EMS World Magazine is the most authoritative source in the world for clinical and educational material designed to improve the delivery of prehospital emergency medical care.
Issue link: https://emsworld.epubxp.com/i/890710
28 NOVEMBER 2017 | EMSWORLD.com D espite major advances in treat- ment and prevention, stroke remains a leading cause of death and disability in the U.S., impact- ing over 795,000 people annually. 1,2 Stroke dispropor tionately af fects race-ethnic minorities, with disparities existing in mor- bidity, mortality, risk-factor prevalence, healthcare access and quality of care. 3 Blacks and Hispanics experience dis- proportionate stroke risk-factor burden and prevalence, higher stroke incidence and higher stroke mortality at younger ages compared to whites. 4–11 Furthermore, race-ethnic disparities in acute stroke care are associated with increased mortality and rehospitalization rates. 12 Race-ethnic minorities are expected to account for 40% of the U.S. population by 2030, making dis- parities in stroke care a growing concern. 3 The causes of health disparities are com- plex and multifactorial. They include the interplay of socioeconomic, cultural and environmental components and contribu- tors such as patients and healthcare sys- tems. Age, race-ethnicity, sex and modifi- able factors such as cultural and language barriers and low health literacy rates are known to contribute to inequalities in stroke care. 3,13 Decreased EMS activation and lim- ited access to quality healthcare services, mainly stroke center-certified hospitals, are also barriers to achieving health equity and favorable stroke outcomes. 14–16 Addressing known disparities in stroke treatment and prevention may reduce the growing global burden of stroke. Stroke registries provide critical insight into clinical practice and disparities in healthcare delivery and allow for the sur- veillance of trends in treatment and quality of care. They are also useful in evaluating clinical effectiveness and quality improve- ment (QI) as well as guideline implementa- tion and adherence. Most national stroke registries were initiated in the mid-'00s and in the last decade have played important roles in accelerating stroke research that affects the advancement and delivery of effective, high-quality care. In the U.S., two active national stroke registries exist, including the American Heart Association's (AHA) performance improvement program Get With The Guide- lines–Stroke (GWTG-S) and the Centers for Disease Control and Prevention-funded By Maria A. Ciliberti-Vargas, MPH; and Ralph L. Sacco, MD, MS, FAHA, FAAN STROKE REGISTRIES: UTILIZING COMPREHENSIVE DATA TO IMPROVE OUTCOMES Editor's note: This is the third in a three-part special series on the pivotal and evolving role of EMS in stroke care. In the September issue, the authors discussed decision-making criteria informing the ideal destination to transport patients with stroke symptoms (www. emsworld.com/article/218589) and profiled novel partnerships between EMS systems and stroke centers (www.emsworld.com/article/218588). Last month, the authors compared new stroke scales for EMS (www.emsworld.com/article/218774) Registries provide critical insight into clinical practice and disparities in healthcare delivery Figure 1: FL-PR CReSD conceptual framework