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

Janet K. Freburger, George M. Holmes, Li Jung E. Ku, Malcolm P. Cutchin, Kendra Heatwole-Shank, Lloyd J. Edwards

Research output: Contribution to journalArticle

41 Citations (Scopus)

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.

Original languageEnglish
Pages (from-to)1220-1229
Number of pages10
JournalArchives of Physical Medicine and Rehabilitation
Volume92
Issue number8
DOIs
Publication statusPublished - 2011 Aug 1

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Subacute Care
Inpatients
Rehabilitation
Databases
Skilled Nursing Facilities
Home Care Services
Hispanic Americans
Stroke
Delivery of Health Care
Geographic Locations
Nursing Care
Stroke Rehabilitation
Cross-Sectional Studies
Logistic Models
Regression Analysis
Outcome Assessment (Health Care)

All Science Journal Classification (ASJC) codes

  • Physical Therapy, Sports Therapy and Rehabilitation
  • Rehabilitation

Cite this

Freburger, Janet K. ; Holmes, George M. ; Ku, Li Jung E. ; Cutchin, Malcolm P. ; Heatwole-Shank, Kendra ; Edwards, Lloyd J. / Disparities in postacute rehabilitation care for stroke : An analysis of the state inpatient databases. In: Archives of Physical Medicine and Rehabilitation. 2011 ; Vol. 92, No. 8. pp. 1220-1229.
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Disparities in postacute rehabilitation care for stroke : An analysis of the state inpatient databases. / Freburger, Janet K.; Holmes, George M.; Ku, Li Jung E.; Cutchin, Malcolm P.; Heatwole-Shank, Kendra; Edwards, Lloyd J.

In: Archives of Physical Medicine and Rehabilitation, Vol. 92, No. 8, 01.08.2011, p. 1220-1229.

Research output: Contribution to journalArticle

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AU - Freburger, Janet K.

AU - Holmes, George M.

AU - Ku, Li Jung E.

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AU - Edwards, Lloyd J.

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N2 - 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.

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