title: The effects of telemedicine on racial and ethnic disparities in access to acute stroke care.
abstract: Racial and ethnic disparities have been previously reported in acute stroke care. We sought to determine the effect of telemedicine (TM) on access to acute stroke care for racial and ethnic minorities in the state of Texas. Data were collected from the US Census Bureau, The Joint Commission and the American Hospital Association. Access for racial and ethnic minorities was determined by summing the population that could reach a primary stroke centre (PSC) or telemedicine spoke within specified time intervals using validated models. TM extended access to stroke expertise by 1.5 million residents. The odds of providing 60-minute access via TM were similar in Blacks and Whites (prevalence odds ratios (POR) 1.000, 95% CI 1.000-1.000), even after adjustment for urbanization (POR 1.000, 95% CI 1.000-1.001). The odds of providing access via TM were also similar for Hispanics and non-Hispanics (POR 1.000, 95% CI 1.000-1.000), even after adjustment for urbanization (POR 1.000, 95% CI 1.000-1.000). We found that telemedicine increased access to acute stroke care for 1.5 million Texans. While racial and ethnic disparities exist in other components of stroke care, we did not find evidence of disparities in access to the acute stroke expertise afforded by telemedicine.
authors.affiliation: Department of Neurology, University of Alabama at Birmingham, Birmingham, AL Stroke Program, Birmingham Veterans Affairs Medical Center, Birmingham, AL mjlyerly@uab.edu.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Lyerly
authors.affiliation: Department of Neurology, University of Texas - Houston Memorial Hermann Medical Center, Houston, TX.
authors.forename: Tzu-Ching
authors.initials: TC
authors.lastname: Wu
authors.affiliation: Department of Neurology, University of Pennsylvania, Philadelphia, PA.
authors.forename: Michael T
authors.initials: MT
authors.lastname: Mullen
authors.affiliation: Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL Health Services and Outcomes Research Center for Outcome and Effectiveness Research and Education (COERE), University of Alabama at Birmingham, Birmingham, AL Center for Excellence in Comparative Effectiveness Research for Eliminating Disparities (CERED) Minority Health & Health Disparities Research Center (MHRC), University of Alabama at Birmingham, Birmingham, AL Geriatric Research Education and Clinical Center (GRECC), Birmingham Veterans Affairs Medical Center, Birmingham, AL.
authors.forename: Karen C
authors.initials: KC
authors.lastname: Albright
authors.affiliation: School of Medicine, Duke University, Durham, NC.
authors.forename: Catherine
authors.initials: C
authors.lastname: Wolff
authors.affiliation: Gertrude Sergievsky Center, Department of Neurology, Columbia University, New York, NY.
authors.forename: Amelia K
authors.initials: AK
authors.lastname: Boehme
authors.affiliation: Department of Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA.
authors.forename: Charles C
authors.initials: CC
authors.lastname: Branas
authors.affiliation: Department of Neurology, University of Texas - Houston Memorial Hermann Medical Center, Houston, TX.
authors.forename: James C
authors.initials: JC
authors.lastname: Grotta
authors.affiliation: Department of Neurology, University of Texas - Houston Memorial Hermann Medical Center, Houston, TX.
authors.forename: Sean I
authors.initials: SI
authors.lastname: Savitz
authors.affiliation: Department of Emergency Medicine, University of Pennsylvania, Philadelphia, PA.
authors.forename: Brendan G
authors.initials: BG
authors.lastname: Carr
mesh_terms: D000328:Adult; D000368:Aged; D005006:Ethnicity / Q000706:statistics & numerical data*; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D054625:Healthcare Disparities / Q000592:standards*; D006801:Humans; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D012307:Risk Factors; D020521:Stroke / Q000628:therapy*; D017216:Telemedicine / Q000706:statistics & numerical data*; D013781:Texas; D014481:United States; D055815:Young Adult
keywords: Teleneurology; ethnic minorities; healthcare access; racial minorities; tele-stroke; telemedicine