Disparities in Stroke Care: A Framework for an Integrated Care Model

Abstract

Purpose Racial and ethnic disparities exist in access and utilization of acute and chronic neurological care. The impact of this is notable in stroke care, with African-Americans and Hispanics having a greater incidence of stroke, higher rates of recurrent strokes, and the greatest disparities in stroke mortality among younger working-age populations compared to Caucasians. While there are many innovative solutions to certain aspects of disparities in stroke care, our current health care delivery system lacks a cohesive design that can integrate these. This paper provides a framework for the implementation of a value-based integrated care model with the intent of improving outcomes and achieving equity in neurological care. Methods Successful value-based healthcare delivery models were analyzed in light of their potential in bridging disparities in care as a whole and specifically for stroke care. The literature on racial and ethnic disparities in stroke care was reviewed and a framework for possible value-based solutions to these disparities was proposed. Conclusion While there is increasing recognition of the benefits in value-based health care, broader implications may extend to bridging disparity gaps. This paper highlights key considerations for neurology leaders and healthcare planners in the implementation of a stroke integrated practice unit designed out of consideration for the diverse patient populations they serve.