In 2004, a New Mexico Department of Health report urged “prompt action now” on the development of a stroke prevention and treatment program. Since then, more than 3,000 New Mexicans have died and 7,500 have been disabled because of stroke. Hundreds have been institutionalized.
The report also recommended that a minimum of four hospitals in the state – including one in Las Cruces – become certified primary stroke centers
Six years later, the state has one such center.
The lack of a comprehensive stroke care system in New Mexico means hundreds of people will die or be disabled every year – and it doesn’t have to be this way, according to one stroke survivor.
“Sometimes after a stroke survivors’ support group meeting, I just sit in my car and cry,” said Dave Bess of Las Cruces. “I’m afraid that one of my friends or neighbors will be the next victim. I don’t want anyone to have to die or have to live their lives under a disability sentence.”
The cost of stroke in New Mexico is $256 million per year – not including the cost of stroke-related rehabilitation and institutionalization. Stroke costs $70 million in hospital care and an additional $130 million in lost productivity each year, according to the New Mexico Department of Health (DOH). Medicaid pays $56 million per year in disability to New Mexico stroke victims, based on statistics from the Center for Disease Control.
And the cost is only going up.
According to the same 2004 report, the incidence of stroke in New Mexico is predicted to grow twice as fast as the population in the next 20 years. However, a telemedicine solution which could help prevent stroke, save lives and reduce disability is within sight.
All that is necessary is the leadership to make it happen, Bess said.
WE CAN DO THIS
The effort to create a system of stroke care in New Mexico has been a case of two steps forward, one-and-a-half steps back, said Dr. Glenn Graham, who chaired the Stroke Task Force that published the 2004 report. Dr. Graham is a neurologist in Albuquerque affiliated with University of New Mexico and the Department of Veterans Affairs.
“We [the Task Force] recognized that stroke care had changed, but the state system of acute stroke care wasn’t changing of its own accord,” he said.
And New Mexico is now in a budget crisis and federal funding is drying up, he said.
“There needs to be champions,” he said. “Internal champions within a single institution who will step up and say, ‘We can do this.'”
According to Bess, who with his wife, Judy, serves on the New Mexico Stroke Advisory Council, the state needs to develop a telemedicine network that would connect UNM Hospital, a certified primary stroke center, to hospitals around the state. With telemedicine, or telestroke, smaller communities can overcome the lack of neurologists. If someone has a stroke, say, in Alamogordo, the vitals can be monitored electronically by a neurologist in Albuquerque. That neurologist will have all the information needed to make critical care decisions.
“All you need is a hub, a center of expertise, and we could have the same care in Las Cruces that they do at UNM Hospital,” Bess said.
All of these projects have obstacles, but the problems are solvable, he said.
Arkansas, for example, launched a telestroke program in 2008 for $6.1 million.
The University of Arkansas contracted with the Arkansas Division of Medical Services, funded by Medicaid, to provide telestroke services. The university’s primary stroke center serves as the hub and nine regional hospitals participate at no cost.
In other parts of the country, such as Florida and Texas, the population is served by a network of certified primary stroke care centers (PSCs), Bess said. Those hospitals that cannot demonstrate competence in stroke care are simply bypassed in favor of those that do.
UNM Hospital, New Mexico’s only primary stroke care center (PSC), was certified in September 2009.
Last month, Christus St. Vincent’s hospital in Santa Fe announced it had aggressively enhanced its stroke protocols.
El Paso has three PSCs: Sierra Medical Center, Las Palmas Medical Center, and Providence Memorial Hospital.
Southern New Mexico and Las Cruces do not have a certified stroke center.
In addition, Bess said the state needs to develop a systematic triage and transfer system. Through a system of alerts, a stroke victim in an isolated, rural area of the state can be transferred by air ambulance to a primary stroke care center in time for treatment.
Several large states with rural populations already have such a system in place, Bess added.
However, New Mexico has yet to fund even a basic awareness campaign on stroke and cardiovascular disease.
“We have an unfunded mandate to raise stroke awareness and create a statewide stroke care system,” said Kevin McFarland, stroke coordinator for the DOH. “Unfortunately, most people will not become aware of stroke until someone they know or love has one.”
TELEMEDICINE COULD TAKE PRIMARY STROKE CARE STATEWIDE
Telemedicine – the use of high-speed broadband connectivity and video conferencing technology to connect neurological experts and Emergency Room staff – is the immediate solution to create a comprehensive system of stroke care in New Mexico, said Dr. Marc Malkoff, medical director of the stroke program at UNM hospital.
Under this plan, neurologists from the UNM Hospital stroke program (and perhaps others in private practice) would be on 24-hour call to participating hospitals. ER staff would transmit CT or MRI scan films and other diagnostic data collected from stroke victims to the hub.
“The telemedicine system would effectively turn every hospital in the state into a primary stroke care center,” Malkoff said.”We could start with a pilot. This is doable.”
The technology is already available in most hospitals, he said.
Hospitals will need to hire a full-time employee to manage a database, but other costs can be shared, he said.
Based on the real-time data, the neurologist can then order the appropriate treatment. In many cases, the appropriate treatment will be intravenous tPA, he said. Also known as the “clot-busting drug,” recombinant tissue plasminogen activator (tPA) can save lives and greatly reduce the risk of disability caused by stroke, Malkoff said.
When administered within a window of three to four-and-half hours, tPA is the only proven treatment for acute stroke, he said.
The DOH and the Stroke Advisory Council have been working on a pilot telemedicine program that would involve UNM Hospital and four other hospitals in the state, according to Jennifer Witten, a member of the council and state healthcare alliance director for the American Heart Association. The program is still in the planning stages.
One of the hospitals, she said, would be in Las Cruces.
TOTALLY BACKWARDS
Dr. Dale Alverson, director of the Center for Telehealth and Cybermedicine Research at the UNM School of Medicine, believes change will come when health care consumers demand it.
“My sense is that the general public will start to demand it when they learn about the four-and-a-half hour window for [tPA] treatment,” he said. “If more consumers are aware, more pressure will be placed on the system to respond.”
However, the immediate issue appears to be money and organization.
Alverson said, “The value of a telemedicine or telestroke program is evident, but how do you pay for it? Where do we find the resources to build a telemedicine network?”
In addition to technical equipment, paperwork and staffing costs, the telemedicine system must be able to sustain itself in the long term, he said.
A business plan is needed to determine how different investors – healthcare providers, insurance companies, hospitals, the state – might share the cost. And an evaluation plan must show that people are being treated more effectively, he said.
However, Alverson said if you extrapolate the costs of not treating people for stroke, then it becomes obvious that a stroke prevention and telestroke program actually saves taxpayers money.
“Medicaid would rather pay for disability than prevention,” he said. “That’s totally backwards. The cost to society [because of disability] is tremendous.”
He also pointed out that currently New Mexicans pay $10 to $15 million per year in health-related travel costs alone. A telemedine system would not only save these costs, but reduce the incidence of injury and death due to travel.
Telemedicine is not the answer to everything, he said, but it will help prevent stroke and brain damage related to it.
Jeff Barnet is a reporter for the Sun-News’ Multimedia Targeted Division. He can be reached at (575) 541-5476.
Website: www.lcsun-news.com/las_cruces-health/ci_15220848