RESUMO
While research and efforts to promote health equity abound, the persistence of disparities by race and ethnicity underscores the limitations of fragmented interventions and the need for systematic, multipronged approaches to health equity. The foundational step towards reducing health disparities is the establishment of the basic information needed to identify and measure those differences, i.e., the accurate capture of race and ethnicity information of all patients. To that end, we present a case study outlining a multifaceted approach for improving the capture of race and ethnicity data in an outpatient setting culminating in a 76% improvement in the completeness of this information. The effectiveness of this plan and its scalability within a large urban health system may benefit similar institutions seeking to improve the collection of race and ethnicity information and the reliability of their data. To this aim, we present an approach relying on the assessment and evaluation of system needs, modification of data infrastructure to align with goals, training, and education of relevant stakeholders, implementation and responsive action to results, and acknowledging limitations and lessons learned. We emphasize that cross-departmental collaboration, stakeholder engagement, institutional support, and culture of anti-racism were essential to the success of this initiative.
RESUMO
BACKGROUND AND PURPOSE: Coronavirus disease 2019 (COVID-19) has been associated with an increased incidence of thrombotic events, including stroke. However, characteristics and outcomes of COVID-19 patients with stroke are not well known. METHODS: We conducted a retrospective observational study of risk factors, stroke characteristics, and short-term outcomes in a large health system in New York City. We included consecutively admitted patients with acute cerebrovascular events from March 1, 2020 through April 30, 2020. Data were stratified by COVID-19 status, and demographic variables, medical comorbidities, stroke characteristics, imaging results, and in-hospital outcomes were examined. Among COVID-19-positive patients, we also summarized laboratory test results. RESULTS: Of 277 patients with stroke, 105 (38.0%) were COVID-19-positive. Compared with COVID-19-negative patients, COVID-19-positive patients were more likely to have a cryptogenic (51.8% versus 22.3%, P<0.0001) stroke cause and were more likely to suffer ischemic stroke in the temporal (P=0.02), parietal (P=0.002), occipital (P=0.002), and cerebellar (P=0.028) regions. In COVID-19-positive patients, mean coagulation markers were slightly elevated (prothrombin time 15.4±3.6 seconds, partial thromboplastin time 38.6±24.5 seconds, and international normalized ratio 1.4±1.3). Outcomes were worse among COVID-19-positive patients, including longer length of stay (P<0.0001), greater percentage requiring intensive care unit care (P=0.017), and greater rate of neurological worsening during admission (P<0.0001); additionally, more COVID-19-positive patients suffered in-hospital death (33% versus 12.9%, P<0.0001). CONCLUSIONS: Baseline characteristics in patients with stroke were similar comparing those with and without COVID-19. However, COVID-19-positive patients were more likely to experience stroke in a lobar location, more commonly had a cryptogenic cause, and had worse outcomes.
