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

Ciliberti-Vargas, Maria A; Gardener, Hannah; Wang, Kefeng; Dong, Chuanhui; Yi, Li; Romano, José G.; Robichaux, Mary; Waddy, Salina P.; Nobo, Ulises; Diaz‐Acosta, Sandra; Rundek, Tatjana; Waters, Michael F.; Sacco, Ralph L.

doi:10.14423/smj.0000000000000667

Cited by 8 publications

(6 citation statements)

References 14 publications

(16 reference statements)

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“…Also, large hospitals (bed size ≥ 450) that have participated in GWTG-S ≥ 6 years are predominantly in southern and central Florida compared to the North and Panhandle. [26] Hospital size and time in the GWTG-S were not significant predictors of DTNT≤60 or DTNT≤45 in our study, but it has been shown that time in GWTG-S is associated with greater achievement GWTG-S predefined stroke performance measures, particularly in larger, teaching hospitals. [24] These factors do not fully explain low achievement of DTNT≤60 and DTNT≤45 in West Central FL.…”

Section: Discussioncontrasting

confidence: 55%

Disparities and Trends in Door-to-Needle Time

Oluwole

Wang

Dong

et al. 2017

Stroke

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Background and Purpose In the US, about half of acute ischemic stroke patients treated with tissue plasminogen activator (tPA) receive treatment within 60 minutes of hospital arrival. We aimed to determine the proportion of patients receiving tPA within 60 minutes (DTNT≤60) and 45 minutes (DTNT≤45) of hospital arrival by race/ethnicity and sex and to identify temporal trends in DTNT≤60 and DTNT≤45. Methods Among 65,654 AIS admissions in the NINDS-funded FL-PR Collaboration to Reduce Stroke Disparities (CReSD) Study from 2010–2015, we included 6,181 IV tPA-treated cases (9.4%). Generalized estimating equations were used to determine predictors of DTNT≤60 and DTNT≤45. Results DTNT≤60 was achieved in 42% and DTNT≤45 in 18% of cases. After adjustment, women less likely received DTNT≤60 (OR=0.81, 95% CI 0.72–0.92) and DTNT≤45 (OR=0.73 95% CI 0.57–0.93). Compared to whites, Blacks less likely had DTNT≤45 during off hours (OR= 0.68, 95% CI 0.47–0.98). Achievement of DTNT≤60 and DTNT≤45 was highest in South Florida (50%, 23%) and lowest in West Central Florida (28%, 11%). Conclusions In the FL-PR Collaboration to Reduce Stroke Disparities, achievement of DTNT≤60 and DTNT≤45 remains low. Compared to Whites, Blacks less likely receive tPA treatment within 45 minutes during off hours. Treatment within 60 and 45 minutes is lower in women compared to men and lowest in West Central Florida compared to other Florida regions and Puerto Rico. Further research is needed to identify reasons for delayed thrombolytic treatment in women and Blacks and factors contributing to regional disparities in DTNT.

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Section: Discussioncontrasting

confidence: 55%

Disparities and Trends in Door-to-Needle Time

Oluwole

Wang

Dong

et al. 2017

Stroke

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“…Data on hospital-level characteristics (academic status, number of beds, and number of years in GWTG-S) were obtained from the AHA database in addition to a selfreported hospital characteristics survey distributed to all hospitals participating in FL-PR CReSD. 20 A combination of persistent or paroxysmal AF and medical history of AF/Flutter was used to define AF in the FLiPER-AF Stroke Study. The use of aspirin, warfarin and DOACs prescribed at discharge from stroke hospitalization were analyzed overall, by race-ethnicity and sex.…”

Section: Methodsmentioning

confidence: 99%

Disparities and Temporal Trends in the Use of Anticoagulation in Patients With Ischemic Stroke and Atrial Fibrillation

Sur

Wang

Tullio

et al. 2019

Stroke

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Background and Purpose-Ischemic stroke (IS) secondary to atrial fibrillation (AF) is largely preventable with the use of anticoagulation. We sought to identify race-ethnic and sex disparities with the use of direct oral anticoagulants (DOACs), aspirin, and warfarin in IS patients with AF, and to identify temporal trends in the utilization of these medications. Methods: The FLorida PuErto Rico Atrial Fibrillation (FLiPER-AF) Stroke Study included 24,040 IS cases enrolled in the Florida-Puerto Rico Collaboration to Reduce Stroke Registry (CReSD) from 2010 to 2016. Multivariable logistic regression models were performed to evaluate the effect of race-ethnicity and sex on utilization of DOACs, aspirin and warfarin for stroke prevention in AF after adjustment for sociodemographic, hospital and clinical factors. Results: Among 24,040 IS cases, 54% were women and 10% Black, 12% FL-Hispanics, 4% PR-Hispanic and 74% Whites. From 2010 to 2016, DOAC use increased from 0% to 36%, warfarin use decreased from 51% to 17% and aspirin use remained relatively stable (42% to 40%). After adjustment, Blacks had higher odds of warfarin (OR=1.22, 95% CI 1.07-1.40) prescription at discharge compared to Whites. Men had higher rates of aspirin (42.1% vs 38.8%), warfarin (33.6% vs. 28.9%) and DOAC (21.3% vs. 19.3%) use compared to women. After adjustment, women had lower odds of being discharged on aspirin (OR=0.92, 95% CI 0.86-0.98) or warfarin (OR=0.91, 95% CI 0.84-0.99). There was no sex difference in use of DOACs. Conclusions: Our study confirmed the increasing use of DOACs, down-trending use of warfarin, while aspirin use remained similar over the years. There are gender and race-ethnic disparities in anticoagulation use in IS patients with AF. It is critical to understand underlying drivers of these disparities in order to develop better practice strategies for stroke prevention in patients with AF.

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“…In comparison, the Florida-Puerto Rico Collaboration to Reduce Stroke Disparities recently reported almost half (49%) of the registry hospitals in Florida had a dedicated neuro-ICU, whereas only 1 hospital (11%) provided this care in Puerto Rico. 13 Furthermore, in North Carolina, stroke-specific hospital resources were not evenly distributed by geographic region and were generally least prevalent in the eastern part of the state, where stroke mortality rates are highest. In addition, we found that less densely populated counties were less likely to report access to stroke specialty physicians and were more than a 1-hour drive from neuro-ICUs.…”

Section: Discussionmentioning

confidence: 99%

“…9,10 Urban-rural and other regional disparities are in part driven by the lack of access to high-quality acute stroke evaluation, treatment, and management. [11][12][13] Specialized physician services and hospital resources are expensive and not feasible to maintain in smaller community hospitals and thus often are concentrated in more urban and populous cities. 12 Statewide assessments of North Carolina hospitals from 1998 to 2008 observed a persistent concentration of certified stroke centers in the central region of the state, leaving large regional gaps.…”

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confidence: 99%

Availability of Hospital Resources and Specialty Services for Stroke Care in North Carolina

Patel

Honvoh

Fernández

et al. 2019

Southern Medical Journal

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Objectives: Effective regionalization of acute stroke care requires assessment and coordination of limited hospital resources. We described the availability of stroke-specific hospital resources (neurology specialty physicians and neuro-intensive care unit [neuro-ICU] bed capacity) for North Carolina overall and by region and population density. We also assessed daily trends in hospital bed availability. Methods: This statewide descriptive study was conducted with data from the State Medical Asset Resource Tracking Tool (SMARTT), a Web-based system used by North Carolina to track available medical resources within the state. The SMARTT system was queried for stroke-specific physician and bed resources at each North Carolina hospital during a 1-year period (June 2015-May 2016), including daily availability of neuro-ICU beds. We compared hospital resources by geographic region and population density (metropolitan, urban, and rural). Results: Data from 108 acute care hospitals located in 75 of 100 counties in North Carolina were included in the analysis. Fifty-seven percent of hospitals had no neurology specialty physicians. Western and eastern North Carolina had the lowest prevalence of these physicians. Most hospitals (88%) had general ICUs, whereas only 17 hospitals (16%) had neuro-ICUs. Neuro-ICUs were concentrated in metropolitan areas and in central North Carolina. On average, there were 276 general ICU and 27 neuro-ICU beds available statewide each day. Daily neuro-ICU bed availability was lowest in eastern and southeastern regions and during the week compared with weekends. Conclusions: In North Carolina, stroke-specific hospital subspecialists and resources are not distributed evenly across the state. Daily bed availability, particularly in neuro-ICUs, is lacking in rural areas and noncentral regions and appears to decrease on weekdays. Regionalization of stroke care needs to consider the geographic distribution and daily variability of hospital resources.

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

Cited by 8 publications

References 14 publications

Disparities and Trends in Door-to-Needle Time

Disparities and Trends in Door-to-Needle Time

Disparities and Temporal Trends in the Use of Anticoagulation in Patients With Ischemic Stroke and Atrial Fibrillation

Availability of Hospital Resources and Specialty Services for Stroke Care in North Carolina

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