Improving Post-Acute Care to Reduce Ethnic Stroke Disparities

摘要 墨西哥裔美国人是拉美裔美国人中人数最多的亚群，也是最大的少数族裔人口 在美国。这个重要的群体正在老龄化，迅速增长，并在全国范围内蔓延。为 近19年来科珀斯克里斯蒂(BASIC)项目中的脑攻击监测提供了丰富的原创 比较墨西哥裔美国人和非西班牙裔白人的中风差异研究。Basic已经演示了 与非西班牙裔白人相比，墨西哥裔美国人的中风发病率更高，而且 墨西哥裔美国人：在过去的十年里，非西班牙裔白人中风的差异仍然完全没有减少。 此外，墨西哥裔美国中风幸存者的神经、功能、认知和生活质量都较差 结果与非西班牙裔白人相比，原因尚不清楚。更糟糕的中风结局 在墨西哥，美国人不是由社会人口统计学来解释的，包括教育和保险，中风 治疗、卒中严重程度或亚型，或卒中前因素。对种族差异的一个潜在解释 在卒中结果中，急性后护理(PAC)在康复形式或资源不足方面的差异 非正式护理。墨西哥几乎没有关于中风康复或非正式中风护理的数据 美国人告知这一假说。目前的提案将利用历史悠久、 基于人口的基本项目，探索墨西哥裔美国人和非西班牙裔白人的PAC 视角：患者、照顾者和社区。首先，这项研究将收集有关政府账目委员会在 并探讨PAC的预测因素，包括社会经济和文化因素 这些可能会因种族而有所不同。我们将充分利用在BASIC TO中收集的丰富中风结果数据 首次探索PAC的种族差异及其对中风预后的种族差异的影响。 其次，这项研究将招募中风护理人员，并收集有关护理经验的全面数据 以及向中风幸存者提供非正式护理的个人的结果。最后，这项研究将采用 确定非正式照顾者的需求与现有社区之间的差距的创新战略 照看的资源。这一系列研究将为各国文化敏感的干预策略提供信息 多个水平改善墨西哥裔美国人的中风预后，墨西哥裔美国人是一个不断增长、老龄化和占多数的少数群体 在接下来的十年里，将越来越多地感受到中风的影响。基础是唯一有能力学习的 解决墨西哥裔美国人中风的这些重要问题。

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.