Differences in Postacute Rehabilitation Recommendations by Ethnicity at an Urban Comprehensive Stroke Center

Abstract

The aim of this study was to investigate differences in postacute rehabilitation discharge recommendations, actual disposition, and rehabilitation duration by ethnicity at an urban Joint Commission Comprehensive Stroke Center. Design: This was a retrospective cohort study of adult acute stroke hospital admissions between January 1, 2016, and December 31, 2019 (n = 1717) who were discharged to home with or without outpatient therapy, inpatient rehabilitation facility, or skilled nursing facility (SNF). Lognormal and multinomial regressions were used to create statistical models evaluating ethnicity-related differences in discharge recommendation and disposition as well as rehabilitation duration while controlling for age, stroke type and severity, insurance type, and medical comorbidities; non-Hispanic white (NHW) patients served as the comparison group. Results: Hispanic patients were less likely to have therapy recommendations of SNF, with a trend toward significance ( P = 0.06), yet statistically more likely to have the actual disposition of SNF ( P = 0.01) than NHW patients. There were no statistically significant differences comparing disposition rates for black and Asian patients to NHW patients for both inpatient rehabilitation facility and SNF. There was no statistically significant difference in rehabilitation duration for black or Hispanic patients compared with NHW patients. Conclusions: Hispanic patients were less likely to have therapy recommended SNF disposition, with a trend toward significance, but significantly more likely to have actual SNF disposition compared with NHW patients after acute stroke.

Referral to Community-Based Rehabilitation Following Acute Stroke: Findings From the COMPASS Pragmatic Trial

“…The majority of studies exploring poststroke referral to community-based rehabilitation are limited to the transition from the acute care setting or inpatient rehabilitation facilities (IRFs) to home, [16][17][18][19][20][21][22][23][24][25][26][27] or use qualitative methods to understand therapists' clinical decisionmaking for postacute care. 12,19 To our knowledge, no studies have examined referral to community-based rehabilitation (both home and outpatient care) for patients who have experienced stroke and are being discharged from the acute care hospital to home.…”