Related Experiment Video
Updated: Sep 13, 2025
Setting Up a Stroke Team Algorithm and Conducting Simulation-based Training in the Emergency Department - A Practical Guide
Published on: January 15, 2017
Stroke Center Certification and Within-Hospital Racial Disparities in Treatment
Renee Y Hsia1,2, Yu-Chu Shen3,4
1Department of Emergency Medicine, University of California, San Francisco.
Insights
Stroke center certification improved treatment access for White patients but not Black patients, highlighting persistent racial disparities in stroke care despite technological advancements. This study underscores the need for equitable care improvements.
Area of Science:
- Neurology
- Public Health
- Health Services Research
Background:
- Access to stroke technology has improved, but its impact on racial disparities in stroke care remains unclear.
- It is unknown if stroke center certification benefits Black and White patients equally or if it has altered existing disparities over time.
Purpose of the Study:
- To investigate the association between hospital stroke center certification and the receipt of acute ischemic stroke treatments.
- To compare health outcomes for Black and White patients following stroke center certification.
Main Methods:
- A cohort study using a linear probability model with hospital fixed effects analyzed Medicare fee-for-service patients with acute ischemic stroke (2009-2019).
- Outcomes were compared before and after hospital stroke certification (treatment group) versus non-certified hospitals (control group).
- Key outcomes included receipt of thrombolytic therapy, mechanical thrombectomy, discharge home at 90 days, and 1-year mortality.
Main Results:
- White patients experienced increased probabilities of receiving thrombolytic therapy and mechanical thrombectomy after stroke center certification.
- Black patients did not show similar increases in the receipt of these acute stroke treatments following certification.
- No significant improvements were observed in discharge home at 90 days or 1-year mortality for either racial group.
Conclusions:
- Stroke center certification led to increased utilization of stroke treatments for White patients but not for Black patients.
- These findings demonstrate persistent racial disparities in stroke care within the same facilities, even after certification.
- The study highlights that increased access to stroke technology has not eliminated racial inequities in acute stroke treatment.
Importance:
Despite improvements in access to stroke technology, it remains unclear whether Black and White patients with stroke experience similar benefits after a hospital becomes stroke certified and whether stroke center expansion has changed disparities between Black and White patients over time.
Objective:
To examine the association of hospital stroke center certification with receipt of acute ischemic stroke treatments and health outcomes between Black and White patients with stroke.
Design, Setting, And Participants:
This cohort study implemented a linear probability model with hospital fixed effects to evaluate changes in outcomes for Black and White patients, comparing outcomes before and after a hospital was certified as a stroke center (treatment group) relative to changes in outcomes at hospitals that did not acquire stroke certification (control group). Participants included patients with acute ischemic stroke who were covered by Medicare fee-for-service, who lived in urban communities, and who were admitted to hospitals between January 1, 2009, and December 31, 2019. Data were analyzed from September 1, 2024, to April 30, 2025.
Exposure:
Admission to a certified stroke center.
Main Outcomes And Measures:
Probability of (1) receipt of thrombolytic therapy, (2) receipt of mechanical thrombectomy, and (3) being home at 90 days and (4) 1-year mortality.
Results:
Among 2 109 075 million admissions of patients with stroke included in the analysis, 15.3% were Black, 84.7% were White, 56.8% were female, 15.3% were 65 to 69 years of age, 16.4% were 70 to 74 years of age, 17.7% were 75 to 79 years of age, 18.8% were 80 to 84 years of age, and 31.9% were 85 years or older. Among White patients, the probability of receiving thrombolytic therapy increased by 1.70 (95% CI, 1.19-2.21) percentage points when a hospital became a primary stroke center (PSC) and 3.76 (95% CI, 2.89-4.62) percentage points when a hospital became a thrombectomy-capable or comprehensive stroke center (TSC or CSC), relative to White patients at non-stroke-certified hospitals. Among Black patients, the probability of receiving thrombolytic therapy did not change when admitted to a new PSC or a new TSC or CSC compared with Black patients at non-stroke-certified hospitals. For thrombectomy, a new TSC or CSC was associated with an increase of 3.74 (95% CI, 3.02-4.45) percentage points for White patients and 0.97 (95% CI, 0.03-1.90) for Black patients. No improvements in being home at 90 days or in 1-year mortality were observed.
Conclusions And Relevance:
In this cohort study, the likelihood of receiving stroke treatments increased for White but not Black patients within the same facility after the center was stroke certified as a PSC or a TSC or CSC. These within-hospital racial differences serve as sobering evidence that racial disparities in stroke care persist despite increased access to care.
Related Concept Videos
01:28Acute Coronary Syndrome IV: Interprofessional Care
01:30Acute Coronary Syndrome I: Introduction
01:29Venous Thrombosis III: Interprofessional Care
01:30Specialized Care Centers and Settings-II
Rural health centers are specialized care facilities in remote locations with very few medical personnel. The primary care providers who run the centers are mostly Registered Nurse Practitioners. Here, emergency treatment is provided to critically ill or injured patients before they are transferred to the closest hospital. Fortunately, due to advancement in technology, many rural healthcare facilities and professionals have easy access to diagnostic and treatment...