Highlights
- •Mexican Americans have worse stroke outcome compared with non Hispanic whites.
- •This difference likely happens in the post-acute care (PAC) period.
- •We present the methods and early recruitment of a novel study of stroke PAC.
- •This study is recruiting well and poised to guide improvements in stroke equity.
Abstract
Objectives
Compared with non-Hispanic whites (NHWs), Mexican Americans (MAs) have worse stroke
outcomes. We report here the methods, background literature, and initial recruitment
of the Brain Attack Surveillance in Corpus Christi-Post Acute Care (BASIC-PAC) Project
which aims to explore PAC in MAs and NHWs from multiple perspectives: patients, caregivers,
and community.
Materials and methods
Rigorous active and passive stroke surveillance captures all strokes in Nueces County,
Texas. Stroke patients are followed for 90 days to determine their care transitions
and factors influencing their rehabilitation setting. Informal caregivers of the stroke
patients are identified and interviewed at 90 days to determine aspects of their caregiving
and caregiver outcomes. Available community resources are compared with stated needs
among stroke patient and caregivers to determine unmet needs.
Results
Between October, 2019 and October, 2021, among the 629 stroke patients eligible, 413
were MA, 227 were NHW. Of the 629, all of the six follow-up calls were completed by
355 of the MAs (87%) and 191 of the NHWs (87%). During this same time period, we attempted
to approach 621 potential caregivers. Of these, 458 (73.8%) potential caregivers participated
in interviews to determine caregiver eligibility, and 373 (81.4%) of these participating
potential caregivers met the eligibility criteria.
Conclusions
BASIC-PAC has strong initial recruitment and is poised to provide valuable data on
multiple aspects of PAC and how PAC differs by ethnicity and contributes to worse
stroke outcomes in MAs. Based on the study findings, interventions can be developed
that will improve stroke health equity.
Keywords
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References
- Temporal trends in ischemic stroke rates by ethnicity, sex, and age (2000-2017): the brain attack surveillance in corpus christi project.Neurology. 11 30 2021; 97: e2164-e2172https://doi.org/10.1212/WNL.0000000000012877
- Neurological, functional, and cognitive stroke outcomes in Mexican Americans.Stroke. Apr 2014; 45: 1096-1101https://doi.org/10.1161/STROKEAHA.113.003912
- Mexican Americans receive less intensive stroke rehabilitation than non-hispanic whites.Stroke. 06 2017; 48: 1685-1687https://doi.org/10.1161/STROKEAHA.117.016931
Bureau USC. Quick facts: Nueces County, Texas. Accessed May 22, 2022. https://www.census.gov/quickfacts/nuecescountytexas
- Racial variations in ischemic stroke-related physical and functional impairments.Stroke. December 1, 1991; 22 (1991): 1497-1501https://doi.org/10.1161/01.str.22.12.1497
- Differences in outcome and predictors between ischemic and intracerebral hemorrhage: The South London stroke register.Stroke. August 1, 2013; 44 (2013): 2174-2181https://doi.org/10.1161/strokeaha.113.001263
- The uniform data system for medical rehabilitation: report of patients with stroke discharged from comprehensive medical programs in 2000-2007.Am J Phys Med Rehabil. 2009; 88: 961-972
- Management of adult stroke rehabilitation care: a clinical practice guideline.Stroke. September 1, 2005; 36 (2005): e100-e143https://doi.org/10.1161/01.str.0000180861.54180.ff
- Does the organization of postacute stroke care really matter?.Stroke. January 1, 2001; 32 (2001): 268-274
Coverage of inpatient rehabilitation services. Accessed June 14, 2011. http://www.cms.gov/MLNMattersArticles/downloads/MM6699.pdf
- The relation between therapy intensity and outcomes of rehabilitation in skilled nursing facilities.Arch Phys Med Rehabil. 2005; 86: 373-379https://doi.org/10.1016/j.apmr.2004.10.018
- Outcome of subacute stroke rehabilitation: a randomized controlled trial.Stroke. April 1, 1998; 29 (1998): 779-784
- Robot-assisted therapy for long-term upper-limb impairment after stroke.N Engl J Med. 2010; 362: 1772-1783
- Medicare spending and outcomes after postacute care for stroke and hip fracture.Med Care. Sep 2010; 48: 776-784https://doi.org/10.1097/MLR.0b013e3181e359df
- Outcomes and costs after hip fracture and stroke: a comparison of rehabilitation settings.JAMA (Chicago, Ill). 1997; 277: 396-404
- Poststroke rehabilitation: outcomes and reimbursement of inpatient rehabilitation facilities and subacute rehabilitation programs.Stroke. 2006; 37: 1477-1482
- Do rehabilitative nursing homes improve the outcomes of care?.J Amn Geriatr Soc. 1996; 44: 545-554
Services DoHaHSCfMM. Inpatient rehabilitation facility prospective payment system. Payment system series. Available at https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/downloads/InpatRehabPaymtfctsht09-508.pdf
- Determining the need for in-patient rehabilitation services post-stroke: results from eight ontario hospitals.Healthcare policy = Politiques de Sante. Feb 2012; 7: e105-e118
- The state-of-the-science: access to postacute care rehabilitation services. A review.Arch Phys Med Rehabil. Nov 2007; 88: 1513-1521https://doi.org/10.1016/j.apmr.2007.06.761
- Disparities in postacute rehabilitation care for stroke: an analysis of the state inpatient databases. Multicenter Study Research Support, N.I.H., Extramural.Arch Phys Med Rehabil. Aug 2011; 92: 1220-1229https://doi.org/10.1016/j.apmr.2011.03.019
- Decomposing racial and ethnic disparities in the use of postacute rehabilitation care.Health Serv Res. Jun 2012; 47 (Pt 1): 1158-1178https://doi.org/10.1111/j.1475-6773.2011.01363.x
Kramer A, Holthaus D, Goodrish G, et al. A Study of Stroke Post-Acute Care Costs and Outcomes: final report. 2006. December 28.
- Bouncing back: patterns and predictors of complicated transitions 30 days after hospitalization for acute ischemic stroke.J Am Geriatr Soc. Mar 2007; 55: 365-373https://doi.org/10.1111/j.1532-5415.2007.01091.x
- Designing multi-ethnic stroke studies: the Brain Attack Surveillance in Corpus Christi (BASIC) project.Ethn Dis. 2004; 14: 520-526
- Acculturation and evaluation of Mexican-Americans with disabilities.J Rehabil. Jan-Mar 1989; 55: 53-57
- The role of families in decisions regarding cancer treatments.Cancer. Apr 1 2015; 121: 1079-1087https://doi.org/10.1002/cncr.29064
- Development of the expectations of filial piety Scale–Spanish version.J Adv Nurs. Dec 2005; 52: 682-688https://doi.org/10.1111/j.1365-2648.2005.03635.x
- Changes in depressive symptoms during widowhood among older Mexican Americans: the role of financial strain, social support, and church attendance.Aging Mental Health. Jun 2017; 21: 586-594https://doi.org/10.1080/13607863.2015.1132676
- Hispanic familism and acculturation: what changes and what doesn't?.Hisp J Behav Sci. 1987; 9 (NOT IN FILE): 397-412
- Cultural values and caregiver preference for Mexican-American and non-Latino White elders.J Cross-Cultural Gerontol. Sep 2009; 24: 225-239https://doi.org/10.1007/s10823-008-9088-0
- Latinas and breast cancer outcomes: population-based sampling, ethnic identity, and acculturation assessment.Cancer Epidemiol Biomark Preven. Jul 2009; 18 (a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology): 2022-2029https://doi.org/10.1158/1055-9965.EPI-09-0238
- Development of a short acculturation scale for hispanics.Hisp J Behav Sci. Jun 1987; 9: 183-205https://doi.org/10.1177/07399863870092005
- The impact of familism on physical and mental health among Hispanics in the United States.Health Psychol Rev. 2011; : 1-33https://doi.org/10.1080/17437199.2011.569936
Evercare and National Alliance on Caregiving. Evercare study of Hispanic family caregiving in the US: Findings from a national study. 2008.http://wwwcaregivingorg/data/Hispanic_Caregiver_Study_web_ENG_FINAL_11_04_08pdf.
- Guardians of health: the dimensions of elder caregiving among women in a Mexico City neighborhood.Social Sci Med. Jan 2009; 68: 228-234https://doi.org/10.1016/j.socscimed.2008.10.026
- Does a helping hand mean a heavy heart? Helping behavior and well-being among spouse caregivers.Psychol Aging. Mar 2010; 25: 108-117https://doi.org/10.1037/a0018064
- “La Lucha”: the experiences of Latino Family caregivers of patients with Alzheimer's disease.Clin Gerontol. 2010; 33: 181-193
- Acculturation, nutrition, and health disparities in Latinos.Am J Clin Nutr. 2011; 93: 1163S-1167S
- Familismo and filial piety among Latino and Asian elders: Reevaluating family and social support.Hisp Health Care Inter. 2007; 5: 81-89
- Social relationships among family caregivers: a cross-cultural comparison between Mexican Americans and non-Hispanic White caregivers.J Transcult Nurs. Oct 2008; 19 (official journal of the Transcultural Nursing Society /Transcultural Nursing Society): 326-337https://doi.org/10.1177/1043659608322499
- Exploring the complexities of familism and acculturation: central constructs for people of Mexican origin.Am J Commun Psychol. 2007; 39 (NOT IN FILE): 61-77
- Hispanic families in the United States: Family structure and process in an era of family change.in: Tienda M Mitchell F Hispanics and the Future of America. National Academies Press, 2006: 138-178
National Alliance for Caregiving. Caregiving in the USA focused look at the ethnicity of those caring for someone age 50 or older 2009. http://wwwcaregivingorg/data/FINAL_EthnicExSum_formatted_w_tocpdf.
AARP. Family caregiving and out-of-pocket costs: 2016 report. November 2016. Available athttp://www.aarp.org/content/dam/aarp/research/surveys_statistics/ltc/2016/family-caregiving-cost-survey-res-ltc.pdf
- Update on the state of the evidence for stroke family caregiver and dyad interventions.Stroke. May 2017; 48: e122-e125https://doi.org/10.1161/STROKEAHA.117.016052
- Comprehensive overview of nursing and interdisciplinary rehabilitation care of the stroke patient: a scientific statement from the American Heart Association.Stroke. Oct 2010; 41: 2402-2448https://doi.org/10.1161/STR.0b013e3181e7512b
- Positive experiences of caregiving in stroke: a systematic review.Disabil Rehabil. 2012; 34: 1413-1422https://doi.org/10.3109/09638288.2011.650307
- Positive caregiving experiences are associated with life satisfaction in spouses of stroke survivors.J Stroke Cerebrovasc Dis. Nov 2012; 21: 801-807https://doi.org/10.1016/j.jstrokecerebrovasdis.2011.04.011
- What makes family caregivers happy during the first 2 years post stroke?.Stroke. Apr 2014; 45: 1084-1089https://doi.org/10.1161/STROKEAHA.113.004309
- Positive aspects of caregiving as a moderator of treatment outcome over 12 months.Psychol Aging. Jun 2007; 22: 361-371https://doi.org/10.1037/0882-7974.22.2.361
- Positive aspects of caregiving - Contributions of the REACH project to the development of new measures for Alzheimer's caregiving.Res Aging. Jul 2004; 26: 429-453https://doi.org/10.1177/0164027504264493
- Family caregiving for patients with stroke. Review and analysis. Review.Stroke J Cereb Circ. Jul 1999; 30: 1478-1485
- Informal caregiving: a reappraisal of effects on caregivers.Soc Iss Policy Rev. Jan 2014; 8: 74-102https://doi.org/10.1111/sipr.12002
- Long-term impact of stroke on family caregiver well-being: a population-based case-control study.Neurology. Mar 31 2015; 84: 1323-1329https://doi.org/10.1212/WNL.0000000000001418
- Stroke patients' informal caregivers. Patient, caregiver, and service factors that affect caregiver strain.Stroke. Aug 1999; 30: 1517-1523https://doi.org/10.1161/01.str.30.8.1517
- Problems and benefits reported by stroke family caregivers: results from a prospective epidemiological study.Stroke. Jun 2009; 40: 2129-2133https://doi.org/10.1161/STROKEAHA.108.545269
- Caregiver mental health and racial/ethnic disparities in stroke: implications for culturally sensitive interventions. Comparative Study Research Support, U.S. Gov't, Non-P.H.S.Rehabil Psychol. Nov 2010; 55: 372-382https://doi.org/10.1037/a0021486
- Screening for depression and suicidality in a VA primary care setting: 2 items are better than 1 item.Am J Manag Care. Nov 2004; 10 (Pt 2): 839-845
- How to Score The SF-12 Physical And Mental Health Summary Scales.3rd ed. The Health Institute, New England Medical Center1998
- Activities of daily living in Mexican American caregivers: the key to continuing informal care.J Family Nurs. Nov 2012; 18: 439-466https://doi.org/10.1177/1074840712450210
- Keeping it in the family: when Mexican American older adults choose not to use home healthcare services.Home Healthc Nurse. May 2011; 29: 282-290https://doi.org/10.1097/NHH.0b013e3182173859
- Elder care among Mexican American families.Clin Nurs Res. Feb 1998; 7: 64-81
- Cultural influences in the patterns of long-term care use among Mexican American family caregivers.J Appl Gerontol. 2008; 27: 141-165
- Needs, concerns, strategies, and advice of stroke caregivers the first 6 months after discharge.J Neurosci Nurs: J Am Assoc Neurosci Nurses. Oct 2002; 34: 242-251
- Concept Mapping for Planning and Evaluation.Sage Publications, 2007 (Accessed May 28, 2022.)
Article Info
Publication History
Published online: November 03, 2022
Accepted:
October 16,
2022
Received:
June 2,
2022
Identification
DOI: https://doi.org/10.1016/j.jstrokecerebrovasdis.2022.106851
Copyright
© 2022 Elsevier Inc. All rights reserved.
