Abstract P231: Geographic Location Impacts Access to Stroke Rehabilitation Services

Abstract

Background: Non-urban hospitals often operate under greater resource constraints and less specialisation due to reduced economy of scale. We assessed whether access to stroke rehabilitation services is affected by hospital geographic location. In addition, we assessed the impact of specific rehabilitation interventions on patient outcomes. Methods: REGIONS Care is a New Zealand (NZ) nationwide prospective observational study with up to one-year follow-up exploring ethnic and geographic inequities in stroke care access and outcome. For this analysis, we compared rehabilitation outcomes and service access in urban versus non-urban hospital settings. The main outcome was favorable modified Rankin Scale of 0-2 at 3, 6, and 12 months. Outcomes were adjusted for age, stroke severity, pre-morbid function, and other potential confounders using multivariate logistic regression. Results: This cohort included 2379 patients with a confirmed diagnosis of stroke who were admitted to a NZ hospital between 1 May 2018 and 31 October 2018. There was no significant difference between geographic locations in access to inpatient services (OR=1.00; p=0.99) or reaching inpatient rehabilitation within seven days of admission (OR=1.16; p=0.32). Patients in non-urban areas had poorer access to intensive inpatient therapy (OR=0.54; p<0.001) and community rehabilitation services (OR=0.68; p<0.001). Compared to patients in urban areas, access to community rehabilitation within seven days of hospital discharge (OR=0.59; p=0.003) was also poorer. Documented goal setting with input from the patient/carer and the interdisciplinary team (IDT) was higher in non-urban centres (OR=1.42; p<0.001). Intensive therapy during inpatient rehabilitation was associated with improved mRS at 3 months (aOR=1.34; p=0.05), 6 months (aOR=1.47; p=0.04) and 12 months (aOR=1.62; p=0.008). Conclusions: Patients admitted to non-urban hospital experience better IDT goal setting, but poorer access to community rehabilitation services and less intensive physical therapy during inpatient rehabilitation. Reduced therapy intensity resulted in a lower rate of functional independence at 3 months. These results will drive service improvements in the stroke rehabilitation space.