Abstract 1122‐000062: Impact of COVID‐19 on Stroke Care in the United States and Potential Solutions

2021 ◽  
Vol 1 (S1) ◽  
Author(s):  
Sanika S Mhatre
Keyword(s):  
United States ◽  
Rural Communities ◽  
Stroke Care ◽  
The United States ◽  
Stroke Patients ◽  
Rural Regions ◽  
Average Delay ◽  
Adequate Treatment ◽  
Stroke Treatment ◽  
Urban Regions

Introduction : The emergence of the COVID‐19 pandemic has negatively impacted medical care across the United States, especially so for rural communities. In this qualitative study, we investigated the barriers to the access of adequate treatment of ischemic stroke that have risen due to COVID‐19 in urban and rural regions of the United States of America. Methods : Using CDC data, we identified 16 regions, consisting of half urban and half rural regions, that had the highest stroke mortality rate and the highest incidence of COVID‐19 cases in the country. We compiled a list of neurointerventionalists practicing in these regions and designed a survey that was emailed to each neurointerventionalist. The survey investigated how stroke treatment in their hospital has been affected by the COVID‐19 pandemic; it additionally contained a request for a virtual interview to allow neurointerventionalists to discuss in greater detail the barriers to stroke treatment they are facing. Neurointerventionalists from hospitals across four urban regions and three rural regions filled out the survey and were then interviewed by Zoom or phone. Results : The survey and the interviews highlighted a number of barriers: hospitals in both urban and rural regions faced an unavailability of ICU beds during COVID surges. As COVID‐19 patients continued to occupy ICU beds, thrombectomy‐capable hospitals could not accept transfer stroke patients. These patients had to be diverted to other thrombectomy‐capable hospitals with vacant ICU beds, resulting in time lost before treatment. Stroke transfer posed more of a challenge in rural regions (as compared to urban communities) due to fewer rural‐area hospitals performing thrombectomy. Secondly, both urban and rural regions saw stroke patients delay their arrival to the hospital. In urban regions, stroke patients delayed their arrival by up to a week in some cases. Patients with milder stroke symptoms did not show up to the hospital for treatment at all, hoping the stroke would subside on its own. This pattern has been attributed to patients’ fear of contracting COVID‐19. In comparison, rural hospitals faced a smaller average delay of up to a few days, as many patients did not see the virus as a threat. The delay was attributed to some patients’ fear of the virus, fear of the procedure, or longstanding physician mistrust. Lastly, rural regions encountered an understaffing of nurses; a likely factor is the incidence of layoffs early in the pandemic, which lessened the time spent at a stroke patient’s bedside and impacted stroke outcome. Conclusions : Urban regions were quicker to adapt to the pandemic than rural regions. They had a greater number of available staff and vacant ICU beds to be able to treat patients with minimal interference. Urban regions could still consider having nearby hospitals communicate with each other so that they can share the burden of care and prevent a single hospital from becoming overwhelmed. Rural regions could especially focus on hiring travel nurses in cases of understaffing, increasing the number of thrombectomy performing centers, and pushing the education of stroke.

scholarly journals Sex disparity in long-term stroke recurrence and mortality in a rural population in the United States

2020 ◽  
Vol 13 ◽  
pp. 175628642097189
Author(s):  
Clare Lambert ◽  
Durgesh Chaudhary ◽  
Oluwaseyi Olulana ◽  
Shima Shahjouei ◽  
Venkatesh Avula ◽  
...  
Keyword(s):  
United States ◽  
Ischemic Stroke ◽  
Rural Population ◽  
The United States ◽  
Competing Risk ◽  
Stroke Recurrence ◽  
Composite Outcome ◽  
Stroke Patients ◽  
Central Pennsylvania ◽  
All Cause Mortality

Background: Several studies suggest women may be disproportionately affected by poorer stroke outcomes than men. This study aims to investigate whether women have a higher risk of all-cause mortality and recurrence after an ischemic stroke than men in a rural population in central Pennsylvania, United States. Methods: We analyzed consecutive ischemic stroke patients captured in the Geisinger NeuroScience Ischemic Stroke research database from 2004 to 2019. Kaplan–Meier (KM) estimator curves stratified by gender and age were used to plot survival probabilities and Cox Proportional Hazards Ratios were used to analyze outcomes of all-cause mortality and the composite outcome of ischemic stroke recurrence or death. Fine–Gray Competing Risk models were used for the outcome of recurrent ischemic stroke, with death as the competing risk. Two models were generated; Model 1 was adjusted by data-driven associated health factors, and Model 2 was adjusted by traditional vascular risk factors. Results: Among 8900 adult ischemic stroke patients [median age of 71.6 (interquartile range: 61.1–81.2) years and 48% women], women had a higher crude all-cause mortality. The KM curves demonstrated a 63.3% survival in women compared with a 65.7% survival in men ( p = 0.003) at 5 years; however, the survival difference was not present after controlling for covariates, including age, atrial fibrillation or flutter, myocardial infarction, diabetes mellitus, dyslipidemia, heart failure, chronic lung diseases, rheumatic disease, chronic kidney disease, neoplasm, peripheral vascular disease, past ischemic stroke, past hemorrhagic stroke, and depression. There was no adjusted or unadjusted sex difference in terms of recurrent ischemic stroke or composite outcome. Conclusion: Sex was not an independent risk factor for all-cause mortality and ischemic stroke recurrence in the rural population in central Pennsylvania.

scholarly journals EPID-07. ACCESS TO GLIOBLASTOMA CLINICAL TRIALS FOR RURAL PATIENTS IN THE UNITED STATES FROM 2010–2020

2020 ◽  
Vol 22 (Supplement_2) ◽  
pp. ii79-ii79
Author(s):  
Kathryn Nevel ◽  
Samuel Capouch ◽  
Lisa Arnold ◽  
Katherine Peters ◽  
Nimish Mohile ◽  
...  
Keyword(s):  
United States ◽  
Clinical Trials ◽  
Rural Communities ◽  
The United States ◽  
Interventional Treatment ◽  
Phase Ii Trials ◽  
Treatment Trials ◽  
Rural Sites ◽  
Rural Patients ◽  
Urban Sites

Abstract BACKGROUND Patients in rural communities have less access to optimal cancer care and clinical trials. For GBM, access to experimental therapies, and consideration of a clinical trial is embedded in national guidelines. Still, the availability of clinical trials to rural communities, representing 20% of the US population, has not been described. METHODS We queried ClinicalTrials.gov for glioblastoma interventional treatment trials opened between 1/2010 and 1/2020 in the United States. We created a Structured Query Language database and leveraged Google application programming interfaces (API) Places to find name and street addresses for the sites, and Google’s Geocode API to determine the county location. Counties were classified by US Department of Agriculture Rural-Urban Continuum Codes (RUCC 1–3 = urban and RUCC 4–9 = rural). We used z-ratios for rural-urban statistical comparisons. RESULTS We identified 406 interventional treatment trials for GBM at 1491 unique sites. 8.7% of unique sites were in rural settings. Rural sites opened an average of 1.7 trials/site and urban sites 2.8 trials/site from 1/2010–1/2020. Rural sites offered more phase II trials (63% vs 57%, p= 0.03) and fewer phase I trials (22% vs 28%, p= 0.01) than urban sites. Rural locations were more likely to offer federally-sponsored trials (p< 0.002). There were no investigator-initiated or single-institution trials offered at rural locations, and only 1% of industry trials were offered rurally. DISCUSSION Clinical trials for GBM were rarely open in rural areas, and were more dependent on federal funding. Clinical trials are likely difficult to access for rural patients, and this has important implications for the generalizability of research as well as how we engage the field of neuro-oncology and patient advocacy groups in improving patient access to trials. Increasing the number of clinical trials in rural locations may enable more rural patients to access and enroll in GBM studies.

scholarly journals 00001 Demographic disparities in proximity to stroke care in the United States

2021 ◽  
pp. 1-2
Author(s):  
Cathy Y. Yu ◽  
Timothy Blaine ◽  
Peter Panagos ◽  
Akash P. Kansagra
Keyword(s):  
United States ◽  
Stroke Care ◽  
The United States

Abstract 1122‐000242: Effect of Covid‐19 on Stroke Treatment in Australia and New Zealand

2021 ◽  
Vol 1 (S1) ◽  
Author(s):  
Ela Machiroutu
Keyword(s):  
New Zealand ◽  
Stroke Care ◽  
Small Subset ◽  
Stroke Patients ◽  
Secondary Research ◽  
Stroke Treatment ◽  
Survey Tool ◽  
Early Adoption ◽  
Survey Responses ◽  
The Impact

Introduction : In general, compared to the rest of the world, the impact of Covid‐19 in the Australia and New Zealand regions has been minimal and this may be attributed to their early adoption of social distancing, stable governments, national wealth and geographic isolation. However, this research was designed to validate this perception amongst the stakeholders. Methods : This research included: primary and secondary research. First, secondary research about Covid‐19 and stroke treatment and Australia and New Zealand in particular was conducted and compiled in a Google spreadsheet. Research sources include Stroke Foundation, Brain Foundation, and World Meters. Data collected included the number of stroke and Covid‐19 cases in Australia and New Zealand as well as a list of stakeholders with their contact information. The stakeholders included neurosurgeons, hospitals, neurologists, interventionists, and vascular surgeons. A survey tool and an interview questions were prepared next. The survey request was emailed to stakeholders, requesting the stakeholders for an interview and survey response. Over the following weeks, survey results came in and interviews were conducted. Since only a small subset of stakeholders responded to the survey (6 survey responses and 4 interviews), this study must be considered to be primarily qualitative in nature. The interviews were conducted online using Zoom. After the interviews, I replayed the interviews and took notes of important details. Results : The survey showed that 83% of the doctors worked in a hospital that had a separate stroke unit and that they perform mechanical thrombectomies most often as a treatment for stroke. Most of the doctors suggested that the stroke numbers have not changed significantly since Covid‐19. Yet, 50% of the doctors said that there had been delays in admitting stroke patients. One third believed Covid‐19 may have made an impact on mortality of stroke patients. One of the interviewees revealed that the main barriers to access to stroke care are the time it takes to treat the patient, fewer locations that treat strokes or perform mechanical thrombectomy, and patients’ reluctance to go to the hospital during the pandemic. Another confirmed that she did think there had been delays due to Covid‐19. Conclusions : Counter to widespread perception, Covid‐19 pandemic DID worsen many barriers for stroke treatment in Australia and New Zealand. These regions have insufficient stroke centers and these are not spread out widely enough for accessibility. Stroke deaths have increased during the Covid‐19 pandemic. Barriers such as time, accessibility, and the patient’s fear of hospitals have affected stroke treatment during the pandemic. Several measures can alleviate the impact: stroke awareness is critical. Every hospital needs to have the ability to assess and treat stroke. Hospitals must run simulations to practice and prepare for different scenarios that they could encounter when dealing with stroke patients. In conclusion, stroke treatment has been affected by the Covid‐19 pandemic and it is critical to minimize and overcome these barriers as stroke is one of the leading causes of death in Australia and New Zealand.

Abstract 1122‐000121: Integrated Geomapping Tool of Certified Stroke Centers in United States: A SVIN MT2020+ Committee Collaboration

2021 ◽  
Vol 1 (S1) ◽  
Author(s):  
Evan Kolesnick ◽  
Evan Kolesnick ◽  
Alfredo Munoz ◽  
Kaiz Asif ◽  
Santiago Ortega‐Gutierrez ◽  
...  
Keyword(s):  
United States ◽  
Acute Stroke ◽  
Clinical Outcomes ◽  
Healthcare Disparities ◽  
Systems Of Care ◽  
Stroke Care ◽  
The United States ◽  
Time Dependent ◽  
Stroke Systems Of Care ◽  
Stroke Center

Introduction : Stroke is a leading cause of morbidity, mortality and healthcare spending in the United States. Acute management of ischemic stroke is time‐dependent and evidence suggests improved clinical outcomes for patients treated at designated certified stroke centers. There is an increasing trend among hospitals to obtain certification as designated stroke centers. A common source or integrated tool providing both information and location of all available stroke centers in the US irrespective of the certifying organization is not readily available. The objective of our research is to generate a comprehensive and interactive electronic resource with combined data on all geographically‐coded certified stroke centers to assist in pre‐hospital triage and study healthcare disparities in stroke including availability and access to acute stroke care by location and population. Methods : Data on stroke center certification was primarily obtained from each of the three main certifying organizations: The Joint Commission (TJC), Det Norske Veritas (DNV) and Healthcare Facilities Accreditation Program (HFAP). Geographic mapping of all stroke center locations was performed using the ArcGIS Pro application. The most current data on stroke centers is presented in an interactive electronic format and the information is frequently updated to represent newly certified centers. Utility of the tool and its analytics are shown. Role of the tool in improving pre‐hospital triage in the stroke systems of care, studying healthcare disparities and implications for public health policy are discussed. Results : Aggregate data analysis at the time of submission revealed 1,806 total certified stroke centers. TJC‐certified stroke centers represent the majority with 106 Acute Stroke Ready (ASR), 1,040 Primary Stroke Centers (PSCs), 49 Thrombectomy Capable Centers (TSCs) and 197 Comprehensive Stroke Centers (CSCs). A total of 341 DNV‐certified programs including 36 ASRs, 162 PSCs, 16 PSC Plus (thrombectomy capable) and 127 CSCs were identified. HFAP‐certified centers (75) include 16 ASRs, 49 PSCs, 2 TSCs and 8 CSCs. A preliminary map of all TJC‐certified CSCs and TSCs is shown in the figure (1). Geospatial analysis reveals distinct areas with currently limited access to certified stroke centers and currently, access to certified stroke centers is extremely limited to non‐existent in fe States (for example: Idaho, Montana, Wyoming, New Mexico and South Dakota). Conclusions : Stroke treatment and clinical outcomes are time‐dependent and prompt assessment and triage by EMS directly to appropriate designated stroke centers is therefore critical. A readily available electronic platform providing location and treatment capability for all nearby certified centers will enhance regional stroke systems of care, including enabling more rapid inter‐hospital transfers for advanced intervention. Identifying geographic areas of limited access to treatment can also help improve policy and prioritize the creation of a more equitable and well‐distributed network of stroke care in the United States.

scholarly journals Exploring Experiences and Perceptions of Older African American Males Aging With HIV in the Rural Southern United States

2016 ◽  
Vol 11 (2) ◽  
pp. 221-232 ◽  
Author(s):  
Barbara J. Blake ◽  
Gloria A. Jones Taylor ◽  
Richard L. Sowell
Keyword(s):  
United States ◽  
African American ◽  
Rural Communities ◽  
African American Men ◽  
Qualitative Content Analysis ◽  
The United States ◽  
Health Concern ◽  
Treatment And Prevention ◽  
Age Related ◽  
Living With Hiv

The HIV (human immunodeficiency virus) epidemic in the United States remains a serious public health concern. Despite treatment and prevention efforts, approximately 50,000 new HIV cases are transmitted each year. Estimates indicate that 44% of all people diagnosed with HIV are living in the southern region of the United States. African Americans represent 13.2% of the United States population; however, 44% (19,540) of reported new HIV cases in 2014 were diagnosed within this ethnic group. The majority of cases were diagnosed in men (73%, 14,305). In the United States, it is estimated that 21% of adults living with HIV are 50 years or older. There exists limited data regarding how well African American men are aging with HIV disease. The purpose of this study was to explore the perceptions and experiences of older African American men living with HIV in rural Georgia. Data were collected from 35 older African American men living with HIV using focus groups and face-to-face personal interviews. Qualitative content analysis revealed six overlapping themes: (1) Stigma; (2) Doing Fine, Most of the Time; (3) Coping With Age-Related Diseases and HIV; (4) Self-Care; (5) Family Support; and (6) Access to Resources. The findings from this study provide new insights into the lives of rural HIV-infected African American men, expands our understanding of how they manage the disease, and why many return to or remain in rural communities.

scholarly journals Variations in support for secondhand smoke restrictions across diverse rural regions of the United States

2018 ◽  
Vol 116 ◽  
pp. 157-165
Author(s):  
Frances A. Stillman ◽  
Erin Tanenbaum ◽  
Mary Ellen Wewers ◽  
Devi Chelluri ◽  
Elizabeth A. Mumford ◽  
...  
Keyword(s):  
United States ◽  
Secondhand Smoke ◽  
The United States ◽  
Rural Regions

Abstract TMP75: Average Medicare Reimbursement for Stroke Care Has Decreased From 2000-2019

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Andrew R Pines ◽  
Jack Haglin ◽  
Bart Demaerschalk
Keyword(s):  
United States ◽  
Price Index ◽  
Hemorrhagic Stroke ◽  
Consumer Price Index ◽  
Stroke Care ◽  
The United States ◽  
Medicare Reimbursement ◽  
Reimbursement Rate ◽  
Icd Codes ◽  
The Difference

Introduction: There is a lack of data regarding financial trends for procedural reimbursement in stroke care. An understanding of such trends is important as progress is made to advance agreeable reimbursement models in the care of stroke patients. The purpose of this study was to evaluate monetary trends in Medicare reimbursement rates for commonly utilized procedures in stroke care from 2000 to 2019. Methods: Reimbursement data for Current Procedural Terminology (CPT) codes was extracted from the Centers for Medicare & Medicaid Services. CPT codes were determined by frequency of procedures for Stroke-related ICD codes at our institution. All monetary data was adjusted for inflation to 2019 US dollars utilizing changes to the United States consumer price index. Results: After adjusting for inflation, the average reimbursement for all four included procedures within hemorrhagic stroke (ICD I60-I62) decreased by 18.4% from 2000 to 2019. The average reimbursement for two procedures within ischemic stroke (ICD I63), craniotomy and thrombectomy, increased by 3.5% (2003 -2019) and increased 3.0% (2016-2019), respectively. Data was not available for craniotomy prior to 2003, and not available for thrombectomy prior to 2016. Further, the adjusted reimbursement rate for included telestroke codes decreased by 12.1% from 2010-2019. All other included procedures decreased by 3.5% throughout this time. The difference in reimbursement rate between telestroke and other stroke-related procedures was statistically significant (p < .0001). Conclusion: To our knowledge, this is the first study to evaluate trends in Medicare reimbursement for stroke care. When adjusted for inflation, Medicare reimbursement for included procedures has steadily decreased from 2000 to 2019. Increased awareness of these trends is important to assure continued access to quality stroke care in the United States.

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