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Comparative Study
. 2017 Jul;110(7):466-474.
doi: 10.14423/SMJ.0000000000000667.

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

Maria A Ciliberti-Vargas  1 , Hannah Gardener  1 , Kefeng Wang  1 , Chuanhui Dong  1 , Li Yi  1 , Jose G Romano  1 , Mary Robichaux  1 , Salina P Waddy  1 , Ulises Nobo  1 , Sandra Diaz-Acosta  1 , Tatjana Rundek  1 , Michael F Waters  1 , Ralph L Sacco  1
Affiliations
Comparative Study

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

Maria A Ciliberti-Vargas et al. South Med J. 2017 Jul.

Abstract

Objectives: Although disparities in stroke care and outcomes have been well documented nationally, state-based registries to monitor acute stroke care in Florida (FL) and Puerto Rico (PR) have not been established. The FL-PR Collaboration to Reduce Stroke Disparities (CReSD) was developed to evaluate race-ethnicity and regional disparities in stroke care performance. The objective of this study was to assess and compare hospital characteristics within a large quality improvement registry to identify characteristics associated with better outcomes for acute ischemic stroke care.

Methods: Trained personnel from 78 FL-PR CReSD hospitals (69 FL, 9 PR) completed a 50-item survey assessing institutional characteristics across seven domains: acute stroke care resource availability, emergency medical services integration, stroke center certification, data collection and use, quality improvement processes, FL-PR CReSD recruitment incentives, and hospital infrastructure.

Results: The rate of survey completion was 100%. Differences were observed both within FL and between FL and PR. Years participating in Get With The Guidelines-Stroke (8.9 ± 2.6 years FL vs 4.8 ± 2.4 years PR, P < 0.0001) and proportion of hospitals with any stroke center certification (94.2% FL vs 11.1% PR, P < 0.0001) showed the largest variations. Smaller hospital size, fewer years in Get With The Guidelines-Stroke, and lack of stroke center designation and acute stroke care practice implementation may contribute to poorer outcomes.

Conclusions: Results from our survey indicated variability in hospital- and system-level characteristics in stroke care across hospitals in Florida and Puerto Rico. Identification of these variations, which may explain potential disparities, can help clinicians understand gaps in stroke care and outcomes and targeted interventions to reduce identified disparities can be implemented.

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Figures

Fig. 1
Fig. 1
(A) GIS of FL and PR hospitals by hospital bed size categorized into tertiles. FL, Florida; GIS, geographic information system; PR, Puerto Rico. (B) GIS map of FL and PR hospitals’ years of participation in the GWTG-S program categorized into tertiles. FL, Florida; GIS, geographic information system; GWTG-S, Get With The Guidelines-Stroke; PR, Puerto Rico. Created using ArcGIS® software by Esri. ArcGIS® and ArcMap™ are the intellectual property of Esri and are used herein under license. Copyright © 2013 Esri. All rights reserved.
Fig. 2
Fig. 2
Temporal improvement in DFC by race-ethnicity. DFC, defect-free care; FL, Florida; NHB, non-Hispanic black; NHW, non-Hispanic white; PR, Puerto Rico. Created using ArcGIS® software by Esri. ArcGIS® and ArcMap™ are the intellectual property of Esri and are used herein under license. Copyright © 2013 Esri. All rights reserved.
Fig. 3
Fig. 3
See this image and copyright information in PMC

References

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    1. Cruz-Flores S, Rabinstein A, Biller J, et al. Racial-ethnic disparities in stroke care: the American experience: a statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2011;42:2091–2116. - PubMed
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