OBJECTIVES: We identified barriers and facilitators to the state-level implementation of primary stroke center (PSC) policies, which encourage the certification or designation of specialized stroke treatment facilities and may address concerns such as transportation bypass, telemedicine, and treatment protocols. METHODS: We studied the experiences of 4 states (Florida, Massachusetts, New Mexico, and New York) selected from the 18 states that had enacted PSC policies or were actively considering doing so. We conducted semistructured interviews during fieldwork in each case study state. RESULTS: Our results showed that system fragmentation, gaps in human and financial resources, and complexity at the interorganizational and operational levels are common barriers and that policy champions, stakeholder support and communication, and operational adaptation are essential facilitators in the adoption and implementation of PSC policies. CONCLUSIONS: The identification of barriers and facilitators reveals the contextual elements that can help or hinder policy implementation and may be useful in informing policy formulation and implementation in other jurisdictions. Proactively identifying jurisdictional challenges and opportunities may help facilitate the policy process for PSC designation and allow jurisdictions to develop more effective stroke systems of care.
OBJECTIVES: We identified barriers and facilitators to the state-level implementation of primary stroke center (PSC) policies, which encourage the certification or designation of specialized stroke treatment facilities and may address concerns such as transportation bypass, telemedicine, and treatment protocols. METHODS: We studied the experiences of 4 states (Florida, Massachusetts, New Mexico, and New York) selected from the 18 states that had enacted PSC policies or were actively considering doing so. We conducted semistructured interviews during fieldwork in each case study state. RESULTS: Our results showed that system fragmentation, gaps in human and financial resources, and complexity at the interorganizational and operational levels are common barriers and that policy champions, stakeholder support and communication, and operational adaptation are essential facilitators in the adoption and implementation of PSC policies. CONCLUSIONS: The identification of barriers and facilitators reveals the contextual elements that can help or hinder policy implementation and may be useful in informing policy formulation and implementation in other jurisdictions. Proactively identifying jurisdictional challenges and opportunities may help facilitate the policy process for PSC designation and allow jurisdictions to develop more effective stroke systems of care.
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Authors: Robert Adams; Joe Acker; Mark Alberts; Liz Andrews; Richard Atkinson; Kathy Fenelon; Anthony Furlan; Meighan Girgus; Katie Horton; Richard Hughes; Walter Koroshetz; Richard Latchaw; Ellen Magnis; Marc Mayberg; Arthur Pancioli; Rose Marie Robertson; Tim Shephard; Rene Smith; Sidney C Smith; Suzanne Smith; Steven K Stranne; Edgar J Kenton; Gil Bashe; Altagracia Chavez; Larry Goldstein; Richard Hodosh; Cindy Keitel; Margaret Kelly-Hayes; Anne Leonard; Lewis Morgenstern; Jack Owen Wood Journal: Stroke Date: 2002-01 Impact factor: 7.914
Authors: M J Alberts; G Hademenos; R E Latchaw; A Jagoda; J R Marler; M R Mayberg; R D Starke; H W Todd; K M Viste; M Girgus; T Shephard; M Emr; P Shwayder; M D Walker Journal: JAMA Date: 2000-06-21 Impact factor: 56.272
Authors: Lee H Schwamm; Robert G Holloway; Pierre Amarenco; Heinrich J Audebert; Tamilyn Bakas; Neale R Chumbler; Rene Handschu; Edward C Jauch; William A Knight; Steven R Levine; Marc Mayberg; Brett C Meyer; Philip M Meyers; Elaine Skalabrin; Lawrence R Wechsler Journal: Stroke Date: 2009-05-07 Impact factor: 7.914
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