Racial‐Ethnic Disparities in Acute Stroke Care in the Florida‐Puerto Rico Collaboration to Reduce Stroke Disparities Study

Abstract

BackgroundRacial‐ethnic disparities in acute stroke care can contribute to inequality in stroke outcomes. We examined race‐ethnic disparities in acute stroke performance metrics in a voluntary stroke registry among Florida and Puerto Rico Get With the Guidelines‐Stroke hospitals.Methods and ResultsSeventy‐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%).ConclusionsRacial‐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.

Stroke Hospital Characteristics in the Florida–Puerto Rico Collaboration to Reduce Stroke Disparities Study

“…In addition to fewer years in the GWTG-S program, differences among PR hospitals, primarily in stroke center certification and the implementation of acute stroke care practices (eg, designated stroke team, stroke care protocols, availability of neurological services), may contribute to identified disparities showing worse performance in all GWTG-S predefined stroke performance metrics among patients in Puerto Rico compared with those in Florida overall. 5 Despite absolute improvements over time, the rate of defect-free care was consistently lower in Puerto Rico compared with Florida, regardless of race-ethnicity, as shown in Figure 2. 6 The widening gap in stroke care between Florida and Puerto Rico further underscores the need for increased healthcare resources in Puerto Rico and continued monitoring of disparities in various metrics of stroke care.…”

Updated Criteria for Population-Based Stroke and Transient Ischemic Attack Incidence Studies for the 21st Century

“…1 There have also been noticeable changes in stroke epidemiology, including diverging trends in stroke incidence and mortality rates in high-income and low to middle-income countries, 2 disproportionally increasing burden of stroke in developing countries, 3 and increased proportion of disability and deaths due to stroke compared to all diseases. 4 Moreover, while most countries have no accurate data on stroke incidence and outcomes, 5 in countries where such studies have been conducted we know that there are large within and between country geographical differences in stroke burden, 1,3 large ethnic/racial disparities in stroke, [6][7][8][9][10][11] and noticeable secular changes in the natural history of stroke and risk factors. 12,13 All these changes, differences, trends and gaps in knowledge necessitate further, more advanced epidemiological studies of stroke in various populations.…”

Does a Care Bundle Reduce Racial Disparities in Postcesarean Surgical Site Infections?

“…In a study using data of the Florida-Puerto Rico registry, a quality improvement program for stroke care improved acute stroke care across all racial-ethnic groups. 34 However, in that study, there were persistent racial disparities in compliance with acute stroke care even after the adoption of the quality improvement program. The cause of persistent disparities in postcesarean surgical site infections in our study may be because of disparities in compliance with the evidence-based care bundle even after the quality improve-ment project.…”

“…Our finding of persistent racial disparities is consistent with previous studies on quality improvement. [34][35][36] In addition, even after the implementation of the care bundle, nonblack women were more likely to have favorable surgical management. In a study using data of the Florida-Puerto Rico registry, a quality improvement program for stroke care improved acute stroke care across all racial-ethnic groups.…”