Association between Healthcare Resources Inputs and Intravenous Tissue Plasminogen Activator Adherence Rate among Patients with Acute Ischemic Stroke

BackgroundIntravenous Tissue Plasminogen Activator (IV rt-PA) significantly improves AIS patients functional outcomes within the treatment window, yet the usage of IV rt-PA among AIS patients are substantially lower in China than in developed countries. Healthcare resource utilization manages effective treatment patterns for patients who are adherent to IV rt-PA. This study investigates the association between healthcare resource inputs and IV rt-PA adherence and the impact of Gross Regional Product (GRP) on IV rt-PA. Methods1,456 hospitals from 31 provinces with 158,003 acute ischemic stroke patients who had received IV rt-PA between 2015-2019 were recruited by the Chinese Stroke Center Alliance. The study outcome was the adherence rate of IV rt-PA in each hospital. Healthcare resource input was identified from three aspects: human, material, and economic. Multivariable linear regression was conducted by adjusting healthcare system characteristics and by further adjustment of GRP. ResultsThe median (interquartile range) of IV rt-PA rate was 19.1% (8.6% -34.6%). Physician-nurse ratio ({beta}=0.023, p<0.001), nurse-bed ratio ({beta}=0.0343, p<0.001), and total health expenditure ({beta}=0.00002, p<0.001) were positively associated with the IV rt-PA adherence rate after controlling healthcare system factors. Through additional adjusting of GRP, only health expenditure was significantly positively associated with IV rt-PA adherence rate ({beta}=0.000018, p<0.001). ConclusionsMore health spending and being equipped with equally proportional physician-nurses and nurse-bed combinations in the provincial hospital will increase adherence to IV rt-PA among AIS patients. The difference in GRP among provinces may stimulate hospitals to provide more healthcare input from the workforce, thus indirectly increasing the usage of IV rt-PA.