Abstract WP192: Comparison Of Ischemic Stroke Outcomes At A Safety Net Hospital And Academic University Hospital

Abstract

Introduction: Healthcare disparities continue to be a critical barrier to achieving good stroke outcomes in all populations including those with least access to care. With this study, we hope to understand barriers to stroke management between two different populations at a safety net hospital (SNH) and academic university hospital (AUH) by examining the differences in risk factor profile and short term outcomes. Methods: Patient data was prospectively collected from 1/2021 to 6/2022, including sex, race/ethnicity, thrombolytic administration, initial NIHSS, insurance, and discharge mRS. All documented patients who presented with and admitted for acute stroke were included. Data was compared between our institution’s hospital and academic university hospital. Statistical analysis was conducted by t-test and chi-square analysis. Results: Over the 18 months that data was collected, 556 patients were seen at the SNH and 575 patients at the AUH. Risk factor profile and insurance status varied between both patient populations (p-value <0.001). SNH patients had fewer known risk factors at admission but demonstrated higher blood pressure, hemoglobin A1c, and cholesterol. There was no difference in rate of thrombolytic administration between both hospitals (p-value .599). SNH patients had significantly higher rates of home discharge (68.4 vs 36.2, p-value <0.001) while AUH showed higher rates of discharge to acute care facility which includes inpatient rehabilitation (55.5 vs 26.5,p < 0.001) Conclusion: Though the acute treatment of stroke remained similar between both patient populations, there was evidence of differences in access to care. SNH patients appear to be receiving less post-stroke rehabilitation which could worsen long term outcomes. SNH patients were less likely to have their stroke risk factors diagnosed at admission suggesting need for increased surveillance and primary care access.