Description
TitleStroke outcomes in New Jersey, 2010-2016
Date Created2021
Other Date2021-05 (degree)
Extent1 online resource (vii, 87 pages)
DescriptionStroke is a significant public health burden, accounting for substantial adult-onset disability and increased financial costs in both direct medical care and lost productivity among the adult survivor population. Secondary and Tertiary prevention efforts, which improve outcomes such as survival and return to pre-morbid function, include accessing appropriate care in a timely manner and utilizing rehabilitation services. Despite clinical guidelines related to stroke care, disparities in population level outcomes, including mortality and disability, still exist. While significant attention has been given to disparities in primary prevention, a focus on secondary and tertiary prevention can identify if the outcomes disparity is attributable to care access and quality of care received.
Quality of stroke care services in the inpatient setting is highly reviewed and assessed and has contributed to significant improvements in the proportion of patients receiving services and treatments critical to optimal outcomes. Given the importance of these clinical measures on long term outcomes and the prevailing disparities in the US, one questions whether quality improvements are universally improving across all patient populations or if there are subsets with worse intra-hospital outcomes.
Using data from the hospitalized stroke population in New Jersey this dissertation aims to determine whether factors other than clinical, including race and ethnicity, sex, and income, are associated with quality care as defined by access to stroke services via emergency medical services (EMS), access to high intensity rehabilitation, as defined as discharge to an inpatient rehabilitation facility (IRF) over a skilled nursing facility (SNF), and receipt of treatment within a defined window of time to prevent complications associated with stroke.
Among stroke cases treated in NJ, there were significant disparities found in access to care. EMS utilization differed significantly by age, insurance type, and by race and income. Access to IRF was significantly lower for women and for minorities. With regard to clinical care in the hospital setting, DVT prophylaxis was greater for men and among select age categories. Hispanic patients were also at increased odds for DVT prophylaxis by day 2 of their inpatient stay.
Secondary and tertiary stroke prevention in NJ are not equal across factors such as age, race/ethnicity and sex. With such variations in these selected outcomes, greater attention is needed to other quality indicators in order to best understand where deviations in the stroke care pathway can be improved in order to impact long term outcomes.
NotePh.D.
NoteIncludes bibliographical references
Genretheses, ETD doctoral
LanguageEnglish
CollectionSchool of Graduate Studies Electronic Theses and Dissertations
Organization NameRutgers, The State University of New Jersey
RightsThe author owns the copyright to this work.
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