Disparities in Post-Acute Rehabilitation Care for Stroke

OBJECTIVE: To use population-based, hospital discharge data to determine the extent to which demographic and geographic disparities exist in the use of PARC following stroke. DESIGN: Cross-sectional analysis of two years (2005-2006) of population-based, hospital discharge data. SETTING: All short-term acute care hospitals in four demographically and geographically diverse states (AZ, FL, NJ, WI). PARTICIPANTS: Individuals 45 years and older (mean age of 72.6 years) admitted to the hospital with a primary diagnosis of stroke, who survived their inpatient stay and who were not transferred to a hospice or other short-term, acute care facility (N=187,188). The sample was 52.4 percent female, 79.5 percent White, 11.4 percent Black, and 9.1 percent Hispanic. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: 1) Discharge to an institution versus home. 2) For those discharged home, discharge home with or without home health (HH). 3) For those discharged to an institution, discharge to an inpatient rehabilitation facility (IRF) or skilled nursing facility (SNF). Multilevel logistic regression analyses were conducted to identify demographic and geographic disparities in PARC use, controlling for illness severity/comorbidities, hospital characteristics, and PARC supply. RESULTS: Blacks, females, older individuals, and those with lower incomes were more likely to be discharged to an institution; Hispanic individuals and the uninsured were less likely. Racial minorities, females, older individuals, and those with lower incomes were more likely to receive HH; uninsured individuals and rural residents were less likely. Blacks, females, older individuals, the uninsured, and those with lower incomes were more likely to use SNF vs IRF care. PARC use varied significantly by state and by hospital. CONCLUSIONS: Several demographic and geographic disparities in PARC use were identified.