Race/Ethnicity, Quality of Care, and Outcomes in Ischemic Stroke

Schwamm, Lee H.; Reeves, Mathew J.; Pan, Wenqin; Smith, Eric E.; Frankel, Michael; Olson, DaiWai M.; Zhao, Xin; Peterson, Eric D.; Fonarow, Gregg C.

doi:10.1161/circulationaha.109.881490

Cited by 234 publications

(250 citation statements)

References 37 publications

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“…GWTG‐Stroke, when linked to administrative data, provides a unique opportunity to systematically characterize patients’ linguistic needs, understand how they are met, and identify their influence on patients’ care and outcomes. Second, our study results expand our knowledge of racial and socioeconomic factors associated with stroke care disparities, reinforcing that we need to better understand and address the social determinants of stroke care and outcomes 40, 41, 42, 43, 44, 45, 46, 47, 48, 49, 50, 51. The Office of Minority Health provides a framework for healthcare systems to meet patient linguistic needs through the National Standards for Culturally and Linguistically Appropriate Services in Health Care 52.…”

Section: Discussionmentioning

confidence: 61%

Professional Medical Interpreters Influence the Quality of Acute Ischemic Stroke Care for Patients Who Speak Languages Other than English

Erfe

Siddiqui

Schwamm

et al. 2017

JAHA

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BackgroundThe inability to communicate effectively in a common language can jeopardize clinicians’ efforts to provide quality patient care. Professional medical interpreters (PMIs) can help provide linguistically appropriate health care, in particular for the >25 million Americans who identify speaking English less than very well. We aimed to evaluate the relationship between use of PMIs and quality of acute ischemic stroke care received by patients who preferred to have their medical care in languages other than English.Methods and ResultsWe analyzed data from 259 non–English‐preferring acute ischemic stroke patients who participated in the American Heart Association Get With The Guidelines–Stroke program at our hospital from January 1, 2003, to April 30, 2014. We used descriptive statistics and logistic regression models to examine associations between involvement of PMIs and patients’ receipt of defect‐free stroke care. A total of 147 of 259 (57%) non–English‐preferring patients received PMI services during their hospital stays. Multivariable analyses adjusting for other socioeconomic factors showed that acute ischemic stroke patients who did not receive PMIs had lower odds of receiving defect‐free stroke care (odds ratio: 0.52; P=0.04).ConclusionsOur findings suggest that PMIs may influence the quality of acute ischemic stroke care.

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Section: Discussionmentioning

confidence: 61%

Professional Medical Interpreters Influence the Quality of Acute Ischemic Stroke Care for Patients Who Speak Languages Other than English

Erfe

Siddiqui

Schwamm

et al. 2017

JAHA

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“…A large study using Get with the Guidelines database for 1181 hospitals examined the quality of ischemic stroke care received by blacks, whites, and Hispanic stroke patients for a 5-year time span [82]. The study found that blacks received fewer evidencebased care processes than Hispanic or white patients, including lower odds of receiving intravenous thrombolysis, deep vein thrombosis prophylaxis, smoking cessation, discharge anti-thrombotics, anticoagulation for atrial fibrillation, and lipid-lowering therapy.…”

Section: Effect Of Race Ethnicity On Outcomesmentioning

confidence: 99%

Stroke Epidemiology: Advancing Our Understanding of Disease Mechanism and Therapy

2011

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Stroke is the fourth killer and number one cause of adult disability in the United States. The estimated direct and indirect costs of stroke care in this country are $68.9 billion for 2009. The prevalence of stroke and its cost will undoubtedly rise as the aging population increases. In addition, stroke incidence and mortality are increasing in less developed countries in which the lifestyles and population restructuring are rapidly changing. More population-based research to assess incidence, risk factors, and outcomes are needed in these countries. Epidemiologic studies can help identify groups of individuals or regions at higher risk for stroke. They can also help us better understand the natural history of certain conditions and therefore push the direction of therapeutic investigations. Furthermore, the study of trends across different time periods and different populations can help investigators evaluate the effects of stroke care programs and treatment options.

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“…In one large nationwide population sample, Nasr et al found lower rates of rt‐PA use for Hispanics 24. In a separate study, Hispanic patients had equivalent odds of receiving therapy as white patients 27. Recognizing the limited and inconsistent evidence concerning stroke and racial disparities, the American Heart Association/American Stroke Association recommended further research on this important topic 28…”

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confidence: 99%

Racial Disparities in Intravenous Recombinant Tissue Plasminogen Activator Use Persist at Primary Stroke Centers

Aparicio

Carr

Kasner

et al. 2015

JAHA

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BackgroundPrimary stroke centers (PSCs) utilize more recombinant tissue plasminogen activator (rt‐PA) than non‐PSCs. The impact of PSCs on racial disparities in rt‐PA use is unknown.Methods and ResultsWe used data from the Nationwide Inpatient Sample from 2004 to 2010, limited to states that publicly reported hospital identity and race. Hospitals certified as PSCs by The Joint Commission were identified. Adults with a diagnosis of ischemic stroke were analyzed. Rt‐PA use was defined by the International Classification of Diseases, 9th Revision procedure code 99.10. Discharges (304 152 patients) from 26 states met eligibility criteria, and of these 71.5% were white, 15.0% black, 7.9% Hispanic, and 5.6% other. Overall, 24.7% of white, 27.4% of black, 16.2% of Hispanic, and 29.8% of other patients presented to PSCs. A higher proportion received rt‐PA at PSCs than non‐PSCs in all race/ethnic groups (white 7.6% versus 2.6%, black 4.8% versus 2.0%, Hispanic 7.1% versus 2.4%, other 7.2% versus 2.5%, all P<0.001). In a multivariable model adjusting for year, age, sex, insurance, medical comorbidities, a diagnosis‐related group–based mortality risk indicator, ZIP code median income, and hospital characteristics, blacks were less likely to receive rt‐PA than whites at non‐PSCs (odds ratio=0.58, 95% CI 0.50 to 0.67) and PSCs (odds ratio=0.63, 95% CI 0.54 to 0.74) and Hispanics were less likely than whites to receive rt‐PA at PSCs (odds ratio=0.77, 95% CI: 0.63 to 0.95). In the fully adjusted model, interaction between race and presentation to a PSC for likelihood of receiving rt‐PA did not reach significance (P=0.98).ConclusionsRacial disparities in intravenous rt‐PA use were not reduced by presentation to PSCs. Black patients were less likely to receive thrombolytic treatment than white patients at both non‐PSCs and PSCs. Hispanic patients were less likely to be seen at PSCs relative to white patients and were less likely to receive intravenous rt‐PA in the fully adjusted model.

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Race/Ethnicity, Quality of Care, and Outcomes in Ischemic Stroke

Cited by 234 publications

References 37 publications

Professional Medical Interpreters Influence the Quality of Acute Ischemic Stroke Care for Patients Who Speak Languages Other than English

Professional Medical Interpreters Influence the Quality of Acute Ischemic Stroke Care for Patients Who Speak Languages Other than English

Stroke Epidemiology: Advancing Our Understanding of Disease Mechanism and Therapy

Racial Disparities in Intravenous Recombinant Tissue Plasminogen Activator Use Persist at Primary Stroke Centers

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