Racial‐Ethnic Disparities in Acute Stroke Care in the Florida‐Puerto Rico Collaboration to Reduce Stroke Disparities Study
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Published:2017-02-02
Issue:2
Volume:6
Page:
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ISSN:2047-9980
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Container-title:Journal of the American Heart Association
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language:en
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Short-container-title:JAHA
Author:
Sacco Ralph L.1, Gardener Hannah1, Wang Kefeng1, Dong Chuanhui1, Ciliberti‐Vargas Maria A.1, Gutierrez Carolina M.1, Asdaghi Negar1, Burgin W. Scott2, Carrasquillo Olveen1, Garcia‐Rivera Enid J.3, Nobo Ulises4, Oluwole Sofia1, Rose David Z.2, Waters Michael F.5, Zevallos Juan Carlos6, Robichaux Mary7, Waddy Salina P.8, Romano Jose G.1, Rundek Tatjana1, Acosta Indrani E., Antevy Peter, Dandapani Bhuvaneswari, Davila Angel, Diaz‐Acosta Sandra, Fenelon Kathy, Gandia Antonio, Gonzalez‐Sanchez Juan A., Hanel Ricardo, Harris Jonathan, Hodges Wayne, Foster Dianne, Inverso Bruce, Luciano Roman Carlos, Mehta Brijesh, Mora Julia, Mueller‐Kronast Nils, Neill Terry, Nelson Joe, Rodriguez Abiezer, Rodriguez‐Colon Julio, Sand Charles, Saunders Rhoda, Walker Jeffrey, Yavagal Dileep,
Affiliation:
1. University of Miami Miller School of Medicine, Miami, FL 2. University of South Florida Morsani College of Medicine, Tampa, FL 3. University of Puerto Rico School of Medicine, San Juan, Puerto Rico 4. Hospital HIMA San Pablo, Caguas, Puerto Rico 5. Barrow Neurological Institute, Phoenix, AZ 6. Florida International University Herbert Wertheim College of Medicine, Miami, FL 7. American Heart Association, Marietta, GA 8. National Institute of Neurological Disorders and Stroke, Bethesda, MD
Abstract
Background
Racial‐ethnic disparities in acute stroke care can contribute to inequality in stroke outcomes. We examined race‐ethnic disparities in acute stroke performance metrics in a voluntary stroke registry among Florida and Puerto Rico Get With the Guidelines‐Stroke hospitals.
Methods and Results
Seventy‐five sites in the Florida Puerto Rico Stroke Registry (66 Florida and 9 Puerto Rico) recorded 58 864 ischemic stroke cases (2010–2014). Logistic regression models examined racial‐ethnic differences in acute stroke performance measures and defect‐free care (intravenous tissue plasminogen activator treatment, in‐hospital antithrombotic therapy, deep vein thrombosis prophylaxis, discharge antithrombotic therapy, appropriate anticoagulation therapy, statin use, smoking cessation counseling) and temporal trends. Among ischemic stroke cases, 63% were non‐Hispanic white (
NHW
), 18% were non‐Hispanic black (
NHB
), 14% were Hispanic living in Florida, and 6% were Hispanic living in Puerto Rico.
NHW
patients were the oldest, followed by Hispanics, and
NHB
s. Defect‐free care was greatest among
NHBs
(81%), followed by
NHWs
(79%) and Florida Hispanics (79%), then Puerto Rico Hispanics (57%) (
P
<0.0001). Puerto Rico Hispanics were less likely than Florida whites to meet any stroke care performance metric other than anticoagulation. Defect‐free care improved for all groups during 2010–2014, but the disparity in Puerto Rico persisted (2010:
NHWs
=63%,
NHBs
=65%, Florida Hispanics=59%, Puerto Rico Hispanics=31%; 2014:
NHWs
=93%,
NHBs
=94%, Florida Hispanics=94%, Puerto Rico Hispanics=63%).
Conclusions
Racial‐ethnic/geographic disparities were observed for acute stroke care performance metrics. Adoption of a quality improvement program improved stroke care from 2010 to 2014 in Puerto Rico and all Florida racial‐ethnic groups. However, stroke care quality delivered in Puerto Rico is lower than in Florida. Sustained support of evidence‐based acute stroke quality improvement programs is required to improve stroke care and minimize racial‐ethnic disparities, particularly in resource‐strained Puerto Rico.
Publisher
Ovid Technologies (Wolters Kluwer Health)
Subject
Cardiology and Cardiovascular Medicine
Cited by
39 articles.
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