Surveying Stroke Rehabilitation in Texas: Capturing Geographic Disparities in Outpatient Clinic Availability

Abstract

Research Objectives To describe geographic disparities in the number of Texas outpatient rehabilitation clinics (ORC) seeing adult stroke patients. Design We surveyed potential clinics by phone and asked if they offered physical therapy (PT), occupational therapy (OT), or speech therapy (SLP) to adult stroke patients in an outpatient setting and if they were using tele-rehab (TR). Responses were aggregated by county (N=240) and grouped by the percentage of the population living in a rural area: not-rural (N= 104, under 50% rural), mostly-rural (N = 78, over 50% rural), and all-rural (N = 58, 100% rural). We estimated incidence from aggregated 2019 hospitalization data and used population data, such as rurality and broadband use, from the U.S. Census. Descriptive statistics and maps were produced in R. Setting Outpatient rehabilitation clinics. Participants We identified and attempted to contact 1,091 potential respondents by searching public online information. Interventions Not applicable. Main Outcome Measures The number of clinics offering PT, OT, SLP, and TR for stroke patients in each county; stroke patients discharged home per 1,000. Results 71% of all-rural counties had zero ORC treating stroke patients, compared to 24% for mostly-rural counties and 19% for not-rural counties, a significant difference (p < .001). Average stroke patients discharged home per 1,000 was higher in all-rural counties (2.58 vs 1.97, 1.66, p < .001), and those counties also had lower rates of broadband coverage (67% vs. 70%, 71%, p = 0.004). Conclusions Geographic disparities exist in stroke rehabilitation availability. Most all-rural counties do not have clinics. Mapping our data shows low availability overlapping with higher discharge rates and lower broadband services. Additional data on rehabilitation utilization, clinic distance, and internet use will further detail access to stroke rehabilitation in Texas. Author(s) Disclosures No disclosures to report. To describe geographic disparities in the number of Texas outpatient rehabilitation clinics (ORC) seeing adult stroke patients. We surveyed potential clinics by phone and asked if they offered physical therapy (PT), occupational therapy (OT), or speech therapy (SLP) to adult stroke patients in an outpatient setting and if they were using tele-rehab (TR). Responses were aggregated by county (N=240) and grouped by the percentage of the population living in a rural area: not-rural (N= 104, under 50% rural), mostly-rural (N = 78, over 50% rural), and all-rural (N = 58, 100% rural). We estimated incidence from aggregated 2019 hospitalization data and used population data, such as rurality and broadband use, from the U.S. Census. Descriptive statistics and maps were produced in R. Outpatient rehabilitation clinics. We identified and attempted to contact 1,091 potential respondents by searching public online information. Not applicable. The number of clinics offering PT, OT, SLP, and TR for stroke patients in each county; stroke patients discharged home per 1,000. 71% of all-rural counties had zero ORC treating stroke patients, compared to 24% for mostly-rural counties and 19% for not-rural counties, a significant difference (p < .001). Average stroke patients discharged home per 1,000 was higher in all-rural counties (2.58 vs 1.97, 1.66, p < .001), and those counties also had lower rates of broadband coverage (67% vs. 70%, 71%, p = 0.004). Geographic disparities exist in stroke rehabilitation availability. Most all-rural counties do not have clinics. Mapping our data shows low availability overlapping with higher discharge rates and lower broadband services. Additional data on rehabilitation utilization, clinic distance, and internet use will further detail access to stroke rehabilitation in Texas.