Abstract TMP30: The Impact of Social Influences on Rehabilitation Services Utilization After Stroke

Abstract

Introduction: Evidence supports that early initiation of rehabilitation is important for patient outcomes after stroke. Thus, determination of patients needing rehabilitation during their acute hospitalization is critical. We assessed the impact of demographic, clinical, and county-level social influences on rate of transfer to a rehabilitation facility after acute stroke hospitalizations. Methods: Using Get with the Guidelines-Stroke registry data and Institute for Health Metrics and Evaluation data, we fitted univariate and multivariate generalized linear mixed models (GLMM) with demographic, clinical, and social variables to determine how social influences of health impacted variances in transfers to rehabilitation facilities. Specific county-level variables assessed were related to education, income, employment, home ownership, and being foreign born. Results: Among 912,488 patients who were assessed or received rehabilitation services due to acute ischemic or intracerebral hemorrhagic stroke, 33.4% of them were transferred to rehabilitation facilities. Multivariate analyses of patient-level demographic and clinical variables achieved an Akaike Information Criterion (AIC) of 925780 (21.0% reduction from the base model) largely driven by clinical factors (mRS at discharge, initial NIHSS, and initial exam findings). When county-level variables related to social influences of health were incorporated, AIC decreased by 23.4% to 871806, indicating a better model fit largely driven by education level. Conclusions: Social influences of health impact transfer to rehabilitation facilities after acute stroke hospitalization. Future studies should focus on individual (versus county-level) metrics of social influences of health and their impact on access to rehabilitation. This information should be used to develop interventions to improve the equity of rehabilitation utilization after stroke.