Abstract
Abstract WP224: Hispanics are Transported With Slower and Less Capable Ambulances During Inter-Hospital Transfer: A Threat to Fairness in the Era of Thrombectomy
Stroke (1970), Vol.49(Suppl_1)
01/22/2018
DOI: 10.1161/str.49.suppl_1.WP224
Abstract
Background & Purpose:
In the mechanical thrombectomy (MT) era, it is imperative to ensure that patients with stroke have a fair access to advanced ground ambulances (AGA) or the more rapid Helicopter Emergency Medical Services (HEMS) to avoid disparities in functional outcomes. In this study we investigated racial/ethnic disparities in the use of AGA or HEMS for inter-hospital transfer of stroke patients in the US.
Methods:
We used Medicare claims for years 2010-2013 for Medicare beneficiaries with a new diagnosis of atrial fibrillation. Cases were patients with a primary diagnosis of ischemic or hemorrhagic stroke that underwent an inter-hospital transfer between acute facilities within the day of the stroke. Transportation was categorized as basic ground, AGA or HEMS. A multinomial logit model was used to adjust for confounders such as patient’s characteristics, distance and geographical location.
Results:
A total of 11,172 acute hospital to hospital transfers were analyzed. In unadjusted analysis, 17.7% of black, 20.9% of Hispanic and 21.7% of white patients were transferred by HEMS, and 73.7% of black, 67.3% of Hispanic and 69.9% of white patients were transferred by AGA (p=0.003). These differences, however, disappeared after controlling for confounders. The exception were Hispanic patients, who remain less likely to be transported by HEMS (OR=0.64; 0.45-0.90; p=0.01) or AGA than white patients (OR=0.74; 0.55-1.00; p=0.048)
Conclusion:
Hispanic patients with stroke undergoing an acute inter-facility transfer are less likely to be transported by HEMS or advance ground ambulances after adjusting for all possible confounders, including distance and insurance. This unacceptable disparity is a barrier to timely access to a thrombectomy-capable hospital and best care en-route for these patients, which may result in worse outcomes after MT.
Details
- Title: Subtitle
- Abstract WP224: Hispanics are Transported With Slower and Less Capable Ambulances During Inter-Hospital Transfer: A Threat to Fairness in the Era of Thrombectomy
- Creators
- MAry S Vaughan Sarrazin - University of IowaEdgar Samaniego - University of IowaWaldo Guerrero - University of IowaSami Alkasab - University of IowaAli Sheharyar - University of IowaKaustubh Limaye - University of IowaSantiago Ortega - University of IowaJames Rossen - University of IowaDavid Hasan - University of IowaEnrique Leira - University of Iowa
- Resource Type
- Abstract
- Publication Details
- Stroke (1970), Vol.49(Suppl_1)
- DOI
- 10.1161/str.49.suppl_1.WP224
- ISSN
- 0039-2499
- eISSN
- 1524-4628
- Language
- English
- Date published
- 01/22/2018
- Academic Unit
- Neurosurgery; Cardiovascular Medicine; Roy J. Carver Department of Biomedical Engineering; General Internal Medicine; Internal Medicine; Health Management and Policy; Neurology; Iowa Neuroscience Institute; Radiology; Epidemiology
- Record Identifier
- 9984363548902771
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