Improving Post-Acute Care to Reduce Ethnic Stroke Disparities

摘要 墨西哥裔美国人是西班牙裔美国人中人数最多的一个亚群体，也是最大的少数民族人口 在美国这一重要群体正在老龄化，迅速增长，并蔓延到全国各地。为 在过去的19年里，科珀斯克里斯蒂脑攻击监测（BASIC）项目提供了丰富的原始资料， 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演示了 墨西哥裔美国人的中风发病率高于非西班牙裔白人， 墨西哥裔美国人：非西班牙裔白色中风差异在过去十年中仍然完全没有减弱。 此外，墨西哥裔美国人中风幸存者的神经功能，功能，认知和生活质量更差 与非西班牙裔白人相比的结果，原因尚不清楚。卒中结局更差 在墨西哥裔美国人中，社会人口统计学不能解释，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。种族差异的一个可能解释是 卒中结局的差异是急性期后护理（PAC）的康复形式或资源不足 非正式护理。事实上，在墨西哥，没有关于中风康复或非正式中风康复的数据。 美国人告知这一假设。目前的提案将利用长期存在的基础设施， 基于人群的BASIC项目，旨在探索墨西哥裔美国人和非西班牙裔白人的PAC， 观点：患者，护理人员和社区。首先，这项研究将收集90年PAC的详细数据， 卒中后30天，并探索PAC的预测因素，包括社会经济和文化因素， 这些可能因种族而异。我们将利用BASIC中收集的丰富卒中结局数据， 首次探索PAC的种族差异及其对卒中结局种族差异的影响。 其次，本研究将招募中风照顾者，并收集有关照顾经验的全面数据 以及为中风幸存者提供非正式护理的个人的结果。最后，研究将采用 确定非正规照料者的需求与现有社区之间差距的创新战略 资源用于开发。这项研究将为跨文化的干预战略提供信息。 多水平改善墨西哥裔美国人的卒中结局，这是一个不断增长的，老龄化的， 在未来十年中，人们将越来越多地感受到中风的影响。BASIC是唯一能够 解决这些关于墨西哥裔美国人中风的重要问题。

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.