Racial-ethnic disparities in acute stroke care in the Florida-Puerto Rico collaboration to reduce stroke disparities study Article

Sacco, RL, Gardener, H, Wang, K et al. (2017). Racial-ethnic disparities in acute stroke care in the Florida-Puerto Rico collaboration to reduce stroke disparities study . 6(2), 10.1161/JAHA.116.004073



cited authors

  • Sacco, RL; Gardener, H; Wang, K; Dong, C; Ciliberti-Vargas, MA; Gutierrez, CM; Asdaghi, N; Burgin, WS; Carrasquillo, O; Garcia-Rivera, EJ; Nobo, U; Oluwole, S; Rose, DZ; Waters, MF; Zevallos, JC; Robichaux, M; Waddy, SP; Romano, JG; Rundek, T; Acosta, IE; Antevy, P; Dandapani, B; Davila, A; Diaz-Acosta, S; Fenelon, K; Gandia, A; Gonzalez-Sanchez, JA; Hanel, R; Harris, J; Hodges, W; Foster, D; Inverso, B; Roman, CL; Mehta, B; Mora, J; Mueller-Kronast, N; Neill, T; Nelson, J; Rodriguez, A; Rodriguez-Colon, J; Sand, C; Saunders, R; Walker, J; Yavagal, D

fiu authors

abstract

  • Background-Racial-ethnic disparities in acute stroke care can contribute to inequality in stroke outcomes. We examined raceethnic 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 NHBs. 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.

publication date

  • January 1, 2017

Digital Object Identifier (DOI)

volume

  • 6

issue

  • 2