Abstract T P296: Race/Ethnicity Disparities in Access to Inpatient Physical and Occupational Therapy Exist

Abstract

Introduction: African-Americans and Hispanics have worse functional outcomes after stroke, although the reasons for these disparities are not known. As more intense rehabilitation therapy after stroke is associated with improved outcomes, we hypothesized that decreased access to therapy during stroke hospitalization may contribute to outcome disparities. Methods: The 2008 State Inpatient Databases (SID) for seven states, which include data on all inpatient discharges within a state were used to identify all primary ischemic stroke (ICD-9-CM 433.x1, 434.x1, 436) and intracerebral hemorrhage discharges (435). Receipt of physical (PT) and occupational (OT) therapy was determined using HCUP definitions. Logistic regression was used to compare receipt of therapy by race/ethnicity adjusting for demographics, insurance, comorbidities, stroke type, and presumptive severity markers (length of stay, ICU use, presentation via ED, receipt of IV tPA, use of life-sustaining treatments). Hospital effects were then accounted for by including all risk adjustors in a multi-level model with a random hospital-level intercept. Results: A total of 472, 210 discharges in 702 hospitals were identified, 59% in whites, 13% in African Americans and 4% in Hispanics; 71% received PT and 47% OT. Before accounting for hospital effects, African-Americans (OR 0.82 for PT, 0.84 for OT) and Hispanics (OR 0.79 for PT, 0.64 for OT) were less likely to receive therapy (p < 0.001 for all comparisons). Hospital was an important predictor of receipt of therapy, intra-class correlation coefficient (ICC) 0.14 for PT and 0.56 for OT. After accounting for the hospital where they were admitted, African-Americans were more likely to receive PT (OR 1.11) and OT (OR 1.08, p < 0.05) and therapy use was the same in Hispanics and whites (OR 1.05 for PT, p = 0.3 and 1.10 for OT, p = 0.09). Conclusions: In this large sample, African-Americans and Hispanics were less likely to receive inpatient PT and OT than whites. This disparity is explained by the fact that minorities receive care at hospitals that use less PT and OT. Optimizing therapy use in these hospitals may improve stroke outcomes and reduce outcome disparities.