ABSTRACTS
Rural Disparities in EMS Stroke Care Performance Measures in North DakotaAuthor: Antonio R. Fernandez, PhD, NRP | | Associate Authors: Christopher T. E. Price, Christine K. Greff, Remle P. Crowe, Alison Treichel, Jennifer K. Wilson, Scott S. Bourn, J. Brent Myers
Introduction North Dakota (ND) recently developed a suite of evidence-based performance measures as part of the Flex-grant funded Rural EMS Counts project, which includes four stroke-related metrics. Little is known regarding rural–urban differences in these performance measures. Objective To compare EMS performance for encounters in ND rural and urban communities on stroke-related Rural EMS Counts measures. Secondarily, for encounters with a positive stroke screen, we evaluated whether the receiving facility was alerted. Methods This retrospective analysis evaluated all 9-1-1 responses submitted to ND for patients with provider impressions consistent with stroke from January 1, 2020 through December 31, 2022. Stroke-related Rural EMS Counts measures included blood glucose (BGL) check performed for suspected stroke, last known well or onset time (LKW) recorded for suspected stroke, and stroke assessment performed for suspected stroke. Further, we determined if the EMS clinician documented a stroke alert/notification for the destination facility when a stroke screen was positive. Comparisons were evaluated based on Centers for Medicare and Medicaid urbanicity (rural/urban). Descriptive statistics and univariate odds ratios were calculated. Results Among all 9-1-1 responses in ND, 1.5% (2,399) met inclusion criteria. Of those, 60% (1,443) occurred in rural areas. Overall, 50% (1,193) were female. The median age was 73 years (IQR: 62–83 years). Most had race/ethnicity documented as White (89%, n = 1,531), followed by American Indian or Alaska Native (7%, n = 119). There was a 29% decrease in odds of having BGL documented in rural areas (OR: 0.71, 95% CI: 0.58–0.86). There was a 62% decrease in the odds of having a LKW documented in rural areas (OR: 0.38, 95% CI: 0.32–0.46). There was a 95% reduced odds of a documented stroke assessment in rural areas (OR: 0.05, 95% CI: 0.04–0.07). When compared to urban areas, the odds of documenting a stroke alert among those with a positive stroke screen were increased threefold in rural areas (OR: 3.36, 95% CI: 2.69–4.20). Conclusion In ND, performance on evidence-based metrics related to stroke assessment and recognition were lower among EMS encounters in rural areas. However, stroke alerts after positive stroke screening were more commonly performed for encounters originating in rural areas. Future studies should explore interventions to help reduce rural–urban disparities.
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