Are racial disparities in stroke care still prevalent in certified stroke centers?

J Stroke Cerebrovasc Dis. 2013 May;22(4):383-8. doi: 10.1016/j.jstrokecerebrovasdis.2011.09.018. Epub 2011 Nov 10.

Abstract

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.

Publication types

  • Comparative Study
  • Multicenter Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • African Americans*
  • Aged
  • Delivery of Health Care, Integrated* / standards
  • Emergency Medical Services
  • Endovascular Procedures
  • European Continental Ancestry Group*
  • Female
  • Guideline Adherence
  • Health Services Accessibility* / standards
  • Healthcare Disparities / ethnology*
  • Healthcare Disparities / standards
  • Humans
  • Joint Commission on Accreditation of Healthcare Organizations*
  • Logistic Models
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Odds Ratio
  • Patient Care Team
  • Practice Guidelines as Topic
  • Practice Patterns, Physicians'
  • Prevalence
  • Quality of Health Care* / standards
  • Retrospective Studies
  • Risk Factors
  • Stroke / diagnosis
  • Stroke / ethnology
  • Stroke / therapy*
  • Thrombolytic Therapy
  • United States / epidemiology