Disparities in postacute rehabilitation care for stroke: an analysis of the state inpatient databases

Abstract

Objective: To determine the extent to which sociodemographic and geographic disparities exist in the use of postacute rehabilitation care (PARC) after stroke.

Design: Cross-sectional analysis of data for 2 years (2005-2006) from the State Inpatient Databases.

Setting: All short-term acute-care hospitals in 4 demographically and geographically diverse states.

Participants: Individuals (age, ≥45y; mean age, 72.6y) with a primary diagnosis of stroke who survived their inpatient stay (N=187,188). The sample was 52.4% women, 79.5% white, 11.4% black, and 9.1% Hispanic.

Interventions: Not applicable.

Main outcome measures: (1) Discharge to an institution versus home. (2) For those discharged to home, receipt of home health (HH) versus no HH care. (3) For those discharged to an institution, receipt of inpatient rehabilitation facility (IRF) or skilled nursing facility (SNF) care. Multilevel logistic regression analyses were conducted to identify sociodemographic and geographic disparities in PARC use, controlling for illness severity/comorbid conditions, hospital characteristics, and PARC supply.

Results: Blacks, women, older individuals, and those with lower incomes were more likely to receive institutional care; Hispanics and the uninsured were less likely. Racial minorities, women, older individuals, and those with lower incomes were more likely to receive HH care; uninsured individuals were less likely. Blacks, women, older individuals, the uninsured, and those with lower incomes were more likely to receive SNF versus IRF care. PARC use varied significantly by hospital and geographic location.

Conclusions: Several sociodemographic and geographic disparities in PARC use were identified.

Figure 1. Conceptual Model

Figure 2. Creation of Final Sample