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CDA 07-012 – HSR&D Study

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CDA 07-012
Racial/Ethnic Differences in Post-Stroke Outcomes
Charles Ellis Jr. BS MA PhD
Ralph H. Johnson VA Medical Center, Charleston, SC
Charleston, SC
Funding Period: August 2009 - July 2012

BACKGROUND/RATIONALE:
Estimates indicate that 15,000 Veterans are hospitalized for stroke each year. Racial/ethnic disparities in initial stroke severity and recovery trajectories have been reported in the veteran population even though reports conclude that there are no racial/ethnic differences in the use of stroke-related care. The lack of racial/ethnic differences in system-level and provider-level factors suggest a need to examine the relationship between patient-level factors and stroke outcomes.


OBJECTIVE(S):
The objective of this project was to use a mixed methods research design to: (1) improve our understanding of the patient-level factors that influence delays in seeking treatment (DST) among Veterans with prior history of stroke and (2) determine whether these patient-level factors differ by race-ethnicity. These objectives will be attained by addressing the following specific aims:

Qualitative Aim: To explore patient-level factors that lead to DST in Veterans with prior stroke.

Quantitative Aim: To evaluate the association between DST and patient-level factors, including stroke symptom awareness/knowledge, health literacy, and social support, among Veterans with prior history of stroke and to explore whether these associations differ by race/ethnicity.

METHODS:
Participants for the project consisted of 100 Veterans who are stroke survivors. Sixteen Veterans participated in the qualitative component of the study. The study used a prospective concurrent mixed methods exploratory design. The qualitative results of the study explained previously unexplored quantitative differences in patient-level factors. A cross sectional sample of veteran stroke survivors were identified to examine variables of interest (i.e., stroke knowledge/awareness, health literacy, and social support) both qualitatively and quantitatively by race-ethnicity. Groups were organized by race-ethnicity (White and African American) and focused on perceptions of stroke symptoms, knowledge of stroke, the decision making process to seek or delay treatment for stroke. Focus groups also emphasize dexpected short-term and long-term consequences of their stroke. For the quantitative portion of the project, a comprehensive survey was completed to address the following: (1) demographics, (2) stroke awareness and knowledge, (3) treatment seeking behaviors, (4) social support, (5) health literacy, (6) depression and (7) medical comorbidity.

FINDINGS/RESULTS:
Not yet available.

IMPACT:
The results of this project have increased our knowledge of previously understudied patient-level factors and racial-ethnic differences in stroke incidence, prevalence, and health and functional outcomes for our nations' Veterans. The early findings of this project were incorporated Merit proposal designed to develop and test a tailored intervention that will improve stroke risk factor control in minority and rural Veterans at-risk for stroke.

PUBLICATIONS:

Journal Articles

  1. Plowman E, Hentz B, Ellis C. Post-stroke aphasia prognosis: a review of patient-related and stroke-related factors. Journal of evaluation in clinical practice. 2012 Jun 1; 18(3):689-94.
  2. Ellis C, Zhao Y, Egede LE. Racial/ethnic disparities in poststroke outpatient rehabilitation among veterans. Journal of the National Medical Association. 2010 Sep 1; 102(9):817-22.
  3. Ellis C, Zhao Y, Egede LE. Racial/ethnic differences in stroke mortality in veterans. Ethnicity & disease. 2009 Jan 1; 19(2):161-5.
Journal Other

  1. Ellis C. Stroke in young adults. Disability and health journal. 2010 Jul 1; 3(3):222-4.
Conference Presentations

  1. Ellis C. Racial-ethnic differences in post-stroke outcomes: issues related to treatment seeking behaviors. Poster session presented at: VA HSR&D Career Development Annual Meeting; 2011 Feb 16; National Harbor, MD.
  2. Ellis C, Dismuke CE. Does Aphasia Influence Hospital Length of Stay and Costs? Paper presented at: American Speech-Language-Hearing Association Annual Convention; 2010 Nov 20; Philadelphia, PA.
  3. Ellis C. Ethnic differences in stroke recognition and access to treatment. Poster session presented at: VA HSR&D Career Development Annual Meeting; 2010 Feb 25; San Francisco, CA.


DRA: Aging, Older Veterans' Health and Care, Brain and Spinal Cord Injuries and Disorders, Cardiovascular Disease
DRE: Diagnosis, Treatment - Observational, Prognosis
Keywords: Prostate disease
MeSH Terms: none

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