DIFFERENCES IN ACCESS AND QUALITY OF CARE DURING ACUTE ISCHEMIC STROKE: FINDINGS FROM THE REGARDS STUDY

Abstract

Evidence suggests there are discrepancies in access and quality of care during hospitalization for acute ischemic stroke. The aim of this study was to characterize differences in receipt of neurologist evaluation, documented evidence of prescribed antihypertensive therapy at discharge, and smoking cessation counseling or advice at discharge by age, race (African American/Black vs. White), sex, and region (Stroke Belt residence vs. other) using population level data from a national cohort study. Secondary analysis of data from participants enrolled in the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study who experienced an adjudicated ischemic stroke between 2003-2016 (n=1042) was conducted to answer study research questions. Results indicated that participants with greater levels of post-stroke functional impairment and those with a greater number of risk factors were more likely to receive neurologist evaluation during the hospital course compared to those with lower levels of post-stroke functional impairment and fewer number of risk factors, respectively (mRS RR, 1.04; 95% CI, 1.01-1.06; Total risk factors RR, 1.02; 95% CI, 1.00-1.04). Stroke Belt residents and those receiving care in rural hospitals were significantly less likely to receive neurologist evaluation compared to non-Stroke Belt residents (RR, 0.95; 95% CI, 0.90-1.01) and participants receiving care in urban hospitals (RR, 0.74; 95% CI, 0.63-0.86). Participants who were older, female, had a greater number of risk factors, and higher BMIs were significantly more likely to receive antihypertensive therapy at discharge compared to younger participants, males, those with fewer risk factors and lower BMIs, respectively (age RR 1.05; 95% CI, 1.02-1.09; female sex RR 1.09; 95% CI, 1.03-1.16; total risk factors RR 1.07; 95% CI, 1.04-1.10; BMI RR 1.01; 95% CI, 1.00-1.01). Only half (50%) of current smokers received smoking cessation counseling or advice at discharge. There was an increasing trend in receipt of smoking cessation counseling at hospital discharge over time (RR 1.12; 95% CI, 1.04-1.21). Findings from this study inform the planning and implementation of multi-level interventions and health-related policy for improving access to high quality stroke care.