Disparities in Postacute Rehabilitation Care for Stroke: An Analysis of the State Inpatient Databases
ABSTRACT To determine the extent to which sociodemographic and geographic disparities exist in the use of postacute rehabilitation care (PARC) after stroke.
Cross-sectional analysis of data for 2 years (2005-2006) from the State Inpatient Databases.
All short-term acute-care hospitals in 4 demographically and geographically diverse states.
Individuals (age, ≥45y; mean age, 72.6y) with a primary diagnosis of stroke who survived their inpatient stay (N=187,188). The sample was 52.4% women, 79.5% white, 11.4% black, and 9.1% Hispanic.
(1) Discharge to an institution versus home. (2) For those discharged to home, receipt of home health (HH) versus no HH care. (3) For those discharged to an institution, receipt of inpatient rehabilitation facility (IRF) or skilled nursing facility (SNF) care. Multilevel logistic regression analyses were conducted to identify sociodemographic and geographic disparities in PARC use, controlling for illness severity/comorbid conditions, hospital characteristics, and PARC supply.
Blacks, women, older individuals, and those with lower incomes were more likely to receive institutional care; Hispanics and the uninsured were less likely. Racial minorities, women, older individuals, and those with lower incomes were more likely to receive HH care; uninsured individuals were less likely. Blacks, women, older individuals, the uninsured, and those with lower incomes were more likely to receive SNF versus IRF care. PARC use varied significantly by hospital and geographic location.
Several sociodemographic and geographic disparities in PARC use were identified.
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ABSTRACT: Large-scale genomics projects such as the Human Genome Project and the International HapMap Project promise significant advances in the ability to diagnose and treat many conditions, including those with a neurological basis. A major focus of research has emerged in the neurological sciences to elucidate the molecular and genetic basis of various neurological diseases. Indeed, genetic factors are implicated in susceptibility for many neurological disorders, with family history studies providing strong evidence of familial risk for conditions such as stroke, Parkinson's, Alzheimer's, and Huntington's diseases. Heritability studies also suggest a strong genetic contribution to the risk for neurological diseases. Genome-wide association studies are also uncovering novel genetic variants associated with neurological disorders. Whole-genome and exome sequencing are likely to provide novel insights into the genetic basis of neurological disorders. Genetic factors are similarly associated with clinical phenotypes such as symptom severity and progression as well as response to treatment. Specifically, disease progression and functional restoration depend, in part, on the capacity for neural plasticity within residual neural tissues. Furthermore, such plasticity may be influenced in part by the presence of polymorphisms in several genes known to orchestrate neural plasticity including brain-derived neurotrophic factor (BDNF) and Apolipoprotein E. (APOE). It is important for neurorehabilitation therapist practicing in the "genomic era" to be aware of the potential influence of genetic factors during clinical encounters, as advances in molecular sciences are revealing information of critical relevance to the clinical rehabilitation management of individuals with neurological conditions.Video Abstract available (See Video, Supplemental Digital Content 1, http://links.lww.com/JNPT/A88) for more insights from the authors.Journal of neurologic physical therapy: JNPT 11/2014; 39(1). DOI:10.1097/NPT.0000000000000066 · 2.89 Impact Factor
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ABSTRACT: To determine which patient-, treatment-, and facility-level characteristics were associated with home discharge among patients hospitalized for stroke within the Department of Veterans Affairs. Retrospective observational study SETTING: Veterans Affairs facilities nationwide PARTICIPANTS: Included were 12,565 veterans hospitalized for stroke during FY2007-FY2008. Not applicable MAIN OUTCOME MEASURE: Discharge location after hospitalization. There were 10,130 veterans (80.6 %) discharged home after hospitalization for acute stroke. Married veterans were more likely than non-married veterans to be discharged home (OR=1.23; 95% CI:1.11-1.35). Compared to veterans admitted to the hospital from home, patients admitted from extended care were less likely to be discharged home (OR=0.04; 95% CI: 0.03-0.07). Compared to those with occlusion of cerebral arteries, patients with intra-cerebral hemorrhage (OR=0.61; 95% CI:0.50-0.74) or other CNS hemorrhage (OR=0.78; 95% CI:0.63-0.96) were less likely to be discharged home while patients with occlusion of pre-cerebral arteries (OR=1.36; 95% CI: 1.07-1.73) were more likely to return home. Evidence of congestive heart failure (OR=0.85; 95% CI:0.76-0.95), fluid and electrolyte disorders (OR=0.86; 95% CI:0.77-0.96), internal organ procedures and diagnostics (OR=0.87; 95% CI:0.78-0.97), and serious nutritional compromise (OR=0.49; 95% CI:0.40-0.62) during hospitalization remained independently associated with lower odds of home discharge. Longer hospitalizations and receipt of rehabilitation services while hospitalized acutely were negatively associated while treatment on more bed sections and rehabilitation accreditation of the facility were positively associated with home discharge. Region exerted a statistically significant effect on home discharge. We found sociological, clinical, and facility-level factors associated with home discharge after hospitalization for acute stroke. Findings document the importance of considering a broad range of characteristics rather than focusing only on a few specific traits during discharge planning.Archives of physical medicine and rehabilitation 03/2014; DOI:10.1016/j.apmr.2014.03.008 · 2.44 Impact Factor