Original Article
Are Racial Disparities in Stroke Care Still Prevalent in Certified Stroke Centers?

https://doi.org/10.1016/j.jstrokecerebrovasdis.2011.09.018Get rights and content

Racial differences in stroke risk and risk factor prevalence are well established. The present study explored racial differences in the delivery of care to patients with acute stroke between Joint Commission (JC)-certified hospitals and noncertified hospitals. A retrospective chart review was conducted in patients sustaining ischemic stroke admitted to 5 JC-certified centers and 5 noncertified hospitals. Demographic data, risk factors, utilization of acute stroke therapies, and compliance with core measures were recorded. Racial disparities were investigated in the entire group as well as for JC-certified and noncertified hospitals separately. A total of 574 patients (25.1% African Americans) were included. African Americans were significantly younger and more likely to have previous stroke, whereas Caucasians were more likely to have coronary disease and atrial fibrillation. There were no racial differences in other risk factors or baseline functions. Median National Institutes of Health Stroke Scale scores were similar in African Americans and Caucasians, as were proportions receiving intravenous tissue plasminogen activator (tPA) therapy (2.1% in African Americans, 3.5% in Caucasians; P = .40) and intervention (4.2% in African Americans, 6.8% in Caucasians; P = .26). Caucasians were more likely to arrive by emergency medical services (65.5% vs 51.5%; P = .004), to be evaluated by a stroke team (19.1% vs 7.7%; P = .001), and to have a documented National Institutes of Health Stroke Scale score (40.2% vs 29.9%; P = .03). African Americans often did not receive intravenous tPA because of a delay in arrival. African Americans performed better on virtually all stroke care variables in JC-certified centers. JC certification reduced disparity in certain variables, including tPA and deep venous thrombosis prophylaxis administration. Important racial disparities exist in the delivery of several acute stroke care variables. Efforts must be focused on eliminating disparities in prehospital delays. Guideline-based care tendered at JC-certified centers might help narrow disparities in acute stroke care delivery.

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

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    Funded by the Blue Cross and Blue Shield Foundation of Michigan.

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