Addressing Racial/Ethnic Disparities in Stroke Care Access Using Hospital Transfer Networks

使用医院转移网络解决中风护理方面的种族/民族差异

• 批准号: 10732804
• 负责人: Korilyn Sauser Zachrison
• 金额: $ 68.03万
• 依托单位: MASSACHUSETTS GENERAL HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-09-01 至 2028-04-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10732804
• 关键词: Acute; Acute myocardial infarction; Address; Affect; American; Area; Behavior; Black race; California; Caring; Cessation of life; Characteristics; Communities; Community Networks; Data; Destinations; Detection; Disparity; Elderly; Emergency Situation; Ensure; Equity; Ethnic Origin; Funding; Geography; Goals; Health Services Accessibility; Health system; Hispanic; Hospitals; Inequality; Inequity; Insurance; Intervention; Interview; Intravenous; Ischemic Stroke; Life; Location; Measures; Methodology; Methods; Minority Groups; Modeling; Native Americans; Not Hispanic or Latino; Outcome; Patient Care; Patient Transfer; Patient-Focused Outcomes; Patients; Pattern; Play; Policy Maker; Process; Publications; Qualitative Methods; Race; Racial Segregation; Reperfusion Therapy; Resources; Role; Science; Stroke; Structural Racism; Structure; System; Time; Trauma; Underserved Population; Uninsured; United States National Institutes of Health; Variant; Work; access disparities; acute stroke; care outcomes; demographics; detection method; deviant; disability; disparity reduction; effective intervention; efficacious intervention; endovascular thrombectomy; ethnic disparity; geographic disparity; health disparity; improved; improved outcome; minority patient; mortality; new technology; older patient; organizational structure; post stroke; primary outcome; racial disparity; response; secondary outcome; stroke intervention; stroke outcome; stroke patient; telestroke; thrombolysis; uptake

PROJECT SUMMARY Stroke occurs commonly in older patients and is a leading cause of long-term disability. Disability and death from stroke can be reduced with timely reperfusion interventions (i.e., intravenous thrombolysis and endovascular thrombectomy) and high-quality stroke center care. Unfortunately, patients from minority or underserved populations have less access to reperfusion interventions and acute stroke expertise. This is largely because stroke centers – the hospitals best equipped to care for stroke patients – are not geographically distributed to match where patients live and many patients initially present to smaller, non- stroke center hospitals. Valuable work has been done to improve the capabilities of that first, smaller hospital, for example through the expansion of telestroke. However, the most effective interventions for stroke will require transfer. Endovascular thrombectomy is only available at hospitals with advanced capabilities, and there are significant geographic and racial/ethnic disparities in access to this highly efficacious intervention. An optimized system of interhospital stroke patient transfers could be a solution to more equitable access to high-quality stroke care. While many factors contributing to disparities in access and outcomes are relatively fixed (e.g., patient demographics or hospital locations), the process of interhospital patient transfers is dynamic and subject to intervention. The decision to transfer, and the timeliness and destination of that transfer decision can be influenced toward improved outcomes tomorrow. Yet there are many factors influencing patient transfer decisions. In this mixed-methods study, we use statewide, all-payer claims data to study the network of over 340 California hospitals connected through stroke patient transfer to understand the relationship between transfer decisions and disparities in patient access and outcomes. We will apply methods from network science, which are ideally suited to characterize and study the dynamic, multi-level, interdependent structure of the stroke patient transfer network. We will develop and apply new methods in network community detection to identify clusters of hospitals closely connected through patient transfer and to study how the racial/ethnic composition of hospital clusters is associated with stroke-related capabilities in the cluster and how clusters change over time (Aim 1). We will quantify patient-level racial and ethnic disparities in stroke access and outcomes and identify factors at the hospital cluster-level associated with disparities (Aim 2). Then, upon identifying clusters of hospitals that are positive and negative deviants (as outliers in achieving high levels of access and low disparities), we will use qualitative methods to identify scalable strategies to reduce inequalities in stroke access and outcomes (Aim 3). We believe that that these solutions will be valuable to health system leaders and policy makers aiming to ensure better access and outcomes for all stroke patients. On a broader level, our findings will be applicable to hospital transfer networks across a broad range of conditions, (e.g., trauma, acute myocardial infarction) to achieve more equitable access to care and improved patient outcomes.

项目摘要 中风通常发生在老年患者中，是长期残疾的主要原因。残疾和死亡 可以通过及时的再灌注干预来减少中风（即，静脉溶栓和 血管内血栓切除术）和高质量卒中中心护理。不幸的是，来自少数民族或 服务不足的人群获得再灌注干预和急性中风专业知识的机会较少。这是 很大程度上是因为中风中心--最有能力照顾中风病人的医院--没有 在地理上分布，以匹配患者居住的地方，许多患者最初出现在较小的，非 中风中心医院已经做了有价值的工作来提高第一家规模较小的医院的能力， 例如通过telestroke的扩展。然而，对中风最有效的干预措施将 需要转移。血管内血栓切除术仅适用于具有先进能力的医院， 在获得这一非常有效的干预措施方面存在着显著的地域和种族/族裔差异。 一个优化的医院间中风患者转移系统可能是一个解决方案，以更公平地获得 高质量的中风护理。虽然造成获得机会和结果不平等的许多因素相对 固定的（例如，患者人口统计学或医院位置），医院间患者转移的过程是动态的 并受到干预。转移的决定，以及转移决定的及时性和目的地 可以影响明天的改善结果。然而，影响患者转移的因素有很多 决策在这项混合方法的研究中，我们使用全州范围内的所有付款人索赔数据来研究网络， 340家加州医院通过中风患者转移连接，以了解 转移决定和患者访问和结果的差异。我们将应用网络方法 科学，这是非常适合表征和研究的动态，多层次，相互依存的结构， 中风病人转移网络我们将开发和应用新的网络社区检测方法， 确定通过病人转移密切联系的医院群，并研究种族/民族 医院集群的组成与集群中与中风相关的能力以及集群如何 随时间变化（目标1）。我们将量化患者在卒中可及性方面的种族和民族差异， 结果，并确定因素在医院集群水平与差异（目标2）。则一经 确定积极和消极偏离的医院集群（作为实现高水平 机会和低差距），我们将使用定性方法来确定可扩展的战略，以减少不平等 卒中通路和结局（目标3）。我们相信这些解决方案对卫生系统将很有价值 领导者和政策制定者，旨在确保所有中风患者获得更好的治疗和结果。在更广泛的 水平，我们的研究结果将适用于医院转移网络在广泛的条件下，（例如， 创伤、急性心肌梗死），以实现更公平地获得护理和改善患者预后。