Abstract
Background and Purpose: A recent ischemic stroke data validation study using California (CA) patient discharge data (PDD) was conducted as part of a public reporting program for the Office of Statewide Health Planning and Development (OSHPD). This validation study demonstrated that use of tissue-type plasminogen activator (tPA) is well-coded in the PDD. Supported by this evidence, we sought to measure tPA usage for ischemic stroke in CA acute care hospitals and to determine whether some hospital or patient characteristics are associated with greater or lower tPA utilization. Methods: Using the OSHPD PDD, we selected adult patients with a primary diagnosis of ischemic stroke admitted to CA acute care hospitals between January 2010 and November 2011. Using bivariate analysis, we explored the association between rates of tPA use and patient age, gender, race, and expected payer, as well as hospital teaching status, location, and size. Results: Among the 74,586 patients hospitalized with acute ischemic stroke in CA, 4,488 patients (6.02%) received tPA. The observed rate of tPA usage among hospitals ranged from 0% to 22.13%.There were no significant gender differences. Younger patients had a higher rate of tPA usage than older patient groups (7.4% vs. 5.8% and 6.1%, P=0.0029). White patients had a higher rate of tPA utilization than Black and Hispanic patients (6.8% vs. 4.2% and 4.4%, P< 0.0001). Those with Medicare (5.9%) and Medi-Cal (5.1%) had a lower rate of tPA utilization than those with private insurance (7.5%), but higher than self-pay patients (4.4%) (P< 0.0001). There was a significantly higher rate of tPA usage in teaching hospitals than non-teaching hospitals (8.6% vs. 5.7%, P< 0.0001) and tPA utilization was significantly greater at urban versus rural hospitals (6.3% vs. 3.3%,P<0.0001). Higher rates of tPA utilization were associated with increased hospital bed size (P< 0.0001). Conclusions: Rates of tPA utilization in CA acute care hospitals varied significantly by hospital teaching status, location, licensed bed size and patient demographic characteristics.
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