Stroke Systems of Care Policies: Evaluating the Predictors of State-Level Adoption of Stroke Systems of Care Policies in the United States Open Access

Abstract

Background: Stroke remains a leading cause of death in the United States. Stroke Systems of Care (SSOC) policies were proposed by the American Heart Association, and subsequently adopted by several states, in an effort to coordinate stroke-related healthcare services to allow for more effective stroke care. The purpose of this study is to better understand factors associated with the enactment of SSOC policies, particularly whether SSOC policies are more likely to be enacted in states with higher racial and ethnic disparities in stroke mortality rates and/or higher stroke mortality rate overall.

Methods: This study applied event history analysis to identify and evaluate predictors in state-level policy adoption of SSOC policies from 2005-2018. These predictors included racial and ethnic disparities in stroke mortality rates, stroke mortality rates overall, age, sex, and neighboring states that previously adopted an SSOC policy in the prior year.

Results: This study demonstrated that racial and ethnic disparities in stroke mortality rates, stroke mortality rates overall, age, and sex were not significant predictors in SSOC policy adoption by state. However, having a neighboring state which previously adopted an SSOC policy was a significant predictor of state-level policy adoption, provided that the state had not adopted an SSOC policy in the prior year.

Conclusion: Despite evidence in the literature demonstrating that significant racial and ethnic disparities exist in stroke care, this study provided evidence indicating that racial and ethnic disparities in stroke mortality rates are not a significant predictor in state-level policy adoption. However, it remains critical that this research continues as SSOC policy data expands and is updated into the 2020s. 

Table of Contents

Table of Contents

INTRODUCTION.........................................................................................1

METHODS..................................................................................................3

RESULTS.....................................................................................................5

DISCUSSION..............................................................................................7

CONCLUSION.............................................................................................8

REFERENCES.............................................................................................10

APPENDICES..............................................................................................11 

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School	Rollins School of Public Health
Department	Epidemiology
Degree	M.P.H.
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health
Keyword	Stroke Systems of Care Policies Stroke
Committee Chair / Thesis Advisor	Alvaro Alonso, Emory University

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