Decomposing racial and ethnic disparities in the use of postacute rehabilitation care

George M. Holmes, Janet K. Freburger, Li Jung E. Ku

Research output: Contribution to journalArticle

13 Citations (Scopus)

Abstract

Objective To determine the degree to which racial and ethnic disparities in the use of postacute rehabilitation care (PARC) are explained by observed characteristics. Data Sources State inpatient databases (SIDs) for 2005 and 2006 from four diverse states were used to identify patients with stays for joint replacement, stroke, or hip fracture. Study Design Our primary outcomes were use of institutional PARC (versus discharge home) and, conditional on discharge to an institution, skilled nursing facility (versus inpatient rehabilitation facility) care. We modified the Oaxaca-Blinder decomposition method to account for the dichotomous outcome and multilevel nature of the data. Data Collection/Extraction Methods Discharges from the four SIDs were included if the principal diagnosis (stroke, hip fracture) or procedure (joint replacement) was in the sample inclusion criteria. Principal Findings Observed characteristics explained roughly half of the unadjusted differences in use of institutional PARC. Patient-level factors (clinical, age) were more explanatory of disparities in institutional PARC use, while hospital-level factors were more explanatory of skilled nursing facility versus inpatient rehabilitation facility care. Conclusions Adjustment for characteristics influencing PARC use both mitigated and exacerbated racial/ethnic disparities in use. The degree to which the characteristics explained the disparity varied across conditions and outcomes.

Original languageEnglish
Pages (from-to)1158-1178
Number of pages21
JournalHealth Services Research
Volume47
Issue number3 PART 1
DOIs
Publication statusPublished - 2012 Jun 1

Fingerprint

Subacute Care
Rehabilitation
Inpatients
Replacement Arthroplasties
Skilled Nursing Facilities
Hip Fractures
Stroke
Databases
Information Storage and Retrieval
Age Factors

All Science Journal Classification (ASJC) codes

  • Health Policy

Cite this

Holmes, George M. ; Freburger, Janet K. ; Ku, Li Jung E. / Decomposing racial and ethnic disparities in the use of postacute rehabilitation care. In: Health Services Research. 2012 ; Vol. 47, No. 3 PART 1. pp. 1158-1178.
@article{06b328be822e4276a8bc9bae66c586b2,
title = "Decomposing racial and ethnic disparities in the use of postacute rehabilitation care",
abstract = "Objective To determine the degree to which racial and ethnic disparities in the use of postacute rehabilitation care (PARC) are explained by observed characteristics. Data Sources State inpatient databases (SIDs) for 2005 and 2006 from four diverse states were used to identify patients with stays for joint replacement, stroke, or hip fracture. Study Design Our primary outcomes were use of institutional PARC (versus discharge home) and, conditional on discharge to an institution, skilled nursing facility (versus inpatient rehabilitation facility) care. We modified the Oaxaca-Blinder decomposition method to account for the dichotomous outcome and multilevel nature of the data. Data Collection/Extraction Methods Discharges from the four SIDs were included if the principal diagnosis (stroke, hip fracture) or procedure (joint replacement) was in the sample inclusion criteria. Principal Findings Observed characteristics explained roughly half of the unadjusted differences in use of institutional PARC. Patient-level factors (clinical, age) were more explanatory of disparities in institutional PARC use, while hospital-level factors were more explanatory of skilled nursing facility versus inpatient rehabilitation facility care. Conclusions Adjustment for characteristics influencing PARC use both mitigated and exacerbated racial/ethnic disparities in use. The degree to which the characteristics explained the disparity varied across conditions and outcomes.",
author = "Holmes, {George M.} and Freburger, {Janet K.} and Ku, {Li Jung E.}",
year = "2012",
month = "6",
day = "1",
doi = "10.1111/j.1475-6773.2011.01363.x",
language = "English",
volume = "47",
pages = "1158--1178",
journal = "Health Services Research",
issn = "0017-9124",
publisher = "Wiley-Blackwell",
number = "3 PART 1",

}

Decomposing racial and ethnic disparities in the use of postacute rehabilitation care. / Holmes, George M.; Freburger, Janet K.; Ku, Li Jung E.

In: Health Services Research, Vol. 47, No. 3 PART 1, 01.06.2012, p. 1158-1178.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Decomposing racial and ethnic disparities in the use of postacute rehabilitation care

AU - Holmes, George M.

AU - Freburger, Janet K.

AU - Ku, Li Jung E.

PY - 2012/6/1

Y1 - 2012/6/1

N2 - Objective To determine the degree to which racial and ethnic disparities in the use of postacute rehabilitation care (PARC) are explained by observed characteristics. Data Sources State inpatient databases (SIDs) for 2005 and 2006 from four diverse states were used to identify patients with stays for joint replacement, stroke, or hip fracture. Study Design Our primary outcomes were use of institutional PARC (versus discharge home) and, conditional on discharge to an institution, skilled nursing facility (versus inpatient rehabilitation facility) care. We modified the Oaxaca-Blinder decomposition method to account for the dichotomous outcome and multilevel nature of the data. Data Collection/Extraction Methods Discharges from the four SIDs were included if the principal diagnosis (stroke, hip fracture) or procedure (joint replacement) was in the sample inclusion criteria. Principal Findings Observed characteristics explained roughly half of the unadjusted differences in use of institutional PARC. Patient-level factors (clinical, age) were more explanatory of disparities in institutional PARC use, while hospital-level factors were more explanatory of skilled nursing facility versus inpatient rehabilitation facility care. Conclusions Adjustment for characteristics influencing PARC use both mitigated and exacerbated racial/ethnic disparities in use. The degree to which the characteristics explained the disparity varied across conditions and outcomes.

AB - Objective To determine the degree to which racial and ethnic disparities in the use of postacute rehabilitation care (PARC) are explained by observed characteristics. Data Sources State inpatient databases (SIDs) for 2005 and 2006 from four diverse states were used to identify patients with stays for joint replacement, stroke, or hip fracture. Study Design Our primary outcomes were use of institutional PARC (versus discharge home) and, conditional on discharge to an institution, skilled nursing facility (versus inpatient rehabilitation facility) care. We modified the Oaxaca-Blinder decomposition method to account for the dichotomous outcome and multilevel nature of the data. Data Collection/Extraction Methods Discharges from the four SIDs were included if the principal diagnosis (stroke, hip fracture) or procedure (joint replacement) was in the sample inclusion criteria. Principal Findings Observed characteristics explained roughly half of the unadjusted differences in use of institutional PARC. Patient-level factors (clinical, age) were more explanatory of disparities in institutional PARC use, while hospital-level factors were more explanatory of skilled nursing facility versus inpatient rehabilitation facility care. Conclusions Adjustment for characteristics influencing PARC use both mitigated and exacerbated racial/ethnic disparities in use. The degree to which the characteristics explained the disparity varied across conditions and outcomes.

UR - http://www.scopus.com/inward/record.url?scp=84861198465&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84861198465&partnerID=8YFLogxK

U2 - 10.1111/j.1475-6773.2011.01363.x

DO - 10.1111/j.1475-6773.2011.01363.x

M3 - Article

C2 - 22172017

AN - SCOPUS:84861198465

VL - 47

SP - 1158

EP - 1178

JO - Health Services Research

JF - Health Services Research

SN - 0017-9124

IS - 3 PART 1

ER -