Structural Racism and Discrimination in the Expansion of Hospital Stroke Care Capacity: A Multi-Level Analysis on Access to Care, Treatment, and Outcomes

其他项目信息-项目摘要/摘要 扩大医院卒中护理能力中的结构性种族主义和歧视 尽管卒中治疗的进展显著降低了 在美国，中风患者在提供中风服务方面的差距越来越大 弱势群体和其他人。没有研究研究结构性种族主义和 跨社区扩展中风护理能力方面的歧视(SRD)及其后续影响 健康差距患者。该项目的长期目标是确定交付过程中的系统级路径 导致NIH指定的健康差距人群日益扩大的差距的急性中风护理 (定义为少数族裔、低收入和农村患者)。总体目标是确定 健康差距患者在卒中护理中经历SRD的机制。 利用2009年至2019年的全国数据，我们提出了三个目标来检验以下假设：目标1， 弱势社区(定义为健康差距较大的隔离地区) 人群)经历了不同的中风护理水平，导致在 相对于其他社区，有可能获得护理。目标2，隔离中的健康差距患者 由于患者重新分配，社区在实际获得和治疗方面的差距越来越大 在具有不同水平的中风护理和医院内差别治疗的医院之间。目标3，即 贫困社区的个人和健康差距患者在以下方面的差距不断扩大 健康和功能结果。 在目标1中，我们将确定哪些类型的弱势社区，如果有的话，在获得 中风护理的获得，以及种族或民族隔离和收入不平等是否导致了这些 地理准入方面的结构性差异。这些结果将有助于认证机构考虑将 社区在认证指南中的需要。在目标2中，我们的结果将阐明患者的再分布模式 能够获得中风护理并准确定位在实际获得方面存在差异的患者的社区 和待遇取决于他们的种族，民族，收入以及每个人的隔离程度 那些维度。结果将确定在哪些社区类型的外展可能是最有效的 缩小中风护理方面的差距。在目标3中，我们的结果将确定健康差距的程度 中风患者a)在采用中风护理后，弱势和非弱势社区之间的差异， 与没有变化的社区相比；以及b)健康差距与同一社区内其他患者之间的差距 当这些社区经历中风护理的变化时，相对于那些有 获得中风护理的机会没有变化。这些发现将确定特定的社区，在那里 干预措施(例如，移动卒中单元、加强远程保健服务)可以产生最大的益处。

OTHER PROJECT INFORMATION – Project Summary/Abstract Structural Racism and Discrimination in the Expansion of Hospital Stroke Care Capacity Although advances in the treatment of stroke have significantly decreased morbidity and mortality for stroke patients in the United States, there is a growing disparity in the provision of stroke services between disadvantaged populations and others. No studies have examined the role of structural racism and discrimination (SRD) in the expansion of stroke care capacity across communities and subsequent effects on health disparity patients. The long-term goal of this project is to identify system-level pathways in the delivery of acute stroke care that contribute to the growing disparities for NIH-designated health disparity populations (defined as racial/ethnic minority, low-income, and rural patients). The overall objective is to determine the mechanisms through which health disparity patients experience SRD in stroke care. Using national data from 2009 to 2019, we propose three aims to test the following hypotheses: Aim 1, That disadvantaged communities (defined as segregated areas with high shares of health disparity populations) experience differential adoption of levels of stroke care, resulting in increased disparities in potential access to care relative to other communities. Aim 2, That health disparity patients in segregated communities experience increased disparities in actual access and treatment due to patient redistribution across hospitals with different levels of stroke care and differential treatment within hospitals. Aim 3, That individuals in disadvantaged communities and health disparity patients experience widening disparities in health and functional outcomes. In Aim 1, we will identify which types of disadvantaged communities, if any, were left behind in gaining stroke care access, and whether racial or ethnic segregation and income inequality contribute to these structural disparities in geographic access. These results will aid certification bodies to consider incorporating community need in certification guidelines. In Aim 2, our results will illuminate patient redistribution patterns in communities that gain access to stroke care and pinpoint patients who experience disparities in actual access and treatment depending on their race, ethnicity, and income as well as the level of segregation in each of those dimensions. Results will identify the types of communities where outreach might be most effective in reducing disparities in stroke care. In Aim 3, our results will determine the extent of health disparities among stroke patients a) between disadvantaged and non-disadvantaged communities after adoption of stroke care, compared to communities with no change; and b) between health disparity and other patients within the same community when those communities experience changes in stroke care, relative to those in communities with no change in access to stroke care. These findings will identify specific communities where additional interventions (e.g., mobile stroke units, enhancing telehealth access) could yield the greatest benefits.