Original ArticleAre Racial Disparities in Stroke Care Still Prevalent in Certified Stroke Centers?
Section snippets
Methods
This study was originally designed to compare ischemic stroke care practices between JC-certified and noncertified hospitals. In this article we report the findings of a prespecified analysis as part of the project. Institutional review board approval was obtained from each participating hospital site.
Five JC-certified and 5 noncertified hospitals in Michigan were selected for the study. The JC-certified hospitals were selected from the largest cities in the state. For each JC-certified
Results
A total of 602 patient charts were abstracted from 10 hospitals (61 charts instead of 60 were abstracted at 2 JC-certified hospitals). Of these, 574 patients with self-reported African American (n = 144) or Caucasian (n = 430) race were included in the present analysis, and 28 patients (1 Native American, 3 Hispanics, 3 Asians, 3 others, and 18 unknown) were excluded. The study group was 46.7% male (n = 268) and 53.3% female (n = 306). The male:female distribution was similar for both races. A
Discussion
The primary results of the present study highlight two aspects of stroke care that can be improved. First, the results confirm a racial disparity in the timeliness of arrival to the ED after the onset of stroke symptoms. More importantly, this delay in arrival explains some of the racial disparity in subsequent stroke care. Second, compliance with core measures for stroke care is better at JC-certified centers compared with noncertified centers. This improved performance is more pronounced
References (24)
- et al.
Racial/ethnic disparities in emergency department waiting time for stroke patients in the United States
J Stroke Cerebrovasc Dis
(2011) - et al.
Disparities in stroke symptomology knowledge among US midlife women: An analysis of population survey data
J Stroke Cerebrovasc Dis
(2009) - et al.
Racial-ethnic disparities in stroke care: The American experience. A statement for healthcare professionals from the American Heart Association/American Stroke Association
Stroke
(2011) - et al.
Heart disease and stroke statistics—2011 update: A report from the American Heart Association
Circulation
(2011) - et al.
Stroke incidence is decreasing in whites but not in blacks: A population-based estimate of temporal trends in stroke incidence from the Greater Cincinnati/Northern Kentucky Stroke Study
Stroke
(2010) - et al.
Racial and geographic differences in awareness, treatment, and control of hypertension: The REasons for Geographic and Racial Differences in Stroke Study
Stroke
(2006) - et al.
Full accounting of diabetes and pre-diabetes in the US population in 1988-1994 and 2005-2006
Diabetes Care
(2009) - et al.
Prevalence and trends in obesity among US adults, 1999-2008
JAMA
(2010) - et al.
Geographic patterns in overall and specific cardiovascular disease incidence in apparently healthy men in the United States
Stroke
(2007) - et al.
Racial/ethnic disparities in mortality by stroke subtype in the United States, 1995-1998
Am J Epidemiol
(2001)
Differences in disability among black and white stroke survivors—United States, 2000–2001
MMWR Morb Mortal Wkly Rep
Population projections of the United States by age, sex, race and Hispanic origin: 1995 to 2050. US Bureau of the Census, Current Population Reports P25–1130
Cited by (32)
Striving for Socioeconomic Equity in Ischemic Stroke Care: Imaging and Acute Treatment Utilization From a Comprehensive Stroke Center
2022, Journal of the American College of RadiologyLack of Racial, Ethnic, and Sex Disparities in Ischemic Stroke Care Metrics within a Tele-Stroke Network
2021, Journal of Stroke and Cerebrovascular DiseasesCitation Excerpt :NHB, NHW, and HIS patients arrived in the ED in a similar timeframe from the time they were last known well. This finding contradicts with several prior studies on non-telestroke settings, which have shown increased onset of symptoms to ED arrival time for Black patients.18,20-23 Arriving to the ED within the accepted treatment time window for tPA could potentially have accounted for the comparable metrics of tPA treatment.
The association between self-declared acute care surgery services and critical care resources: Results from a national survey
2020, Journal of Critical CareCitation Excerpt :Thus, our findings suggest that ACS models were they to be implemented within a larger regionalized approach to EGS care present an opportunity to overcome local critical care restraints through defined processes for triage and transfer. When the same approach has been taken for patients with other unexpected need for emergency care due to traumatic injury, suspected myocardial infarction, and possible cerebrovascular accident, outcomes have improved [24-34]. A study from the Michigan Quality Collaborative with overall 30-day mortality of 4.1% reported that an ACS model of care, compared to a GSOC model, was associated with a 31% decrease in EGS mortality [35].
The impact of ethnic/racial status on access to care and outcomes after stroke: A narrative systematic review
2019, Journal of Vascular NursingCitation Excerpt :Though not widely studied, other outcomes related to care access were examined in 4 of the reviewed studies. Blacks were less likely to 1) be evaluated at primary stroke centers if rural-living or lived in the “stroke belt”17; 2) have a National Institutes of Health Stroke Scale assessment performed and documented at non–Joint Commission–certified hospitals31; 3) receive occupational or physiotherapy independent of age or stroke severity28; or 4) receive deep vein thrombosis prophylaxis, discharge anti-thrombotics, anticoagulants for atrial fibrillation, lipid-lowering therapy, or smoking cessation treatment,37 relative to whites. Though not clear, these concerns may be related to place of residence and socioeconomic status.
Disparities in access to emergency general surgery care in the United States
2018, Surgery (United States)Socioeconomic disparities in the utilization of mechanical thrombectomy for acute ischemic stroke
2014, Journal of Stroke and Cerebrovascular Diseases
Funded by the Blue Cross and Blue Shield Foundation of Michigan.