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Multicenter Study
. 2019 Jan 8;8(1):e009649.
doi: 10.1161/JAHA.118.009649.

Racial/Ethnic Disparities in Mortality Among Medicare Beneficiaries in the FL - PR CR eSD Study

Hannah Gardener  1 , Erica C Leifheit  2 , Judith H Lichtman  2 , Yun Wang  2 , Kefeng Wang  1 , Carolina M Gutierrez  1 , Maria A Ciliberti-Vargas  1 , Chuanhui Dong  1 , Sofia Oluwole  1 , Mary Robichaux  1 , Jose G Romano  1 , Tatjana Rundek  1 , Ralph L Sacco  1 ; FL‐PR CReSD Investigators and Collaborators
Affiliations
Multicenter Study

Racial/Ethnic Disparities in Mortality Among Medicare Beneficiaries in the FL - PR CR eSD Study

Hannah Gardener et al. J Am Heart Assoc. .

Abstract

Background Racial/ethnic disparities in acute stroke care may impact stroke outcomes. We compared outcomes by race/ethnicity among elderly Medicare beneficiaries in hospitals participating in the FL-PR CReSD (Florida-Puerto Rico Collaboration to Reduce Stroke Disparities) registry with those in hospitals not participating in any quality improvement programs (non- QI ) in Florida and Puerto Rico (PR). Methods and Results The population included fee-for-service Medicare beneficiaries age 65+ in Florida and PR , discharged with primary diagnosis of ischemic stroke ( International Classification of Diseases, Ninth Revision, Clinical Modification [ICD-9-CM], codes 433, 434, 436) in 2010-2013. We used mixed logistic models to assess racial/ethnic differences in outcomes (in-hospital, 30-day, and 1-year mortality, and 30-day readmission) for CR e SD and non- QI hospitals, adjusted for demographic and clinical characteristics. The study included 62 CR e SD hospitals (N=44 013, 84% white, 9% black, 4% Florida Hispanic, 1% PR Hispanic) and 113 non- QI hospitals (N=14 422, 78% white, 7% black, 5% Florida Hispanic, 8% PR Hispanic). For patients treated at CR e SD hospitals, there were no differences in risk-adjusted in-hospital mortality by race/ethnicity; blacks had lower 30-day mortality versus whites (odds ratio, 0.86; 95% confidence interval, 0.77-0.97), but higher 30-day readmission (hazard ratio, 1.09; 1.00-1.18) and 1-year mortality (odds ratio, 1.13; 1.04-1.23); Florida Hispanics had lower 30-day readmission (hazard ratio, 0.87; 0.78-0.98). PR Hispanic and black stroke patients treated at non- QI hospitals had higher risk-adjusted in-hospital, 30-day and 1-year mortality, but similar 30-day readmission versus whites treated in non- QI hospitals. Conclusions Disparities in outcomes were less common in CR e SD than non- QI hospitals, suggesting the benefits of quality improvement programs, particularly those focusing on racial/ethnic disparities.

Keywords: Medicare; disparities; mortality; race and ethnicity; stroke.

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Figures

Figure 1
Figure 1
Unadjusted racial/ethnic differences in mortality and readmission by hospital type.* *In both CReSD and non‐QI hospitals, all P<0.001 for the comparison of outcomes by race. CReSD indicates Collaboration to Reduce Stroke Disparities; Florida Hispanic, Hispanics living in Florida; non‐QI, non–quality improvement; PR Hispanic, Hispanics living in Puerto Rico.
Figure 2
Figure 2
Mortality and readmission in CReSD vs non‐QI hospitals. Models adjusted for demographic characteristics and comorbid conditions. CRESD indicates Collaboration to Reduce Stroke Disparities; HR, hazard ratio; non‐QI, non–quality improvement; OR, odds ratio.
Figure 3
Figure 3
Adjusted racial/ethnic differences in mortality and readmission by hospital type. Models adjusted for demographic characteristics and comorbid conditions. CRESD indicates Collaboration to Reduce Stroke Disparities; Florida Hispanic, Hispanics living in Florida; non‐QI, non–quality improvement; PR Hispanic, Hispanics living in Puerto Rico.
See this image and copyright information in PMC

References

    1. Cruz‐Flores S, Rabinstein A, Biller J, Elkind MS, Griffith P, Gorelick PB, Howard G, Leira EC, Morgenstern LB, Ovbiagele B, Peterson E, Rosamond W, Trimble B, Valderrama 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
    1. Schwamm LH, Fonarow GC, Reeves MJ, Pan W, Frankel MR, Smith EE, Ellrodt G, Cannon CP, Liang L, Peterson E, Labresh KA. Get With the Guidelines–Stroke is associated with sustained improvement in care for patients hospitalized with acute stroke or transient ischemic attack. Circulation. 2009;119:107–115. - PubMed
    1. Song S, Fonarow GC, Olson DM, Liang L, Schulte PJ, Hernandez AF, Peterson ED, Reeves MJ, Smith EE, Schwamm LH, Saver JL. Association of Get With the Guidelines–Stroke Program Participation and clinical outcomes for Medicare beneficiaries with ischemic stroke. Stroke. 2016;47:1294–1302. - PMC - PubMed
    1. Sacco RL, Gardener H, Wang K, Dong C, Ciliberti‐Vargas MA, Gutierrez CM, Asdaghi N, Burgin WS, Carrasquillo O, Garcia‐Rivera EJ, Nobo U, Oluwole S, Rose DZ, Waters MF, Zevallos JC, Robichaux M, Waddy SP, Romano JG, Rundek T. Racial‐ethnic disparities in acute stroke care in the Florida–Puerto Rico Collaboration to Reduce Stroke Disparities Study. J Am Heart Assoc. 2017;6:e004073 DOI: 10.1161/JAHA.116.004073. - DOI - PMC - PubMed
    1. Reeves MJ, Fonarow GC, Smith EE, Pan W, Olson D, Hernandez AF, Peterson ED, Schwamm LH. Representativeness of the Get With the Guidelines–Stroke Registry: comparison of patient and hospital characteristics among Medicare beneficiaries hospitalized with ischemic stroke. Stroke. 2012;43:44–49. - PubMed

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