Abstract T MP45: Ethnic Differences in Access to Post-acute Care Following Stroke: The BASIC Project

Abstract

Background: Mexican Americans (MAs) have worse post-stroke functional and neurologic outcomes than non-Hispanic whites (NHWs). Ethnic differences in utilization and intensity of post-acute care (PAC) are possible explanations. We tested the hypothesis that MAs have less utilization and less intense PAC than NHWs in a bi-ethnic stroke population. Methods: Stroke patients (n=393) were identified from the BASIC Project (2009-2011). Patients admitted from a nursing home and those discharged to a setting other than home or institutional PAC were excluded. Ethnicity was based on self-report. Utilization of any institutional PAC (inpatient rehabilitation facility (IRF) or skilled nursing facility (SNF)) following hospital discharge was determined from UB-92 claims forms. Intensity of rehabilitation was explored by comparing utilization of IRF versus SNF among those receiving PAC. Hierarchical logistic regression models to account for clustering of patients within hospitals were used to determine the associations between ethnicity and utilization and intensity of PAC. Models were run unadjusted and adjusted for demographics (age, sex), socioeconomic status (insurance, education), clinical stroke factors (NIHSS, stroke type), and pre-stroke factors (comorbidity index, pre-stroke function, pre-stroke cognition). Results: Sixty-three percent were MA (n=249); 49% (n=194) were women. Median age was 66 (IQR: 57-78); median NIHSS was 4 (IQR: 2-8). Among MAs, 64% were discharged to home, 21% to a SNF and 15% to an IRF. Among NHWs, 53% were discharged to home, 26% to a SNF, and 22% to an IRF. In the unadjusted model MAs were 39% (OR=0.61; 95% CI: 0.39, 0.94) less likely to utilize institutional PAC than NHWs. After adjustment, MAs were 41% (OR=0.59; 95% CI: 0.32, 1.09) less likely to utilize institutional PAC than NHWs. Among those who utilized PAC there were no ethnic differences in intensity (IRF vs SNF) in unadjusted (p=0.36) or adjusted (p=0.63) analyses. Conclusion: We found a trend towards MAs having less utilization of PAC than NHWs following stroke. Additional research with more refined measures of PAC is needed to understand the role that access to, and effectiveness of, rehabilitative services play in ethnic differences in post-stroke outcomes.