Healthcare Resource Availability, Quality of Care, and Acute Ischemic Stroke Outcomes.
Healthcare resources vary geographically, but associations between hospital-based resources and acute stroke quality and outcomes remain unclear.



Using Get With The Guidelines-Stroke and Dartmouth Atlas of Health Care data, we examined associations between healthcare resource availability, stroke care, and outcomes. We categorized hospital referral regions with high-, medium-, or low-resource levels based on the 2006 national per-capita availability median of 6 relevant acute stroke care resources. Using multivariable logistic regression, we examined healthcare resource level and in-hospital quality and outcomes. Of 1 480 308 admitted ischemic stroke patients (2006-2013), 28.8% were hospitalized in low-, 44.4% in medium-, and 26.9% in high-resource hospital referral regions. Quality-of-care/timeliness metrics, adjusted length of stay, and in-hospital mortality were similar across all resource levels.



Significant variation exists in regional availability of healthcare resources for acute ischemic stroke treatment, yet among Get With the Guidelines-Stroke hospitals, quality of care and in-hospital outcomes did not differ by regional resource availability.
Duke Clinical Research Institute, Durham, NC emily.obrien@duke.edu.
Emily C
EC
O'Brien
Duke Clinical Research Institute, Durham, NC.
Jingjing
J
Wu
Duke Clinical Research Institute, Durham, NC.
Xin
X
Zhao
Department of Health Sciences Research, Mayo Clinic, Rochester, MN.
Phillip J
PJ
Schulte
UCLA Division of Cardiology, Los Angeles, CA.
Gregg C
GC
Fonarow
Duke Clinical Research Institute, Durham, NC.
Adrian F
AF
Hernandez
Stroke Service, Massachusetts General Hospital, Harvard Medical School, Boston, MA.
Lee H
LH
Schwamm
Duke Clinical Research Institute, Durham, NC.
Eric D
ED
Peterson
Brigham and Women's Hospital Heart and Vascular Center, Harvard Medical School, Boston, MA.
Deepak L
DL
Bhatt
University of Calgary, Alberta, Canada.
Eric E
EE
Smith
D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000453:epidemiology / Q000628:therapy*; D003422:Critical Care / Q000458:organization & administration*; D005260:Female; D006295:Health Resources / Q000458:organization & administration*; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D011787:Quality of Health Care; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology
healthcare resources; outcomes research; stroke care