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From the Comprehensive Stroke Program (B.S.J.), Department of Neurology, Wayne State University School of Medicine, Detroit, Departments of Neurology (G.B.) and Epidemiology (G.B., A.J.M., M.J.R.), Michigan State University, Lansing, Department of Neurology (S.H.), University of Michigan, Ann Arbor, Borgess Health System (R.K.), Kalamazoo, and Michigan Department of Community Health (S.R.), Lansing.
Address correspondence and reprint requests to Dr Jacobs, University Health Center, 8C, 4201 St. Antoine, Detroit, MI 48201; e-mail: bjacobs{at}med.wayne.edu
Objective: To examine whether differences exist in the in-hospital diagnostic evaluation and treatment of African American and white patients with ischemic stroke (IS) and TIA.
Methods: The authors used a state-wide hospital-based stroke registry prototype designed to measure and track the quality of acute stroke care. Weighted descriptive statistics for each racial group are reported for the following variables, which were deemed to be potential confounders of the association between race and the quality of stroke care: age, gender, insurance status, emergency medical services arrival, functional status on presentation, modified Rankin score at discharge, stroke subtype, neurologist involved in care, and stroke pathway utilization. The magnitude and significance of the associations between race and each quality indicator of in-hospital acute stroke care were determined by separate multiple logistic regression models, adjusting for all potential confounding variables.
Results: Among patients admitted with IS and TIA who were alive at discharge (n = 1,837), 340 (18.5%) were African American and 1497 (81.5%) were white. After multivariate analysis, African Americans were less likely to have a door-to-CT time of less than 25 minutes (odds ratio [OR] 0.13 [CI 0.049 to 0.32]), obtain cardiac monitoring (OR 0.54 [CI 0.29 to 1.03]), undergo dysphagia screening (OR 0.69 [CI 0.50 to 0.95]), and receive smoking cessation counseling (OR 0.27 [CI 0.17 to 0.42]).
Conclusions: Quality of hospital care for African American and white patients with acute ischemic stroke and TIA was similar in many respects. However, African Americans were less likely to receive a CT within 25 minutes of arrival, cardiac monitoring, dysphagia screening, and smoking cessation counseling.
Supported by US Centers for Disease Control and Prevention cooperative agreement no. U50/CCU520272-01.
Disclosure: The authors report no conflicts of interest.
Received May 31, 2005. Accepted in final form December 1, 2005.
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