title: Barriers and facilitators to implementing primary stroke center policy in the United States: results from 4 case study states.
abstract: OBJECTIVE
  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.
authors.affiliation: Department of Public Administration and Policy, School of Public and International Affairs, University of Georgia, Athens, GA 30602, USA. cmsotool@uga.edu
authors.forename: Laurence J
authors.initials: LJ
authors.lastname: O'Toole
authors.forename: Catherine P
authors.initials: CP
authors.lastname: Slade
authors.forename: Gene A
authors.initials: GA
authors.lastname: Brewer
authors.forename: Lauren N
authors.initials: LN
authors.lastname: Gase
mesh_terms: D005431:Florida / Q000453:epidemiology; D006291:Health Policy; D006801:Humans; D008404:Massachusetts / Q000453:epidemiology; D009516:New Mexico / Q000453:epidemiology; D009518:New York / Q000453:epidemiology; D020521:Stroke / Q000453:epidemiology / Q000517:prevention & control*; D014481:United States / Q000453:epidemiology