Sex differences in acute telestroke care: more to the story.

Background: Previous studies have shown sex differences in stroke care. Female patients have both lower thrombolytic treatment rates with OR reported as low as 0.57 and worse outcomes. With updated standards of care and improved access to care through telestroke, there is potential to reduce or alleviate these disparities. Methods: Acute stroke consultations seen by TeleSpecialists, LLC physicians in the emergency department in 203 facilities (23 states) from January 1, 2021 to April 30, 2021 were extracted from the Telecare by TeleSpecialists™ database. The encounters were reviewed for demographics, stroke time metrics, thrombolytics candidate, premorbid modified Rankin Score, NIHSS score, stroke risk factors, antithrombotic use, admitting diagnosis of suspected stroke, and reason not treated with thrombolytic. The treatment rates, door to needle (DTN) times, stroke metric times, and variables of treatment were compared for females and males. Results: There were 18,783 (10,073 female and 8,710 male) total patients included. Of the total, 6.9% of females received thrombolytics compared to 7.9% of males (OR 0.86, 95% CI 0.75-0.97, p = 0.006). Median DTN times were shorter for males than females (38 vs. 41 min, p < 0.001). Male patients were more likely to have an admitting diagnosis of suspected stroke, p < 0.001. Analysis by age showed the only decade with significant difference in thrombolytics treatment rate was 50-59 with increased treatment of males, p = 0.047. When multivariant logistic regression analysis was performed with stroke risk factors, NIHSS score, age, and admitting diagnosis of suspected stroke, the adjusted odds ratio for females was 0.9 (95% CI 0.8, 1.01), p = 0.064. Conclusion: While treatment differences between sexes existed in the data and were apparent in univariate analysis, no significant difference was seen in multivariate analysis once stroke risk factors, age, NIHSS score and admitting diagnosis were taken into consideration in the telestroke setting. Differences in rates of thrombolysis between sexes may therefore be reflective of differences in risk factors and symptomatology rather than a healthcare disparity.

Gender Differences in Reimbursement Among Orthopaedic Surgeons: A Cross-sectional Analysis of Medicare Claims.

INTRODUCTION: Inequalities involving women across orthopaedic subspecialties continue to be highlighted in the literature. Previous analyses exploring reimbursement differences between sexes have not controlled for confounding factors or have been limited by small sample sizes. Our study used Medicare data on a national sample of orthopaedic surgeons to better evaluate these disparities. METHODS: This cross-sectional analysis used publicly available data from the Centers for Medicare & Medicaid Services Physician and Other Supplier Public Use File. Using each provider's National Provider Identifier number, this data set was linked to the National Plan and Provider Enumeration System downloadable file and the 2019 National Provider Compare Database. Mean differences were calculated using the Welch t -test. Multivariate linear regression analysis was conducted to determine the effect of sex on total Medicare payments per physician, controlling for years in practice, practice diversity, clinical productivity, and subspecialty. RESULTS: Nineteen thousand six orthopaedic surgeons were included in our analysis. Of these providers, 1,058 were female (5.6%) and 17,948 were male (94.4%). Male orthopaedic surgeons billed an average of 19.40 unique billing codes per provider and female orthopaedic surgeons billed 14.4 per provider ( P < 0.001). Female orthopaedic surgeons billed an average of 1,245.5 services per physician while male orthopaedic surgeons billed 2,360.7 services per physician. The mean difference in payment between male and female orthopaedic surgeons was $59,748.7 ( P < 0.001). Multivariate linear regression showed that female sex was a significant predictor of lower total yearly Medicare reimbursement ( P < 0.001). DISCUSSION: These findings emphasize the need for additional efforts to help ensure reimbursement differences do not deter women from pursuing orthopaedics. Healthcare organizations should use this information to ensure equal salary negotiating power among their employees while additionally addressing potential biases and misconceptions related to referrals and surgeon aptitude, respectively.

The impact of race and ethnicity on acute telestroke care: A multistate experience.

INTRODUCTION: Previous analyses suggest that ethnic and racial differences exist in acute stroke care including thrombolytic treatment rates. The current study evaluates ethnic or racial differences in acute stroke treatment within a multi-state telestroke program. METHODS: Acute telestroke consultations seen in the Emergency Department in 203 facilities and 23 states were extracted from the Telecare by TeleSpecialistsTM database. Cases were reviewed for age, race, ethnicity, sex, last known normal time, arrival time, treatment with thrombolytic therapy, door-to-needle (DTN) time, and baseline National Institutes of Health Stroke Scale score. Race was defined as Black, White, or Other; ethnicity was defined as Hispanic or non-Hispanic. RESULTS: The current study included 13,221 acute telestroke consultations consisting of 9890 White, 2048 Black, and 1283 patients classified as Other. A total of 934 patients were Hispanic and 12,287 patients were non-Hispanic. There were no statistically significant differences noted in thrombolytic treatment rates when comparing White (7.9%) patients with non-White patients (7.4%), p = 0.36, or comparing Black (8.1%) with non-Black patients (7.8%), p = 0.59. In addition, there were no statistically significant differences in treatment rates comparing Hispanic (6.3%) with non-Hispanic (7.9%) patients, p = 0.072. We noted no measurable differences in DTN times by race or ethnicity. CONCLUSIONS: Contrary to previous reports, we failed to detect any significant differences in thrombolytic treatment rates and DTN times by race or ethnicity among stroke patients in a multistate telestroke program. These findings support the hypothesis that telestroke may mitigate racial and ethnic disparities which may be attributable to local variability in stroke procedures or access to healthcare.