Race/Ethnicity, quality of care, and outcomes in ischemic stroke

Lee H. Schwamm, Mathew J. Reeves, Wenqin Pan, Eric E. Smith, Michael R. Frankel, Daiwai Olson, Xin Zhao, Eric Peterson, Gregg C. Fonarow

Research output: Contribution to journalArticle

138 Scopus citations

Abstract

Prior studies suggest differences in stroke care associated with race/ethnicity. We sought to determine whether such differences existed in a population of black, Hispanic, and white patients hospitalized with stroke among hospitals participating in a quality-improvement program. METHODS AND RESULTS: We analyzed in-hospital mortality and 7 stroke performance measures among 397 257 patients admitted with ischemic stroke to 1181 hospitals participating in the Get With The Guidelines-Stroke program 2003 through 2008. Relative to white patients, black and Hispanic patients were younger and more often had diabetes mellitus and hypertension. After adjustment for both patient-and hospital-level variables, black patients had lower odds relative to white patients of receiving intravenous thrombolysis (odds ratio[OR], 0.84; 95% confidence interval[CI], 0.77 to 0.91), deep vein thrombosis prophylaxis (OR, 0.88; 95% CI, 0.83 to 0.92), smoking cessation (OR, 0.85; 95% CI, 0.79 to 0.91), discharge antithrombotics (OR, 0.88; 95% CI, 0.84 to 0.92), anticoagulants for atrial fibrillation (OR, 0.84; 95% CI, 0.75 to 0.94), and lipid therapy (OR, 0.91; 95% CI, 0.88 to 0.96), and of dying in-hospital (OR, 0.90; 95% CI, 0.85 to 0.95). Hispanic patients received similar care as their white counterparts on all 7 measures and had similar in-hospital mortality. Black (OR, 1.31; 95% CI, 1.28 to 1.35) and Hispanic (OR, 1.16; 95% CI, 1.11 to 1.20) patients had higher odds of exceeding the median length of hospital stay relative to whites. During the study, quality of care improved in all 3 race/ethnicity groups. CONCLUSIONS: Black patients with stroke received fewer evidence-based care processes than Hispanic or white patients. These differences could lead to increased risk of recurrent stroke. Quality of care improved substantially in the Get With The Guidelines-Stroke Program over time for all 3 racial/ethnic groups.

Original languageEnglish (US)
Pages (from-to)1492-1501
Number of pages10
JournalCirculation
Volume121
Issue number13
DOIs
StatePublished - Apr 1 2010

Keywords

  • Epidemiology
  • Ethnicity
  • Quality of health care
  • Race
  • Stroke
  • Thrombolysis

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

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    Schwamm, L. H., Reeves, M. J., Pan, W., Smith, E. E., Frankel, M. R., Olson, D., Zhao, X., Peterson, E., & Fonarow, G. C. (2010). Race/Ethnicity, quality of care, and outcomes in ischemic stroke. Circulation, 121(13), 1492-1501. https://doi.org/10.1161/CIRCULATIONAHA.109.881490