Mary Vaughan Sarrazin1, Kaustubh Limaye2, Edgar A Samaniego3, Sami Al Kasab4, Ali Sheharyar5, Sudeepta Dandapat6, Waldo R Guerrero7, David M Hasan8, Santiago Ortega-Gutierrez9, Colin P Derdeyn10, James C Torner11, Angel Chamorro12, Enrique C Leira13. 1. Department of Internal Medicine, University of Iowa, Iowa City, Iowa. Electronic address: mary-vaughan-sarrazin@uiowa.edu. 2. Department of Neurology, University of Iowa, Iowa City, Iowa. Electronic address: kaustubh-limaye@uiowa.edu. 3. Department of Neurology, University of Iowa, Iowa City, Iowa. Electronic address: edgar-samaniego@uiowa.edu. 4. Department of Neurology, University of Iowa, Iowa City, Iowa. Electronic address: sami-alkasab@uiowa.edu. 5. Department of Neurology, University of Iowa, Iowa City, Iowa. Electronic address: alisheharyar7@gmail.com. 6. Department of Neurology, University of Iowa, Iowa City, Iowa. Electronic address: sudeepta-dandapat@uiowa.edu. 7. Department of Neurology, University of Iowa, Iowa City, Iowa. Electronic address: waldo-guerrero@uiowa.edu. 8. Department of Neurosurgery, University of Iowa, Iowa City, Iowa. Electronic address: david-hasan@uiowa.edu. 9. Department of Neurology, University of Iowa, Iowa City, Iowa. Electronic address: santy-ortega@uiowa.edu. 10. Department of Radiology, University of Iowa, Iowa City, Iowa. Electronic address: colin-derdeyn@uiowa.edu. 11. Department of Epidemiology, University of Iowa, Iowa City, Iowa. Electronic address: james-torner@uiowa.edu. 12. Department of Neurology, University of Iowa, Iowa City, Iowa; Department of Neurology, University of Barcelona, Barcelona, Catalonia, Spain. Electronic address: ACHAMORRO@clinic.ub.es. 13. Department of Neurology, University of Iowa, Iowa City, Iowa; Department of Neurosurgery, University of Iowa, Iowa City, Iowa; Department of Epidemiology, University of Iowa, Iowa City, Iowa. Electronic address: enrique-leira@uiowa.edu.
Abstract
BACKGROUND AND PURPOSE: Mechanical thrombectomy (MT) is a time-dependent therapy that is only available at a limited number of hospitals. As such, patients that live at a considerable distance of those specialized centers often require rapid interhospital emergent evacuation with Helicopter Emergency Medical Services (HEMS) to be considered for MT. It is not known whether the use of HEMS is equitable across different groups of patients. METHODS: Acute ischemic stroke patients emergently transferred to another facility were identified in a retrospective review of a large Medicare claims database. Mode of transportation (HEMS, advanced, or basic ground ambulances) was determined by CPT codes. Distance from patient's residence to the closest center with MT capabilities was calculated. Generalized linear mixed logit models were used to determine the odds of HEMS relative to ground services for Hispanic and non-Hispanic black (NHB) patients relative to non-Hispanic white (NHW) patients while controlling for confounders. RESULTS: A total of 8027 patients that underwent emergent interhospital transportation were analyzed. HEMS utilization was 18.1% for NHB, 20.6% for Hispanics, and 21.6% for NHW (P = .054). In adjusted analyses for confounders, including distance to a MT-capable hospital, Hispanic patients were less likely than NHWs to be transported by HEMS. While that association had marginal significance for the whole United States (OR = .76; 95% CI, .57-1.01; P = .055), it was statistically significant for patients living in the southern region of the United States (OR = .6; 95% CI, .40-.92; P = .019). DISCUSSION: Our findings suggest there is a disparity in the use of HEMS in Hispanic stroke patients compared to NHW. Such a disparity may delay arrival to a MT-capable hospital, delay treatment times, or lead to ineligibility for MT altogether. Given the known benefit of MT and known existing disparities in stroke treatment and outcomes, it is important to further investigate and address disparities in mode of interhospital transportation.
BACKGROUND AND PURPOSE: Mechanical thrombectomy (MT) is a time-dependent therapy that is only available at a limited number of hospitals. As such, patients that live at a considerable distance of those specialized centers often require rapid interhospital emergent evacuation with Helicopter Emergency Medical Services (HEMS) to be considered for MT. It is not known whether the use of HEMS is equitable across different groups of patients. METHODS: Acute ischemic strokepatients emergently transferred to another facility were identified in a retrospective review of a large Medicare claims database. Mode of transportation (HEMS, advanced, or basic ground ambulances) was determined by CPT codes. Distance from patient's residence to the closest center with MT capabilities was calculated. Generalized linear mixed logit models were used to determine the odds of HEMS relative to ground services for Hispanic and non-Hispanic black (NHB) patients relative to non-Hispanic white (NHW) patients while controlling for confounders. RESULTS: A total of 8027 patients that underwent emergent interhospital transportation were analyzed. HEMS utilization was 18.1% for NHB, 20.6% for Hispanics, and 21.6% for NHW (P = .054). In adjusted analyses for confounders, including distance to a MT-capable hospital, Hispanic patients were less likely than NHWs to be transported by HEMS. While that association had marginal significance for the whole United States (OR = .76; 95% CI, .57-1.01; P = .055), it was statistically significant for patients living in the southern region of the United States (OR = .6; 95% CI, .40-.92; P = .019). DISCUSSION: Our findings suggest there is a disparity in the use of HEMS in Hispanic strokepatients compared to NHW. Such a disparity may delay arrival to a MT-capable hospital, delay treatment times, or lead to ineligibility for MT altogether. Given the known benefit of MT and known existing disparities in stroke treatment and outcomes, it is important to further investigate and address disparities in mode of interhospital transportation.
Authors: Mark O McCarron; Mike Clarke; Paul Burns; Michael McCormick; Peter McCarron; Raeburn B Forbes; Luke V McCarron; Fiona Mullan; Ferghal McVerry Journal: Front Neurol Date: 2021-02-12 Impact factor: 4.003
Authors: Sushanth Rao Aroor; Kaiz S Asif; Jennifer Potter-Vig; Arun Sharma; Bijoy K Menon; Violiza Inoa; Cynthia B Zevallos; Jose G Romano; Santiago Ortega-Gutierrez; Larry B Goldstein; Dileep R Yavagal Journal: J Stroke Date: 2022-01-31 Impact factor: 6.967
Authors: Kori S Zachrison; Margaret E Samuels-Kalow; Sijia Li; Zhiyu Yan; Mathew J Reeves; Renee Y Hsia; Lee H Schwamm; Carlos A Camargo Journal: J Am Coll Emerg Physicians Open Date: 2022-03-14