The influence of race on SLP utilisation and costs among persons with aphasia

Abstract

ABSTRACTBackground: Recent evidence suggests racial disparities exist in post-stroke conditions such as aphasia, yet the underlying cause of such disparities is unclear. Disparities in rehabilitation service utilisation have been previously proposed as a contributor to racial disparities in post-stroke outcomes.Aim: To examine racial differences in speech–language pathology (SLP) service utilisation and costs among persons with aphasia being treated in acute care hospitals in North Carolina.Methods & Procedures: The North Carolina Healthcare Cost and Utilization Project data from 2011 to 2012 were analysed to examine SLP service utilisation and costs for stroke patients with aphasia. Analyses included length of stay (LOS) and charges/costs of SLP services. Generalised linear models were constructed to determine the impact of demographic characteristics, stroke severity, residence, and hospital fixed effects (variability of hospital management practices) on SLP utilisation and costs.Outcomes & Results: Approximately 5% more Blacks with aphasia were seen for SLP services than Whites with aphasia. LOSs were 2.1 days longer in acute care at 17% greater cost. Generalised linear models showed that Blacks with aphasia were seen for approximately 0.416 more visits than Whites after controlling for demographic characteristics, stroke/illness severity and residence and 0.25 more visits after controlling for hospital fixed effects. The slight increase in visits occurred at a cost of $57 when controlling for demographic characteristics, $63 when controlling for stroke/illness severity, $50 when controlling for residence, and $23 when controlling for hospital fixed effects.Conclusions: Blacks with aphasia utilise more SLP services during longer LOSs and with greater costs when compared to Whites with aphasia.