Improving Post-Acute Care to Reduce Ethnic Stroke Disparities

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Abstract Mexican Americans are the most numerous sub-group of Hispanic Americans, the largest minority population in the United States. This important group is aging, growing rapidly and spreading throughout the country. For the past 19 years the Brain Attack Surveillance in Corpus Christi (BASIC) Project has provided rich original stroke disparities research comparing Mexican Americans and non Hispanic whites. BASIC has demonstrated that stroke incidence is higher in Mexican Americans compared with non Hispanic whites and that the relative Mexican American:Non-Hispanic white stroke disparity remains completely unabated over the last decade. Further, Mexican American stroke survivors have worse neurologic, functional, cognitive and quality of life outcomes compared with non Hispanic whites for reasons that are not yet understood. Worse stroke outcomes in Mexican Americans are not explained by socio-demographics, including education and insurance, stroke treatment, stroke severity or subtype, or pre-stroke factors. One potential explanation for the ethnic differences in stroke outcome is differences in post-acute care (PAC) in the form of rehabilitation or insufficiently resourced informal care. Virtually no data exists on stroke rehabilitation or informal stroke caregiving in Mexican Americans to inform this hypothesis. The current proposal will leverage the infrastructure of the longstanding, population-based BASIC Project to explore PAC in Mexican Americans and non-Hispanic whites from multiple perspectives: patients, caregivers, and community. First, the study will collect detailed data on PAC in the 90 days following stroke and explore the predictors of PAC, including socio-economic and cultural factors, and how these may differ by ethnicity. We will capitalize on the rich stroke outcome data collected in BASIC to explore for the first time ethnic differences in PAC and their influence on ethnic disparities in stroke outcomes. Second, the study will enroll stroke caregivers and collect comprehensive data on the caregiving experiences and outcomes of individuals providing informal care to stroke survivors. Finally, the study will employ an innovative strategy to determine gaps between the needs of informal caregivers and available community resources for caregiving. This line of research will inform culturally sensitive intervention strategies across multiple levels to improve stroke outcomes in Mexican Americans, a growing, aging and large minority population that will increasingly feel the impact from stroke in the next decade. BASIC is the only study capable of addressing these important questions about stroke in Mexican Americans.