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The relationship between stroke system organization and disparities in access to stroke center care in California

BACKGROUND: There are significant racial and ethnic disparities in receipt of reperfusion interventions for acute ischemic stroke. Our objective was to determine whether there are disparities in access to stroke center care by race or ethnicity that help explain differences in reperfusion therapy an...

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Autores principales: Zachrison, Kori S., Samuels‐Kalow, Margaret E., Li, Sijia, Yan, Zhiyu, Reeves, Mathew J., Hsia, Renee Y., Schwamm, Lee H., Camargo, Carlos A.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: John Wiley and Sons Inc. 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8921441/
https://www.ncbi.nlm.nih.gov/pubmed/35316966
http://dx.doi.org/10.1002/emp2.12706
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author Zachrison, Kori S.
Samuels‐Kalow, Margaret E.
Li, Sijia
Yan, Zhiyu
Reeves, Mathew J.
Hsia, Renee Y.
Schwamm, Lee H.
Camargo, Carlos A.
author_facet Zachrison, Kori S.
Samuels‐Kalow, Margaret E.
Li, Sijia
Yan, Zhiyu
Reeves, Mathew J.
Hsia, Renee Y.
Schwamm, Lee H.
Camargo, Carlos A.
author_sort Zachrison, Kori S.
collection PubMed
description BACKGROUND: There are significant racial and ethnic disparities in receipt of reperfusion interventions for acute ischemic stroke. Our objective was to determine whether there are disparities in access to stroke center care by race or ethnicity that help explain differences in reperfusion therapy and to understand whether interhospital patient transfer plays a role in improving access. METHODS: Using statewide administrating data including all emergency department and hospital discharges in California from 2010 to 2017, we identified all acute ischemic stroke patients. Primary outcomes of interest included presentation to primary or comprehensive stroke center (PSC or CSC), interhospital transfer, discharge from PSC or CSC, and discharge from CSC alone. We used hierarchical logistic regression modeling to identify the relationship between patient‐ and hospital‐level characteristics and outcomes of interest. RESULTS: Of 336,247 ischemic stroke patients, 55.4% were non‐Hispanic White, 19.6% Hispanic, 10.6% non‐Hispanic Asian/Pacific Islander, and 10.3% non‐Hispanic Black. There was no difference in initial presentation to stroke center hospitals between groups. However, adjusted odds of reperfusion intervention, interhospital transfer and discharge from CSC did vary by race and ethnicity. Adjusted odds of interhospital transfer were lower among Hispanic (odds ratio [OR] 0.94, 95% confidence interval [CI] 0.89 to 0.98) and non‐Hispanic Asian/Pacific Islander patients (OR 0.84, 95% CI 0.79 to 0.90) and odds of discharge from a CSC were lower for Hispanic (OR 0.91, 95% CI 0.85 to 0.97) and non‐Hispanic Black patients (OR 0.74, 95% CI 0.67 to 0.81). CONCLUSIONS: There are racial and ethnic disparities in reperfusion intervention receipt among stroke patients in California. Stroke system of care design, hospital resources, and transfer patterns may contribute to this disparity.
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spelling pubmed-89214412022-03-21 The relationship between stroke system organization and disparities in access to stroke center care in California Zachrison, Kori S. Samuels‐Kalow, Margaret E. Li, Sijia Yan, Zhiyu Reeves, Mathew J. Hsia, Renee Y. Schwamm, Lee H. Camargo, Carlos A. J Am Coll Emerg Physicians Open Neurology BACKGROUND: There are significant racial and ethnic disparities in receipt of reperfusion interventions for acute ischemic stroke. Our objective was to determine whether there are disparities in access to stroke center care by race or ethnicity that help explain differences in reperfusion therapy and to understand whether interhospital patient transfer plays a role in improving access. METHODS: Using statewide administrating data including all emergency department and hospital discharges in California from 2010 to 2017, we identified all acute ischemic stroke patients. Primary outcomes of interest included presentation to primary or comprehensive stroke center (PSC or CSC), interhospital transfer, discharge from PSC or CSC, and discharge from CSC alone. We used hierarchical logistic regression modeling to identify the relationship between patient‐ and hospital‐level characteristics and outcomes of interest. RESULTS: Of 336,247 ischemic stroke patients, 55.4% were non‐Hispanic White, 19.6% Hispanic, 10.6% non‐Hispanic Asian/Pacific Islander, and 10.3% non‐Hispanic Black. There was no difference in initial presentation to stroke center hospitals between groups. However, adjusted odds of reperfusion intervention, interhospital transfer and discharge from CSC did vary by race and ethnicity. Adjusted odds of interhospital transfer were lower among Hispanic (odds ratio [OR] 0.94, 95% confidence interval [CI] 0.89 to 0.98) and non‐Hispanic Asian/Pacific Islander patients (OR 0.84, 95% CI 0.79 to 0.90) and odds of discharge from a CSC were lower for Hispanic (OR 0.91, 95% CI 0.85 to 0.97) and non‐Hispanic Black patients (OR 0.74, 95% CI 0.67 to 0.81). CONCLUSIONS: There are racial and ethnic disparities in reperfusion intervention receipt among stroke patients in California. Stroke system of care design, hospital resources, and transfer patterns may contribute to this disparity. John Wiley and Sons Inc. 2022-03-14 /pmc/articles/PMC8921441/ /pubmed/35316966 http://dx.doi.org/10.1002/emp2.12706 Text en © 2022 The Authors. JACEP Open published by Wiley Periodicals LLC on behalf of American College of Emergency Physicians https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc-nd/4.0/ (https://creativecommons.org/licenses/by-nc-nd/4.0/) License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made.
spellingShingle Neurology
Zachrison, Kori S.
Samuels‐Kalow, Margaret E.
Li, Sijia
Yan, Zhiyu
Reeves, Mathew J.
Hsia, Renee Y.
Schwamm, Lee H.
Camargo, Carlos A.
The relationship between stroke system organization and disparities in access to stroke center care in California
title The relationship between stroke system organization and disparities in access to stroke center care in California
title_full The relationship between stroke system organization and disparities in access to stroke center care in California
title_fullStr The relationship between stroke system organization and disparities in access to stroke center care in California
title_full_unstemmed The relationship between stroke system organization and disparities in access to stroke center care in California
title_short The relationship between stroke system organization and disparities in access to stroke center care in California
title_sort relationship between stroke system organization and disparities in access to stroke center care in california
topic Neurology
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8921441/
https://www.ncbi.nlm.nih.gov/pubmed/35316966
http://dx.doi.org/10.1002/emp2.12706
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