Disparities in home health service providers among Medicare beneficiaries with stroke

Abstract

This study examined the intensity of home health services, as defined by the number of visits and service delivery by rehabilitation specialists, among Medicare beneficiaries with stroke. A cross-sectional secondary data analysis was conducted using 2009 home health claims data obtained from the Centers for Medicare and Medicaid Services' Research Data Assistance Center. There were no significant rural-urban differences in the number of home health visits. Rural beneficiaries were significantly less likely than urban beneficiaries to receive services from rehabilitation specialists. Current home health payment reform recommendations may have unintended consequences for rural home health beneficiaries who need therapy services.

Use of Outpatient Rehabilitation Among Adult Stroke Survivors — 20 States and the District of Columbia, 2013, and Four States, 2015

“…Stroke recovery can be a long and complex process, involving multiple domains of therapy (e.g., physical, occupational, communication, and cognitive) and occurs in inpatient rehabilitation facilities, skilled nursing facilities, and outpatient rehabilitation facilities. Benefits of stroke outpatient rehab have been determined to improve patient functional status, survival, cardiovascular risk profiles, and quality of life and reduce risks for recurrent strokes and psychological or stress disorders ( 3 , 4 , 8 , 9 ). Generally, stroke outpatient rehab participation is underutilized ( 3 , 8 ), which this study found to be true for all subgroups and states included in the analysis.…”

“…Benefits of stroke outpatient rehab have been determined to improve patient functional status, survival, cardiovascular risk profiles, and quality of life and reduce risks for recurrent strokes and psychological or stress disorders ( 3 , 4 , 8 , 9 ). Generally, stroke outpatient rehab participation is underutilized ( 3 , 8 ), which this study found to be true for all subgroups and states included in the analysis. No subgroup had outpatient rehab use rates >40%, and no state had use rates >50%.…”

“…Although estimates of stroke outpatient rehab referral might be high, participation in stroke outpatient rehab remains suboptimal. Barriers to participation in stroke outpatient rehab are evident ( 3 , 8 – 10 ), but focused attention on system-level interventions that ensure participation is needed, especially among populations with lower levels of participation. Interventions that might improve outpatient rehab participation include increasing coverage for outpatient rehab services by health insurers, reducing copayments, extending rehab clinic hours to improve access availability, and implementing standardized assessments by health care professionals to guide appropriate referrals to outpatient rehab at hospital discharge ( 3 – 5 , 8 ).…”

“…Barriers to participation in stroke outpatient rehab are evident ( 3 , 8 – 10 ), but focused attention on system-level interventions that ensure participation is needed, especially among populations with lower levels of participation. Interventions that might improve outpatient rehab participation include increasing coverage for outpatient rehab services by health insurers, reducing copayments, extending rehab clinic hours to improve access availability, and implementing standardized assessments by health care professionals to guide appropriate referrals to outpatient rehab at hospital discharge ( 3 – 5 , 8 ). Stroke survivors should be educated about stroke outpatient rehab opportunities possibly available in their community that reduce barriers related to transportation and time (e.g., telehealth, mobileHealth, and home-based care) ( 3 , 5 , 6 , 8 – 10 ).…”

Issues in rehabilitation of patients after stroke in the out-patient setting

“…Определены преимущества амбулаторного реабилитационного лече-ния, направленного на улучшение функционального ста-туса пациента, профилей риска сердечно-сосудистых заболеваний и качества жизни, повышение выживаемо-сти, а также на снижение риска повторных инсультов и психологических или стрессовых расстройств [14][15][16][17].…”