Abstract TP146: Trend, Outcomes, and Predictors of Utilization of Speech Rehabilitation Therapy in Acute Ischemic Stroke Hospitalization

Abstract

Background: At least one-fourth of all stroke survivors experience language impairments. Many recover within a few months after the stroke, but up to 60% still have language impairments more than six months after a stroke, known as chronic aphasia. We aimed to look the outcomes, cost, a length of stay (LOS), and predictors of utilization of speech rehabilitation therapy (SRT) in stroke patients. Methods: We performed a cross-sectional study using the Nationwide Inpatient Sample (NIS) (years 2003-2013) in adult hospitalizations for AIS who had undergone SRT. We performed weighted analyses using chi-square, Cochran-Armitage Trend-test, and t-test to find outcomes, trend, and cost and LOS respectively. Multivariate survey logistic regression was done to evaluate the predictors of utilization of SRT. Results: Amongst 4,566,282 AIS hospitalizations, 23,597 had SRT. There was a decrease in trend (0.9% in 2003 to 0.55% in 2013, p<0.001). The mean LOS was longer by 2 days, the cost of hospitalization was higher by $11517, and outcomes were poor in AIS patients on SRT compared to those without (Table). The predictors for higher utilization in AIS patients on SRT included African American (aOR: 1.64; 95% CI: 1.48-1.82), Hispanic (aOR: 1.78; 95% CI: 1.52-2.09), Asian/pacific islander (aOR: 2.04; 95% CI: 1.56-2.67), urban teaching hospitals (aOR: 1.40; 95% CI: 1.23-1.60), depression (aOR: 1.16; 95% CI: 1.01-1.35), tPA treatment (aOR: 1.47; 95% CI: 1.20-1.81), alcohol (aOR: 1.33; 95% CI: 1.07-1.64), and atrial fibrillation (aOR: 1.17; 95% CI: 1.05-1.31). Significant predictors for lower utilization included emergency admission type, urban non-teaching hospital, medium bed-size hospitals, large bed-size hospitals, and private insurance. Conclusion: High cost and LOS might be responsible for declined utilization of SRT in private insurance payers but poor outcomes even after SRT need further research to evaluate the cost-effectiveness of therapy.