Disparities in Transition of Care after Acute Stroke Hospitalization: The Transition of Care Stroke Disparity Study (TCSD-S)

中风和心脏病在非传染性疾病中所占比例最大， 全球死亡。在美国，每年有795，000例中风病例和150，000例中风死亡。数字 将随着人口老龄化而急剧增加。中风仍然是造成严重长期残疾的主要原因 少数民族受到了伤害。黑人和西班牙裔人中风的风险更大， 年龄更小;黑人中风死亡率更高。急性期脑卒中护理质量的评价 住院治疗得到改善，但几乎没有证据表明导致有效卒中的过程质量 预防和康复出院后。急性发作后30天意外再入院 中风住院是常见，高达25%，并导致额外的发病率和费用。中风对 患者、家庭和社区的生活质量，以及卫生保健的使用和成本负担是巨大的。 我们提出了护理转变卒中差异研究（TCSD-S），其主要目的是确定种族- 中风护理从医院到家庭的过渡和结果中的种族和性别差异， 健康与这些差距，并制定有效的医院发起的系统级倡议， 减少差异和再入院，并改善卒中结局。为达致这个目标，我们会 充分利用我们独特的佛罗里达卒中登记处（FSR）丰富的基础设施和资源，其中包括 完善的医院网络、医疗服务提供者、与AHA的伙伴关系以及其他佛罗里达利益相关者。 我们将评估药物治疗的依从性、健康的生活方式、康复干预的利用率和医疗服务。 在代表性的佛罗里达综合卒中中心出院回家后30天进行随访。 一个新的过渡中风护理性能指数（TOSC PI）将被推导和验证。这个指数将是 主要结局与再入院和卒中结局（残疾，复发， 心血管事件和死亡）。将通过结构化电话收集关于TOSC和卒中结局的数据 在出院后30天和90天进行访谈，并审查患者病历。TOSC差异的预测因素， 将使用从FSR获得的索引卒中的基线院内数据和社会 健康的决定因素通过一种新的数据收集工具从公开的记录中获得。 根据已确定的TOSC差异预测因素，我们将制定并评估以下举措的可行性： 减少TOSC差异，通过TOSC差异仪表板瞄准护理系统，以及医疗保健 提供者提供培训模块，以加强出院和随访期间的患者教育和支持。 我们将比较计划前后的TOSC PI和结果。 本研究的成功完成将确定医院与家庭TOSC的差异，定义关键预测因素 不良TOSC和中风结果，并制定可在卫生系统中扩展的计划， 这将解决差异，再入院率和不良结果。

Stroke, together with heart disease, accounts for the largest proportion of non-communicable diseases and deaths worldwide. In the US, there are 795,000 annual stroke cases and 150,000 deaths from stroke. Numbers will steeply increase with the aging population. Stroke remains the main cause of serious long-term disability with minorities being affected disproportionally. Greater risk of stroke exists among blacks and Hispanics at younger ages; blacks have greater stroke mortality. Though measures of quality of stroke care during acute hospitalization have improved, little evidence exists on the quality of processes leading to effective stroke prevention and rehabilitation after hospital discharge. Unexpected hospital readmissions 30 days after acute stroke hospitalization are common, as high as 25%, and lead to excess morbidity and cost. Stroke impact on patients', families', and communities' quality of life, and the burden on use and cost of health care is enormous. We propose the Transitions of Care Stroke Disparity Study (TCSD-S) with the main objective to identify race- ethnic and sex disparities in hospital-to-home transition of stroke care and outcomes, social determinants of health associated with these disparities, and to develop effective hospital-initiated system level initiatives to reduce disparities and readmissions, and to improve stroke outcomes. To achieve this objective, we will capitalize on the rich infrastructure and resources of our unique Florida Stroke Registry (FSR), which includes a well-developed network of hospitals, health providers, partnership with the AHA, and other Florida stakeholders. We will evaluate medication adherence, healthy lifestyle, utilization of rehabilitation interventions and medical follow-up 30 days after hospital discharge to home across representative Florida Comprehensive Stroke Centers. A novel Transitions of Stroke Care Performance Index (TOSC PI) will be derived and validated. Thi index will be a primary outcome together with hospital readmissions and stroke outcomes (disability, recurrence, cardiovascular events, and death). Data on TOSC and stroke outcomes will be collected by structured telephone interviews at 30 and 90 days after discharge and review of patient charts. Predictors of TOSC disparities and outcomes will be evaluated using baseline in-hospital data of the index stroke obtained from the FSR, and Social Determinants of Health obtained through a novel data collection instrument from publicly available records. Based on identified predictors of TOSC disparities, we will develop and assess the feasibility of initiatives to reduce TOSC disparities, targeting systems of care with a TOSC disparities dashboard, and health care providers with a training module for enhanced patient education and support at discharge and during follow-up. We will compare the TOSC PI and outcomes before and after the initiatives. The successful completion of this study will identify disparities in hospital-to-home TOSC, define key predictors of poor TOSC and stroke outcomes, and develop initiatives which will be scalable across health systems and which will address disparities, readmission rates, and poor outcomes.