Disparities in Post-Acute Stroke Rehabilitation Utilization

With NO objective diagnosis of damage it becomes impossible to write up discharge care that would point exactly to what therapy protocols are needed.
https://wakespace.lib.wfu.edu/handle/10339/86352

abstract

Despite the fact that rehabilitation services are integral in the recovery of an individual’s functional abilities after stroke, the method by which these services are recommended and then utilized are ill-defined. This study analyzes data from the ongoing COMprehensive Post-Acute Stroke Services (COMPASS) pragmatic clinical trial to explore factors that may influence referrals to rehabilitation services at hospital discharge and clinic follow-up visits and receipt of those recommended rehabilitation services for patients who have experienced an acute stroke. Out of 1,695 enrolled COMPASS participants, 604 (35.6%) were referred to rehabilitation at hospital discharge. Factors that influenced referral included age, stroke severity category [National Institute of Health Stroke Scale (NIHSS)], and ambulatory status. Elderly participants (≥age 65) had the greatest odds referral at discharge (81%). Those with NIHSS scores in the minor category (NIHSS 1-4) had more than double the odds (OR=2.65) and those in the moderate to severe category (NIHSS 5-42) had more than five times the odds (OR=5.61) of being referred at discharge than those with no stroke symptoms (NIHSS 0). Participants unable to ambulate at discharge had more than eight times the odds (OR=8.81) of being referred than those who independently ambulated. Receipt of recommended rehabilitation, however, was low. Only 50 (44%) and 29 (35%) of participants referred for home health or to outpatient rehabilitation, respectively, actually received all the care to which they were referred, which limited the robustness of data analysis. Non-white participants had a 78% decreased odd of receiving recommended outpatient services. Ethnicity, gender, or hospital location did not influence receipt of services, even after adjusting for stroke severity, ambulatory status at admission and age. These findings indicate that a significant gap exists between referral to and receipt of recommended post-acute stroke rehabilitation services; mechanisms to bridge the gap are required to optimize functional outcomes and qualities of life of survivors of stroke.