Regional and Racial Variations in the Use of Thrombolytic Therapy for Acute Stroke at US Academic Medical Centers: The UHC Stroke Benchmarking Project
BACKGROUND: Few national data are available regarding current status stroke thrombolytic use in the US. This information is important to identify trends in acute stroke management and potential barriers to therapy. To address this issue, the UHC Stroke Benchmarking Project recently assessed the status of thrombolytic therapy in a survey of academic medical centers around the country. METHODS: Between 11/17/99 and 12/27/99, a comprehensive questionnaire was retrospective completed on a consecutive sample of acute stroke patients admitted to each participating hospital. Extensive demographic information regarding the use of thrombolytic therapy in these patients was also obtained. RESULTS: 42 hospitals participated in the study. The hospitals were evenly distributed between the Northeast (n=11), Midwest (n=10), South (n=9) and West (n=12). Overall, of the 1196 patients included in the study, 66 (5.5%) received thrombolytic treatment (55 IV, 11 IA). 190 patients were considered IV thrombolytic eligible, and 32.8% of these received thrombolytic treatment. There were significant regional and racial variations in thrombolytic use. The rate of thrombolytic use was lowest in the South (1.2%) and highest in the MW (9.5%). 64.3% of thrombolytic eligible patients received treatment in the MW, while only 7.7% of eligible patients received treatment in the South (OR 10.3, CI 2.4–44.5, p<0.005). Logistic regression analysis also revealed that Caucasians had a significantly greater probability of treatment than non-Caucasians (OR 3.7 CI 1.4–9.9, p=0.0056). Conclusion: At academic medical centers, a low proportion of patients receive thrombolytic therapy. Moreover, these data indicate that there are significant regional and race specific differences in thrombolytic therapy which should be addressed in order to increase the rate of thrombolytic use nationwide. The UHC database could be a useful mechanism by which monitor such changes in acute stroke care.