Post-stroke rehabilitation has been shown to improve outcomes among patients, but the limited available evidence suggests that rural residents and African Americans are less likely to receive this care. Our analysis will determine whether residence or race-based disparities exist in post-stroke care, after taking into consideration differences in patient status.

Statement of the Problem: Stroke is one of the leading causes of death and disability in the United States; African Americans have a higher burden of disease than other populations. The types of post-stroke care received affects functional status and the likelihood of being discharged back to the community. Failure to receive appropriate care has the potential to exacerbate rural and racial/ethnic health disparities.

Project goals: This project will examine the type of post-acute care received by rural patients, to identify disparities that may be associated with rural residence and race/ethnicity. We will also examine effects associated with location of the discharge hospital (local, distant, critical access), transfers during hospitalization, while holding patient characteristics such as age and comorbidity statistically equal.

Methods: We will conduct a cross-sectional analysis of Medicare beneficiaries who were admitted to an inpatient hospital with a diagnosis of stroke, using 2009 claims data. Claims will be linked into per-person records using the unique, non-identifiable number assigned by CMS. Among patients with stroke, we will examine disposition (discharged to home, inpatient rehabilitation facility (IRF), skilled nursing facility (SNF), home health, or death) subset by rurality, race/ethnicity, and region.

To examine the effects of care at a distant hospital, we will evaluate post acute care type by the distance between the discharge facility and the patient's ZIP Code area. We hypothesize that greater distance will reduce the likelihood of IRF or SNF placement, unless the discharge hospital contains IRF or SNF swing beds. Finally, we will examine if the characteristics of the episode of care are related to post-stroke care. Specifically, we will examine if patients who were transferred from one facility to another during their episode of care are more or less likely to receive IRF or SNF care upon discharge.

Anticipated publications or products: A technical report summarizing project findings will be developed, along with shorter materials such as fact sheets and postcards. A short video will be developed to summarize study findings.

Publications

• Disparities in Home Health Service Providers Among Medicare Beneficiaries with Stroke
  Journal Article
  Rural and Minority Health Research Center
  Date: 01/2016
  Examines the intensity of home health services, by the number of visits and service delivery by rehabilitation specialists, among Medicare beneficiates with stroke. There were no significant rural-urban differences in the number of home health visits, but rural residents were less likely to receive services from rehabilitation specialists.