Abstract Details

Title Low Volume non-PSC Hospitals Are More Likely to Transfer Whites but Not Blacks for a Higher Level of Stroke Care

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) S52 - Acute Non-Interventional Stroke Care (3:52 PM-4:03 PM)

Poster/Presentation
Number 003

Background Disparities exist ant many levels of stroke care. We have previously reported that “drip and ship” patients received at our tertiary center were younger and less often black when compared to those presenting directly.

Objective To determine if age and race disparities exist in inter-hospital transfer to a higher level of care (HLOC) for acute ischemic stroke (AIS) patients.

Design/Methods In this cross-sectional analysis, we extracted patient characteristics and transfer status of AIS patients from State Emergency Department Databases (SEDD) and State Inpatient Databases (SID) of 5 states between 1/1/2010 and 12/29/2010. Hospital characteristics were determined using the American Hospital Association Annual Survey Database and The Joint Commission. We used Poisson regression with robust variance estimation adjusted for age, gender, payer type, Elixhauser comorbidities, and state to estimate prevalence ratios (PRs) and the proportion of whites and blacks, aged 18-64 or ≥65 years transferred by PSC status and hospital AIS volume.

Results We identified 58,321 AIS discharges admitted through the ED, of whom 29% were aged 18-64 years. Overall, 4.8% were transferred to a HLOC and black patients were less likely to be transferred compared with whites (white: 5.0%; black: 3.9%; PR 0.76; 95% CI 0.68-0.84). Among AIS patients aged 18-64 years presenting to very low volume non-PSC hospitals (2 AIS discharges/month), blacks had a lower predicted percent transferred when compared with whites (white: 29.9%; black: 16.2%; 13.6% difference; 95% CI 6.6-20.6). Differences by race were present for non-PSC hospitals with volumes as large as 8 AIS discharges/month (white: 12.7%; black: 9.8%; 2.9% difference; 95% CI 0.9-4.9). Similar, although slightly smaller, differences were observed in older patients.

Conclusions These findings suggest that age and race disparities exist in inter-hospital transfer for AIS. Specifically, black AIS patients aged <65 years have a lower probability of being transferred to a HLOC.

Authors/Disclosures
Michael J. Lyerly, MD, FAAN (University of Alabama At Birmingham) PRESENTER	Dr. Lyerly has received personal compensation in the range of $500-$4,999 for serving as an Expert Witness for various private legal firms.
Karen C. Albright, DO, DO, PhD, MS, MPH (FDA)	Dr. Albright has nothing to disclose.
Farhaan S. Vahidy, MBBS, PhD (Houston Methodist)	Dr. Vahidy has nothing to disclose.
George Howard, PhD (UAB School of Public Hlth)	Dr. Howard has received personal compensation in the range of $10,000-$49,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Bayer.
John Donnelly	No disclosure on file

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