title: Geographic and sociodemographic disparities in drive times to Joint Commission-certified primary stroke centers in North Carolina, South Carolina, and Georgia.
abstract: BACKGROUND
  Timely access to facilities that provide acute stroke care is necessary to reduce disabilities and death from stroke. We examined geographic and sociodemographic disparities in drive times to Joint Commission-certified primary stroke centers (JCPSCs) and other hospitals with stroke care quality improvement initiatives in North Carolina, South Carolina, and Georgia.
  
  
  METHODS
  We defined boundaries for 30- and 60-minute drive-time areas to JCPSCs and other hospitals  by  using geographic information systems (GIS) mapping technology and calculated the proportions of the population living in these drive-time areas by sociodemographic characteristics. Age-adjusted county-level stroke death rates were overlaid onto the drive-time areas.
  
  
  RESULTS
  Approximately 55% of the population lived within a 30-minute drive time to a JCPSC; 77% lived within a 60-minute drive time. Disparities in percentage of the population within 30-minute drive times were found by race/ethnicity, education, income, and urban/rural status; the disparity was largest between urban areas (70% lived within 30-minute drive time) and rural areas (26%). The rural coastal plains had the largest concentration of counties with high stroke death rates and the fewest JCPSCs.
  
  
  CONCLUSIONS
  Many areas in this tri-state region lack timely access to JCPSCs. Alternative strategies are needed to expand provision of quality acute stroke care in this region. GIS modeling is valuable for examining and strategically planning the distribution of hospitals providing acute stroke care.
authors.affiliation: University of Illinois at Chicago School of Public Health, Chicago, IL, USA.
authors.forename: Jenna A
authors.initials: JA
authors.lastname: Khan
authors.forename: Michele
authors.initials: M
authors.lastname: Casper
authors.forename: Andrew W
authors.initials: AW
authors.lastname: Asimos
authors.forename: Lydia
authors.initials: L
authors.lastname: Clarkson
authors.forename: Dianne
authors.initials: D
authors.lastname: Enright
authors.forename: Laura J
authors.initials: LJ
authors.lastname: Fehrs
authors.forename: Mary
authors.initials: M
authors.lastname: George
authors.forename: Khosrow
authors.initials: K
authors.lastname: Heidari
authors.forename: Sara L
authors.initials: SL
authors.lastname: Huston
authors.forename: Laurie H
authors.initials: LH
authors.lastname: Mettam
authors.forename: G Ishmael
authors.initials: GI
authors.lastname: Williams
authors.forename: Linda
authors.initials: L
authors.lastname: Schieb
authors.forename: Sophia
authors.initials: S
authors.lastname: Greer
mesh_terms: D002568:Certification; D004632:Emergency Medical Services / Q000592:standards*; D005845:Georgia / Q000453:epidemiology; D006301:Health Services Needs and Demand / Q000592:standards*; D054624:Health Status Disparities; D054625:Healthcare Disparities; D006761:Hospitals; D006801:Humans; D015994:Incidence; D009657:North Carolina / Q000453:epidemiology; D012189:Retrospective Studies; D013022:South Carolina / Q000453:epidemiology; D020521:Stroke / Q000453:epidemiology / Q000628:therapy*; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D014187:Transportation of Patients / Q000592:standards*