Research shows that there are large disparities in stroke services in the US

Low-income communities are up to 42% less likely to obtain stroke center certification.

Hospitals in poor communities are significantly less likely to receive certification for stroke services, leaving them unable to provide urgent, life-saving treatment, UC San Francisco researchers report in a 14-year study of the nation’s hospitals.

In contrast, hospitals in economically mixed or affluent communities were more likely to become stroke-certified. Such specialized services are associated with better care for patients after a stroke. The findings show significant disparities across the United States in access to critical neurological treatments, the researchers said.

The study was published on July 25 in JAMA network opened.

“Some hospitals do not have the necessary resources to treat patients who experience certain types of strokes,” said lead researcher Renee Y. Hsia, MD, professor of emergency medicine at UCSF and vice chair of healthcare research in the department of emergency medicine.

“Our findings can help inform the adoption of broad social and policy interventions at the local, state, and federal levels to promote equity and access to important community resources.”

Socio-economic disadvantage

Introduced in 2004 to improve the quality and coordination of acute stroke care, stroke center certification is awarded to acute care hospitals that demonstrate their ability to provide specialized stroke services.

Researchers looked at 5,055 acute, non-federal hospitals between 2009 and 2022. They found that 6% of hospitals were in the most affluent communities, 11% in relatively advantaged communities, 39% in mixed, 36% in relatively disadvantaged communities and 7% in relatively disadvantaged communities. in the most disadvantaged. Hospital ownership varied: 57% of hospitals were not-for-profit, 17% were for-profit, and 22% were publicly owned.

After adjusting for population size and hospital capacity, researchers found that hospitals near socioeconomically disadvantaged communities were 20 to 42% less likely to obtain stroke center certification compared to hospitals near communities of average socioeconomic status.

“Hospitals with stroke centers that serve patients with a large share of commercial insurance and Medicare tend to be revenue centers, meaning they bring in money for the hospitals,” said Hsia, who also works at the UCSF Philip R. Lee Institute for Health Policy. Studies. “While stroke centers in areas with a ‘poor’ patient payer mix – those with uninsured or Medicaid-insured patients with low reimbursement rates – will operate with much lower or often negative profit margins for those services.

“Providing support for hospitals in underserved communities to obtain stroke center certification can help reduce disparities in stroke care,” she said.

The other authors were Nandita Sarkar, Ph.D., of the National Bureau of Economic Research in Cambridge, Massachusetts; and Yu-Chu Shen, Ph.D., of Department of Defense Management at the Naval Postgraduate School in Monterey, California.