Racial/ethnic disparities in mortality among medicare beneficiaries in the FL-PR CReSD study

FL-R CReSD Investigators Collaborators

Research output: Contribution to journalArticlepeer-review

5 Scopus citations

Abstract

Background-—Racial/ethnic disparities in acute stroke care may impact stroke outcomes. We compared outcomes by race/ ethnicity among elderly Medicare beneficiaries in hospitals participating in the FL-PR CReSD (Florida–Puerto Rico Collaboration to Reduce Stroke Disparities) registry with those in hospitals not participating in any quality improvement programs (non-QI) in Florida and Puerto Rico (PR). Methods and Results-—The population included fee-for-service Medicare beneficiaries age 65+ in Florida and PR, discharged with primary diagnosis of ischemic stroke (International Classification of Diseases, Ninth Revision, Clinical Modification [ICD-9-CM], codes 433, 434, 436) in 2010–2013. We used mixed logistic models to assess racial/ethnic differences in outcomes (in-hospital, 30-day, and 1-year mortality, and 30-day readmission) for CReSD and non-QI hospitals, adjusted for demographic and clinical characteristics. The study included 62 CReSD hospitals (N=44 013, 84% white, 9% black, 4% Florida Hispanic, 1% PR Hispanic) and 113 non-QI hospitals (N=14 422, 78% white, 7% black, 5% Florida Hispanic, 8% PR Hispanic). For patients treated at CReSD hospitals, there were no differences in risk-adjusted in-hospital mortality by race/ethnicity; blacks had lower 30-day mortality versus whites (odds ratio, 0.86; 95% confidence interval, 0.77–0.97), but higher 30-day readmission (hazard ratio, 1.09; 1.00–1.18) and 1-year mortality (odds ratio, 1.13; 1.04–1.23); Florida Hispanics had lower 30-day readmission (hazard ratio, 0.87; 0.78–0.98). PR Hispanic and black stroke patients treated at non-QI hospitals had higher risk-adjusted in-hospital, 30-day and 1-year mortality, but similar 30-day readmission versus whites treated in non-QI hospitals. Conclusions-—Disparities in outcomes were less common in CReSD than non-QI hospitals, suggesting the benefits of quality improvement programs, particularly those focusing on racial/ethnic disparities.

Original languageEnglish (US)
Article numbere009649
JournalJournal of the American Heart Association
Volume8
Issue number1
DOIs
StatePublished - Jan 1 2019

Keywords

  • Disparities
  • Medicare
  • Mortality
  • Race and ethnicity
  • Stroke

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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