Abstract 24: Nationwide Trends and Disparities in Utilization of Inpatient Rehabilitation for Stroke Patients

Abstract

Introduction: Transfer to an inpatient rehabilitation (IR) facility (IRF) provides multiple benefits to stroke patients including improvements in functional independence measures, neurological impairments, stroke-related medical complications, and reduction in readmissions. We report nationwide trends and disparities in post-stroke IR utilization. Methods: We analyzed the National Inpatient Sample for years 2006 - 2011 and used ICD-9 codes to identify adult patients with ischemic stroke, intracerebral hemorrhage and subarachnoid hemorrhage. Institutionalized care (IC) included transfer to skilled nursing and long term care facilities. We fit survey design multivariable logistic regression models to determine nationally representative trends in IR utilization and report crude and adjusted odds ratios (OR) and 95% confidence intervals (CI) for factors associated with IR utilization, including level of care (LOC) as defined by teaching status of the hospital. Results: Based on our criteria 3,112,120 patients were included in analyses, of whom 16.2% utilized IRF. There was a significantly increasing trend in post-stroke IR utilization over the period of investigation (OR 1.06, 95%CI 1.04-1.09), with 19.5% patients discharged to IRF in 2011 (Figure 1). Older age and female gender were independently associated with decreased IR utilization (Table 1). Patients utilizing IR had significantly greater odds of being discharged from a teaching hospital after controlling for demographic, clinical, comorbidity, and resource utilization factors (OR 1.40, 95% CI 1.23 - 1.47). Conclusion: Our analysis indicates overall low nationwide IR utilization. However, there is an increasing trend in utilization of IR, albeit with age, gender, and LOC disparities. After adjustments, patients discharged from non-teaching hospitals are 29% less likely to receive IR. Further studies should focus on barriers to utilizing post-stroke IR, including socioeconomic status.