Abstract W MP98: Ethnic Differences in Stroke Quality of Care Between Mexican Americans and Non-Hispanic Whites: The BASIC Project

Abstract

Background: Mexican Americans (MAs) have worse outcomes after stroke than non-Hispanic Whites (NHWs). We investigated ethnic differences in the quality of inpatient stroke care between MAs and NHWs to determine if quality differences may contribute to the observed outcome disparity. Methods: Cases of ischemic stroke were identified from the population-based Brain Attack Surveillance in Corpus Christi (BASIC) project (February 2009- June 2012). Quality of inpatient stroke care was assessed with seven quality metrics based on the 2008 Joint Commission Primary Stroke Center definitions. Two summary measure of overall quality were also created (binary defect-free care and a continuous composite score: proportion of achieved eligible measures). Multilevel generalized linear regression models were used to assess ethnic differences in quality of care, both unadjusted and then adjusting for hospital-level effects, demographics and confounders. Results: A total of 757 individuals were included (480 MAs and 277 NHWs). MAs were less likely than NHWs to receive tPA (RR: 0.71, 95% confidence interval (CI) 0.53, 0.96, p=0.026), and MAs with atrial fibrillation were less likely to receive anticoagulant medications at discharge (RR 0.71, 95% CI 0.55, 0.91, p=0.008). There were no ethnic differences in the other individual quality measures, or in the two overall summary measures. Adjustment for hospital clustering, demographics, and other confounders (summary measures only) resulted in little to no change in the association between ethnicity and quality (Table). Conclusions: There were no ethnic differences in the overall quality of stroke care between MAs and NHWs, though ethnic differences were seen in indicators for tPA and anticoagulant at discharge for atrial fibrillation. Since less than 20% of the population were eligible for these two measures, factors other than quality are likely to be primarily responsible for ethnic differences in stroke outcome.