ANALYSIS OF THE GROWTH AND GEOGRAPHICAL VARIATION OF STROKE CENTERS ACROSS THE UNITED STATES (2008–2017)
Hsia, Renee, UCSF
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Stroke certification is a voluntary program undertaken by hospitals. This thesis examines the expansion of stroke-certified hospitals between 2008 and 2017, and whether growth of stroke centers is concentrated in wealthier and urban communities. It further examines whether there are differences between early and late adopters of stroke certification. The data comprises of hospital characteristics of 4,584 hospitals and the population characteristics of the Hospital Service Area (HSA) each hospital serves. I used Cox proportional hazard models to analyze systemic differences—with focus on income levels and locality—between stroke certified and non-stroke certified hospitals, and between early and late adopters. The results show that hospitals in low-income HSAs are less likely to achieve stroke certification than hospitals in high income HSAs. Also, hospitals in rural localities are less likely to achieve stroke certification than their urban counterparts. Results also show that early adopters tend to have better hospital capacities and services than late adopters. Left to their own devices, hospitals may decide whether to pursue stroke certification based on economic incentives and competition for patient revenue. Healthcare policy makers may want to pay attention toward improving quality stroke care access for low-income and rural communities.
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