Disparities in stroke rehabilitation: results of a study in an integrated health system in northern California.

Physical Medicine and Rehabilitation, Napa Solano Service Area, and Research and Training, Kaiser Foundation Rehabilitation Center, Vallejo, CA 94589, USA.
PM&R (Impact Factor: 1.66). 02/2009; 1(1):29-40. DOI: 10.1016/j.pmrj.2008.10.012
Source: PubMed

ABSTRACT To determine whether there are disparities in postacute stroke rehabilitation based on type of stroke, race/ethnicity, sex/gender, age, socioeconomic status, geographic region, or service area referral patterns in a large integrated health system with multiple levels of care.
Cohort study tracking rehabilitation services for 365 days after acute hospitalization for a first stroke.
The Northern California Kaiser Permanente Health System (approximately 3.3 million membership population)
A total of 11,119 patients hospitalized for acute stroke from 1996 to 2003. The cohort includes patients discharged from acute care after a stroke. Postacute care rehabilitation services were evaluated according to the level of care ever-received within the 365 days after discharge from acute care, including inpatient rehabilitation hospital (IRH), skilled nursing facility (SNF), home health and outpatient, or no rehabilitation services.
Not applicable.
Service delivery.
Patients discharged to an IRH had longer lengths of stay in acute care. Patients with hemorrhagic stroke were less likely to be treated in an IRH. Patients whose highest level of rehabilitation was SNF were older and more likely to be women. After adjusting for age and other covariates, women were less likely to go to an IRH than men. Asian and black patients were more likely than white patients to be treated in an IRH or SNF. Also more likely to go to an IRH were patients from higher socioeconomic groups, from urban areas, and from geographic areas close to the regional rehabilitation hospital.
These results suggest variation in care delivery and extent of postacute care based on differences in patient demographics and geographic factors. Results also varied over time. Some minority populations in this cohort appeared to be more likely to receive IRH care, possibly because of disease severity, family support systems, cultural factors, or differences in referral patterns.

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    The Journal of Rural Health 01/2014; 30(1). · 1.77 Impact Factor
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    ABSTRACT: OBJECTIVE. Previous studies have shown socioeconomic disparities in imaging utilization for both acute and chronic diseases. We studied a nationwide database to determine whether insurance-based disparities exist in the utilization of imaging for acute ischemic stroke. MATERIALS AND METHODS. Inpatients with a primary diagnosis of acute ischemic stroke from November 2005 through December 2011 were identified from the Perspective database. Patients were stratified into four groups according to insurance status as follows: uninsured, Medicaid, Medicare, and private insurance. Utilization rates of head CT, perfusion CT, head MRI, noninvasive head angiography (including head CT angiography [CTA] and head MR angiography [MRA]), noninvasive neck angiography (including neck CTA and neck MRA), carotid ultrasound, and echocardiography were compared using a chi-square test. A multivariable logistic regression model adjusting for potential confounding variables was fit to determine the association between insurance status and imaging utilization. RESULTS. A total of 210,212 patients were included in this study: 10,396 patients (5.0%) were uninsured, 14,243 patients (6.8%) had Medicaid, 153,209 patients (72.9%) had Medicare, and 32,364 patients (15.4%) had private insurance. Even after we had controlled for confounding variables, significant disparities existed in imaging utilization. Compared with patients with private insurance, uninsured patients had significantly lower odds of noninvasive head angiography (odds ratio [OR] = 0.78, 95% CI = 0.74-0.81, p < 0.0001), neck angiography (OR = 0.79, 95% CI = 0.76-0.83, p < 0.0001), and head MRI (OR = 0.77, 95% CI = 0.74-0.81, p < 0.0001). The same was true for Medicaid and Medicare patients. CONCLUSION. Disparities exist in the utilization of noninvasive head and neck imaging, MRI, and echocardiography for patients with acute ischemic stroke based on patient insurance status. More research is needed to understand these disparities.
    American Journal of Roentgenology 08/2014; 203(2):372-376. · 2.74 Impact Factor
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    Rehabilitation Nursing. 01/2014; 39(1).

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