Ciliberti-Vargas Maria A, Gardener Hannah, Wang Kefeng, Dong Chuanhui, Yi Li, Romano Jose G, Robichaux Mary, Waddy Salina P, Nobo Ulises, Diaz-Acosta Sandra, Rundek Tatjana, Waters Michael F, Sacco Ralph L
From the University of Miami Miller School of Medicine, Miami, Florida, University of Miami School of Architecture, Coral Gables, Florida, the National Institute for Neurological Diseases and Stroke, Bethesda, Maryland, Hospital HIMA San Pablo, Caguas, Puerto Rico, American Heart Association Greater Southeast Affiliate, San Juan, Puerto Rico, and the Barrow Neurological Institute, Phoenix, Arizona.
South Med J. 2017 Jul;110(7):466-474. doi: 10.14423/SMJ.0000000000000667.
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.
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.
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, < 0.0001) and proportion of hospitals with any stroke center certification (94.2% FL vs 11.1% PR, < 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.
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.
尽管全国范围内卒中治疗及预后的差异已有充分记录，但佛罗里达州（FL）和波多黎各（PR）尚未建立用于监测急性卒中治疗情况的州级登记系统。为评估卒中治疗表现方面的种族和地区差异，开展了佛罗里达州-波多黎各减少卒中差异协作项目（CReSD）。本研究的目的是在一个大型质量改进登记系统中评估和比较医院特征，以确定与急性缺血性卒中治疗更好预后相关的特征。
来自78家佛罗里达州-波多黎各CReSD医院（69家在佛罗里达州，9家在波多黎各）的经过培训的人员完成了一项包含50个条目的调查，评估七个领域的机构特征：急性卒中治疗资源可用性、紧急医疗服务整合、卒中中心认证、数据收集与使用、质量改进流程、佛罗里达州-波多黎各CReSD招募激励措施以及医院基础设施。
调查完成率为100%。在佛罗里达州内部以及佛罗里达州和波多黎各之间均观察到差异。参与“遵循卒中指南”项目的年限（佛罗里达州为8.9±2.6年，波多黎各为4.8±2.4年，P<0.0001）以及有任何卒中中心认证的医院比例（佛罗里达州为94.2%，波多黎各为11.1%，P<0.0001）差异最为显著。医院规模较小、参与“遵循卒中指南”项目的年限较短、缺乏卒中中心认定以及未实施急性卒中治疗实践可能导致预后较差。
我们的调查结果表明，佛罗里达州和波多黎各各医院在卒中治疗的医院层面和系统层面特征存在差异。识别这些可能解释潜在差异的变化，有助于临床医生了解卒中治疗和预后方面的差距，并可实施针对性干预措施以减少已识别的差异。
