Abstract TMP22: Removing Disparities Related to Thrombectomy Transfers Within an Integrated Healthcare System Across Fourteen Primary Stroke Centers

Abstract

Introduction: Patients who present to a PSC with a large vessel occlusion are often transferred to hospitals with thrombectomy capability. Inequities in rates of hospital transfer amongst patients across various gender, racial background, and socioeconomic status are well established. A common metric used to determine quality of care in such transfers is the Door In Door Out (DIDO) time. We hypothesized that there would be no difference in the DIDO using an established systematic approach to transfers in our 14-hospital integrated healthcare system. Methods: All interhospital transfers for thrombectomy across our 14 PSCs were examined from 10/2020 - 4/2023. Age, gender, race/ethnicity, and insurance status were abstracted and used to assess if disparities in DIDO were present. ANOVA and Chi-Square were used for statistical analysis. Results: 307 patients were identified over a 3-year period across all our sites. 48.9% were female with a mean age of 69.7 (±16.2). The median NIHSS was 13 (IQR 7 - 20) and the median DIDO was 96 mins (IQR 74 - 131 mins). There was no difference in median DIDO between females 94 mins (IQR 74 - 132 mins) and males 98 mins (IQR 73 - 98 mins) (p = 0.2). When compared to White patients, there was no difference in median DIDO for Asian American/Pacific Islander (AAPI) (12.6 mins, p = 0.6), Black (-2.1 mins, p = 1.0), or Hispanic patients (7.6 mins, p = 0.7). The insurance status of our patient population was predominantly Medicare (56.4%), followed by Commercial (26.4%), Medicaid (8.1%), and Self- Pay (2.9%). The remainder were classified as Other/Missing (6.2%). When compared to the remainder of the population, we found no difference in median DIDO for patients on Medicare (-2.0 mins, p = 0.7) or Medicaid (10.8 mins, p = 0.3). Conclusions: A Southern California integrated healthcare system’s approach to thrombectomy transfers enables the removal of disparities in DIDO regardless of gender, racial background, and insurance status.