No Racial Difference in Rehabilitation Therapy Across All Post-Acute Care Settings in the Year Following a Stroke

Abstract

Background and Purpose Black stroke survivors experience greater post-stroke disability than whites. Differences in post-acute rehabilitation may contribute to this disparity. Therefore, we estimated racial differences in rehabilitation therapy utilization, intensity and the number post-acute care settings in the first year after a stroke. Methods We used national Medicare data to study 186,168 elderly black and white patients hospitalized with a primary diagnosis of stroke in 2011. We tabulated the proportion of stroke survivors receiving physical, occupational and speech and language therapy in each post-acute care setting (inpatient rehabilitation facility, skilled nursing facility and home health agency), minutes of therapy, and number of transitions between settings. We then used generalized linear models to determine whether racial differences in minutes of physical therapy were influenced by demographics, comorbidities, thrombolysis, and markers of stroke severity. Results Black stroke patients were more likely to receive each type of therapy than white stroke patients. Compared to white stroke patients, black stroke patients received more minutes of physical therapy (897.8 vs. 743.4; p<0.01), occupational therapy (752.7 vs. 648.9; p<0.01), and speech and language therapy (865.7 vs. 658.1; p<0.01). There were no clinically significant differences in physical therapy minutes after adjustment. Blacks had more transitions (median 3, IQR (1–5)) than whites (median 2, IQR (1–5), p < 0.01). Conclusions There are no clinically significant racial differences in rehabilitation therapy utilization or intensity after accounting for patient characteristics. It is unlikely that differences in rehabilitation utilization or intensity are important contributors to racial disparities in post-stroke disability.

Racial and Ethnic Disparities in Discharge to Rehabilitation Following Burn Injury

“…Compared with White stroke patients, Black stroke patients received more minutes of physical therapy, occupational therapy, and speech and language therapy. 16 One possible explanation for our findings may be the increased proportion of insured Black patients at 64.0% and even when uninsured at admission, and Black patients are more likely to eligible for indigent care or Medicaid before discharge as U.S. citizens. Insurance status is an important predictor of hospital disposition and access to specialized posthospital care.…”

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.…”

The difficulty of studying race-ethnic stroke rehabilitation disparities in a community

“…Third, alternative data sources, such as publically available administrative data, could be used to measure rehabilitation utilization. Medicare based data are being utilized in currently funded projects 13 ; however, stroke disparities are most pronounced in those less than 65 years of age and therefore, Medicare data does not capture the age range most critical for consideration of race-ethnic disparities in outcomes. Other potential data sources that could be utilized include the State Inpatient Databases, the National Inpatient Sample, or use of Optum®, a large data warehouse of privately insured patients supplemented with Medicaid mix data that can be purchased.…”