Racial-ethnic disparities in acute stroke care in the Florida-Puerto Rico collaboration to reduce stroke disparities study

Background-racial-ethnic disparities in acute stroke care can contribute to inequality in stroke outcomes. we examined raceethnic disparities in acute stroke performance metrics in a voluntary stroke registry among florida and puerto rico get with the guidelines-stroke hospitals. methods and results-seventy-five sites in the florida puerto rico stroke registry (66 florida and 9 puerto rico) recorded 58 864 ischemic stroke cases (2010-2014). logistic regression models examined racial-ethnic differences in acute stroke performance measures and defect-free care (intravenous tissue plasminogen activator treatment,in-hospital antithrombotic therapy,deep vein thrombosis prophylaxis,discharge antithrombotic therapy,appropriate anticoagulation therapy,statin use,smoking cessation counseling) and temporal trends. among ischemic stroke cases,63% were non-hispanic white (nhw),18% were non-hispanic black (nhb),14% were hispanic living in florida,and 6% were hispanic living in puerto rico. nhw patients were the oldest,followed by hispanics,and nhbs. defect-free care was greatest among nhbs (81%),followed by nhws (79%) and florida hispanics (79%),then puerto rico hispanics (57%) (p < 0.0001). puerto rico hispanics were less likely than florida whites to meet any stroke care performance metric other than anticoagulation. defect-free care improved for all groups during 2010-2014,but the disparity in puerto rico persisted (2010: nhws=63%,nhbs=65%,florida hispanics=59%,puerto rico hispanics=31%; 2014: nhws=93%,nhbs=94%,florida hispanics=94%,puerto rico hispanics=63%). conclusions-racial-ethnic/geographic disparities were observed for acute stroke care performance metrics. adoption of a quality improvement program improved stroke care from 2010 to 2014 in puerto rico and all florida racial-ethnic groups. however,stroke care quality delivered in puerto rico is lower than in florida. sustained support of evidence-based acute stroke quality improvement programs is required to improve stroke care and minimize racial-ethnic disparities,particularly in resource-strained puerto rico. © 2017 the authors.