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

for the FL-PR CReSD Investigators and Collaborators

Research output: Contribution to journalArticle

9 Citations (Scopus)

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.

Original languageEnglish (US)
Article numbere004073
JournalJournal of the American Heart Association
Volume6
Issue number2
DOIs
StatePublished - 2017

Fingerprint

Puerto Rico
Stroke
Hispanic Americans
Quality Improvement
Registries
Logistic Models
Hydroxymethylglutaryl-CoA Reductase Inhibitors
Quality of Health Care
Tissue Plasminogen Activator
Smoking Cessation
Therapeutics
Ethnic Groups
Venous Thrombosis

Keywords

  • Cerebrovascular disease
  • Disparities
  • Ethnicity
  • Race

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Racial-ethnic disparities in acute stroke care in the Florida-Puerto Rico collaboration to reduce stroke disparities study. / for the FL-PR CReSD Investigators and Collaborators.

In: Journal of the American Heart Association, Vol. 6, No. 2, e004073, 2017.

Research output: Contribution to journalArticle

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title = "Racial-ethnic disparities in acute stroke care in the Florida-Puerto Rico collaboration to reduce stroke disparities study",
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.",
keywords = "Cerebrovascular disease, Disparities, Ethnicity, Race",
author = "{for the FL-PR CReSD Investigators and Collaborators} and Sacco, {Ralph L} and Hannah Gardener and Kefeng Wang and Chuanhui Dong and Ciliberti-Vargas, {Maria A.} and Gutierrez, {Carolina M.} and Negar Asdaghi and Burgin, {W. Scott} and Olveen Carrasquillo and Garcia-Rivera, {Enid J.} and Ulises Nobo and Sofia Oluwole and Rose, {David Z.} and Waters, {Michael F.} and Zevallos, {Juan Carlos} and Mary Robichaux and Waddy, {Salina P.} and Romano, {Jose G} and Tatjana Rundek and Acosta, {Indrani E.} and Peter Antevy and Bhuvaneswari Dandapani and Angel Davila and Sandra Diaz-Acosta and Kathy Fenelon and Antonio Gandia and Gonzalez-Sanchez, {Juan A.} and Ricardo Hanel and Jonathan Harris and Wayne Hodges and Dianne Foster and Bruce Inverso and Roman, {Carlos Luciano} and Brijesh Mehta and Julia Mora and Nils Mueller-Kronast and Terry Neill and Joe Nelson and Abiezer Rodriguez and Julio Rodriguez-Colon and Charles Sand and Rhoda Saunders and Jeffrey Walker and Yavagal, {Dileep R}",
year = "2017",
doi = "10.1161/JAHA.116.004073",
language = "English (US)",
volume = "6",
journal = "Journal of the American Heart Association",
issn = "2047-9980",
publisher = "Wiley-Blackwell",
number = "2",

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T1 - Racial-ethnic disparities in acute stroke care in the Florida-Puerto Rico collaboration to reduce stroke disparities study

AU - for the FL-PR CReSD Investigators and Collaborators

AU - Sacco, Ralph L

AU - Gardener, Hannah

AU - Wang, Kefeng

AU - Dong, Chuanhui

AU - Ciliberti-Vargas, Maria A.

AU - Gutierrez, Carolina M.

AU - Asdaghi, Negar

AU - Burgin, W. Scott

AU - Carrasquillo, Olveen

AU - Garcia-Rivera, Enid J.

AU - Nobo, Ulises

AU - Oluwole, Sofia

AU - Rose, David Z.

AU - Waters, Michael F.

AU - Zevallos, Juan Carlos

AU - Robichaux, Mary

AU - Waddy, Salina P.

AU - Romano, Jose G

AU - Rundek, Tatjana

AU - Acosta, Indrani E.

AU - Antevy, Peter

AU - Dandapani, Bhuvaneswari

AU - Davila, Angel

AU - Diaz-Acosta, Sandra

AU - Fenelon, Kathy

AU - Gandia, Antonio

AU - Gonzalez-Sanchez, Juan A.

AU - Hanel, Ricardo

AU - Harris, Jonathan

AU - Hodges, Wayne

AU - Foster, Dianne

AU - Inverso, Bruce

AU - Roman, Carlos Luciano

AU - Mehta, Brijesh

AU - Mora, Julia

AU - Mueller-Kronast, Nils

AU - Neill, Terry

AU - Nelson, Joe

AU - Rodriguez, Abiezer

AU - Rodriguez-Colon, Julio

AU - Sand, Charles

AU - Saunders, Rhoda

AU - Walker, Jeffrey

AU - Yavagal, Dileep R

PY - 2017

Y1 - 2017

N2 - 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.

AB - 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.

KW - Cerebrovascular disease

KW - Disparities

KW - Ethnicity

KW - Race

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