Abstract W P272: Healthcare Resource Availability, Acute Ischemic Stroke Outcomes and Quality of Care

Abstract

Background: Healthcare resources vary by geographic region, but the association between hospital-based resources and acute stroke outcomes has not been well-characterized. Methods: We used data from Get With The Guidelines-Stroke (GWTG-Stroke), a national, inpatient quality improvement initiative, and the Dartmouth Atlas of Healthcare (DAH) to examine the association between regional healthcare resource availability, stroke care, and outcomes. We categorized each hospital resource region (HRR) according to whether it was above or below the 2006 national median in availability of six resources: neurologists, radiologists, ER physicians, rehabilitation specialists, hospital-based RNs, and inpatient beds. Each HRR was then classified as High (>50th percentile in at least 5 resource categories), Medium (>50th percentile in 3 or 4 categories), or Low resource (>50th percentile in fewer than 3 categories). We used multivariable logistic regression to examine healthcare resource level and in-hospital outcomes. Results: Of 1,480,308 ischemic stroke patients admitted from 2006-2013, 28.8% were hospitalized in low resource HRRs, 44.4% in medium resource HRRs, and 26.9% in high resource HRRs. Demographic distributions were similar across resource levels. In unadjusted models, global p-values were non-significant and all standardized differences between resource levels were <10% for the defect free care composite measure and all but one individual quality measure (discharge statin therapy). Adjusted length of stay and in-hospital mortality were similar across all resource levels, including in a sensitivity analysis adjusting for NIHSS (recorded in 60.7%; data not shown). Conclusions: Among hospitals participating in GWTG-Stroke, differences in regional resource availability did not influence acute ischemic stroke quality of care or in-hospital outcomes.