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.

项目概要 中风常见于老年患者，是导致长期残疾和死亡的主要原因。 通过及时的再灌注干预（即静脉溶栓和 不幸的是，患者来自少数或少数族裔。 服务不足的人群获得再灌注干预和急性卒中专业知识的机会较少。 主要是因为中风中心（最有能力照顾中风患者的医院）没有 地理分布与患者居住地相匹配，许多患者最初就诊于规模较小的非 中风中心医院已经做了宝贵的工作来提高第一家小型医院的能力， 例如，通过扩大远程中风然而，最有效的中风干预措施将是。 需要转移的血管内血栓切除术只能在具有先进能力的医院进行，并且 在获得这种高效干预措施方面存在显着的地理和种族/族裔差异。 优化的院内中风患者转移系统可能是更公平地获得服务的解决方案 虽然导致获得和结果差异的许多因素是相对的。 固定的（例如患者人口统计数据或医院位置），院间患者转移的过程是动态的 并受到干预的决定，以及该转移决定的及时性和目的地。 然而，影响患者转移的因素有很多。 在这项混合方法研究中，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运连接起来，了解之间的关系 我们将应用网络方法。 科学，非常适合表征和研究动态的、多层次的、相互依存的结构 我们将开发并应用网络社区检测的新方法来 确定通过患者转移紧密相连的医院集群，并研究种族/族裔如何 医院集群的组成与集群中的中风相关能力相关，以及集群如何 随着时间的推移而变化（目标 1），我们将量化患者在中风治疗方面的种族和民族差异。 结果并确定医院集群层面与差异相关的因素（目标 2）。 识别存在正偏差和负偏差的医院集群（作为实现高水平异常值的医院） 准入和低差距），我们将使用定性方法来确定可扩展的战略，以减少不平等 我们相信，这些解决方案对卫生系统有价值。 领导人和政策制定者旨在确保所有中风患者获得更好的治疗机会并获得更好的结果。 水平，我们的研究结果将适用于各种条件下的医院转运网络（例如， 外伤、急性心肌梗塞），以实现更公平地获得护理并改善患者的治疗效果。