Background and Purpose: Demographic disparities in proximity to stroke care influence time to treatment and clinical outcome but remain understudied at the national level. This study quantifies the relationship between distance to the nearest certified stroke hospital and census-derived demographics. Methods: This cross-sectional study included population data by census tract from the United States Census Bureau’s 2014–2018 American Community Survey, stroke hospitals certified by a state or national body and providing intravenous thrombolysis, and geographic data from a public mapping service. Data were retrieved from March to November 2020. Quantile regression analysis was used to compare relationships between road distance to the nearest stroke center for each census tract and tract-level demographics of age, race, ethnicity, medical insurance status, median annual income, and population density. Results: Two thousand three hundred eighty-eight stroke centers and 71 929 census tracts including 316 995 649 individuals were included. Forty-nine thousand nine hundred eighteen (69%) tracts were urban. Demographic disparities in proximity to certified stroke care were greater in nonurban areas than urban areas. Higher representation of individuals with age ≥65 years was associated with increased median distance to a certified stroke center in nonurban areas (0.51 km per 1% increase [99.9% CI, 0.42–0.59]) but not in urban areas (0.00 km [−0.01 to 0.01]). In urban and nonurban tracts, median distance was greater with higher representation of American Indian (urban: 0.10 km per 1% increase [0.06–0.14]; nonurban: 1.06 km [0.98–1.13]) or uninsured populations (0.02 km [0.00–0.03]; 0.27 km [0.15–0.38]). Each $10 000 increase in median income was associated with a decrease in median distance of 5.04 km [4.31–5.78] in nonurban tracts, and an increase of 0.17 km [0.10–0.23] in urban tracts. Conclusions: Disparities were greater in nonurban areas than in urban areas. Nonurban census tracts with greater representation of elderly, American Indian, or uninsured people, or low median income were substantially more distant from certified stroke care.
BackgroundThe emergence of dissemination and implementation (D&I) science has driven a rapid increase in studies of how new scientific discoveries are translated and developed into evidence-based programs and policies. However, D&I science has paid much less attention to what happens to programs once they have been implemented. Public health programs can only deliver benefits if they reach maturity and sustain activities over time. In order to achieve the full benefits of significant investment in public health research and program development, there must be an understanding of the factors that relate to sustainability to inform development of tools and trainings to support strategic long-term program sustainability. Tobacco control programs, specifically, vary in their abilities to support and sustain themselves over time. As of 2018, most states still do not meet the CDC-recommended level for funding their TC program, allowing tobacco use to remain the leading cause of preventable disease and death in the USA. The purpose of this study is to empirically develop, test, and disseminate training programs to improve the sustainability of evidence-based state tobacco control programs and thus, tobacco-related health outcomes.MethodsThis paper describes the methods of a group randomized, multi-phase study that evaluates the empirically developed “Program Sustainability Action Planning Training” and technical assistance in US state-level tobacco control programs. Phase 1 includes developing the sustainability action planning training curriculum and technical assistance protocol and developing measures to assess long-term program sustainability. Phase 2 includes a group randomized trial to test the effectiveness of the training and technical assistance in improving sustainability outcomes in 24 state tobacco control programs (12 intervention, 12 comparison). Phase 3 includes the active dissemination of final training curricula materials to a broader public health audience.DiscussionEmpirical evidence has established that program sustainability can improve through training and technical assistance; however, to our knowledge, no evidence-based sustainability training curriculum program exists. Therefore, systematic methods are needed to develop, test, and disseminate a training that improves the sustainability of evidence-based programs.Trial registrationNCT03598114. Registered 25 July 2018—retrospectively registered.
the majority of the literature has insufficient data on radiation dose exposure and patient-reported outcome comparisons between these two approaches. Methods We retrospectively analyzed 198 patients who underwent diagnostic cerebral angiograms (DCA) at a community hospital from 5/1/2018 to 11/31/2020 during the initial phase of adopting a TRA-first approach. Patients were grouped into two cohorts: TRA (n=49) and TFA (n=149). We compared radiation exposure parameters (total fluoroscopy time (FT), total radiation dose (TD), and dose area product (DAP), number of vessels injected, and patient-reported Global Health physical and mental outcome Scores (PRO GHS) at 30 days post-procedure. Also, a second radiation exposure comparative analysis was performed among patients who received a complete 6-vessel DCA. Results Fluoroscopy time was significantly greater in TRA compared with TFA (15.5 min vs. 10.5 min; p < 0.001). In addition, TRA had a significantly higher total dose (286 mGy vs. 220.3 mGy; p = 0.027) and dose area product (3300.2 mGym 2 vs. 2442 mGym 2 ; p = 0.027) when compared with TFA. Analysis of only 6-vessel DCAs also showed that TRA had a significantly higher FT (18.4 vs 11, p<0.001), DAP (3868 vs 2604, p=0.01), and TD (308.65 vs 224.5, p=0.01) in comparison to TFA.Despite observing a longer FT in TRA, results showed fewer vessels injected (TRA vs TFA; 5 vs 6, p=0.031), and a notably lower success rate in acquiring a 6-P-038
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