Background: Texas is a large state with high demographic and geographic diversity. We analyzed the distribution of high-risk patients and stroke care hospitals to determine how to optimally distribute resources to benefit the largest number of patients.
Methods: Data on overall state demographics were based on 2013 estimates derived from 2010 US census data. The number of hospitals was provided by the Department of State Health Services (DSHS). Stroke patients were ascertained via cms.gov and Texas DSHS data. Stroke data were available from 233 of 254 counties. Hospital designation in Texas is based on state-based criteria, but largely follows the definitions used by the Joint Commission.
Results: Texas has approximately 26.4 million people (43% white, 39% Hispanic, 12% black, and 6% other). There are almost 3.3 million Medicare beneficiaries, of whom 94,071 have had a stroke. Texas has 649 hospitals with 84,000 licensed beds. There are 135 stroke facilities in 49 counties; 205 counties have no designated stroke facilities. Stroke designated hospitals include 12 CSCs, 110 PSCs, and 13 ASRH. There are 79 Critical Access Hospitals (CAH) that provide varying degrees of stroke care but have diverse locations (see map). The majority of Stroke Centers are located in or around large urban areas. The number of stroke patients varied significantly by county, with as few as 11 and as many as 12,844 in some counties. Many counties with large Medicare populations have few or no stroke centers.
Conclusions: The distribution of stroke patients and stroke facilities in Texas is often mismatched. Processes to better match stroke resources with high-risk populations might improve stroke systems of care and perhaps outcomes. Conversion of some CAHs to ASRHs might alleviate some of these disparities.