title: The Effect of Telemedicine on Access to Acute Stroke Care in Texas: The Story of Age Inequalities.
abstract: Background. Ischemic stroke is a time sensitive disease with the effectiveness of treatment decreasing over time. Treatment is more likely to occur at Primary Stroke Centers (PSC); thus rapid access to acute stroke care through stand-alone PSCs or telemedicine (TM) is vital for all Americans. The objective of this study is to determine if disparities exist in access to PSCs or the extended access to acute stroke care provided by TM. Methods. Data from the US Census Bureau and the 2010 Neilson Claritas Demographic Estimation Program, American Hospital Association annual survey, and The Joint Commission list of PSCs and survey response data for all hospitals in the state of Texas were used. Results. Over 64% of block groups had 60-minute ground access to acute stroke care. The odds of a block group having 60-minute access to acute stroke care decreased with age, despite adjustment for sex, race, ethnicity, socioeconomic status, urbanization, and total population. Conclusion. Our survey of Texas hospitals found that as the median age of a block group increased, the odds of having access to acute stroke care decreased.
authors.affiliation: Geriatric Research, Education and Clinical Center (GRECC), Birmingham VA Medical Center, Birmingham, AL 35249, USA ; Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, AL 35249, USA.
authors.forename: Karen C
authors.initials: KC
authors.lastname: Albright
authors.affiliation: Department of Neurology, Columbia University, New York, NY 10032, USA.
authors.forename: Amelia K
authors.initials: AK
authors.lastname: Boehme
authors.affiliation: Department of Neurology, University of Pennsylvania, Philadelphia, PA 19104, USA.
authors.forename: Michael T
authors.initials: MT
authors.lastname: Mullen
authors.affiliation: Stroke Program, Department of Neurology, University of Texas-Houston Memorial Hermann Medical Center, Houston, TX 77030, USA.
authors.forename: Tzu-Ching
authors.initials: TC
authors.lastname: Wu
authors.affiliation: Department of Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA 19104, USA.
authors.forename: Charles C
authors.initials: CC
authors.lastname: Branas
authors.affiliation: Stroke Program, Department of Neurology, University of Texas-Houston Memorial Hermann Medical Center, Houston, TX 77030, USA.
authors.forename: James C
authors.initials: JC
authors.lastname: Grotta
authors.affiliation: Stroke Program, Department of Neurology, University of Texas-Houston Memorial Hermann Medical Center, Houston, TX 77030, USA.
authors.forename: Sean I
authors.initials: SI
authors.lastname: Savitz
authors.affiliation: Department of Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA 19104, USA.
authors.forename: Catherine
authors.initials: C
authors.lastname: Wolff
authors.affiliation: Department of Health Care Organization and Policy, School of Public Health, University of Alabama at Birmingham, Birmingham, AL 35249, USA.
authors.forename: Bisakha
authors.initials: B
authors.lastname: Sen
authors.affiliation: Department of Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA 19104, USA ; Department of Emergency Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA.
authors.forename: Brendan G
authors.initials: BG
authors.lastname: Carr