,650 ischemic strokes)**
Interventional Cardiology
Number of trained Interventionalists
Neuro-Intervention
Overall Annual Addressable Market in US*
Ove
rall
Annu
al A
ddre
ssab
le M
arke
t Cov
erag
e
* Sources: Heart Disease and Stroke Statistics – 2014 Update, American Heart Association 2014. ** STOP-stroke study, Stroke 2009; 40(12): 3834-3840.
4 4
Workforce Trends: Neuro-Intervention vs. Interventional Cardiology
Neurosurgery
Neuro Intervention Neurology
Radiology
This is a team sport!
Administration
TSI Clinical Team
Parita Bhuva, MD Ryan Gianatasio, MD Paul A. Hansen, MD Vallabh Janardhan, MD Director, TSI
TSI Stroke Intervention Physicians
Josh Canfield TSI Practice
Manager
TSI Physician Services
Alex Venizelos, MD Keyur Patel, MD Suman Nalluri, MD MPH Chandril Chugh, MD
TSI Stroke & Neuro-critical Care Physicians (Stroke Intervention – In training)
Tanzila Shams, MD MHA
TSI Research Fellow
TSI Administrative Team
Mark Whitley Sr. VP Bus. Dev.
Kathy Sheets, VP Physician Recruitment
Anita Guthmann Director,
Comprehensive Stroke
Vallabh Janardhan, MD Director, TSI
Helen Hare Program Coordinator
Tammy Stilling Neuroscience Business
Development
Scott Manis VP, Rural Outreach
Will Smitham VP, HCAPS
Beth Tuma VP Sales
Joshua Hunter Director, Physician
Recruitment
Level 2
Level 2
Level 2
Level 3
Level 3
Level 2
Level 2
Level 3
Level 3 Level 2
Level 2
Level 2
Level 2
Level 1
Level 1
Level 1=Comprehensive Stroke Center; Level 2=Primary Stroke Center; Level 3=Stroke Support Facility
First in US geographically placed multi-hub & spoke Regional stroke network: Texas Stroke Institute
Level 1
Level 2 OUMC Level 1
Q&A
