Differences in rehabilitation evaluation access for rural and socially disadvantaged stroke survivors

ABSTRACT

Background

Most stroke survivors have ongoing deficits and report unmet needs. Despite evidence that rehabilitation improves stroke survivors’ function, access to occupational and physical therapy is limited. Describing access to care for disadvantaged communities for different levels of stroke severity will provide proportions used to create Markov economic models to demonstrate the value of rehabilitation.

Objectives

The objective of this study was to explore differences in the frequency of rehabilitation evaluations via outpatient therapy and home health for Medicare Part B ischemic stroke survivors in rural and socially disadvantaged locations.

Methods

We completed a retrospective, descriptive cohort analysis using the 2018 and 2019 5% Medicare Limited Data Sets (LDS) from the Centers for Medicare and Medicaid Services using STROBE guidelines for observational studies. We extracted rehabilitation Current Procedural Terminology (CPT) codes for those who received occupational or physical therapy to examine differences in therapy evaluations for rural and socially disadvantaged populations.

Results

Of the 9,076 stroke survivors in this cohort, 44.2% did not receive any home health or outpatient therapy. Of these, 64.7% had a moderate or severe stroke, indicating an unmet need for therapy. Only 2.0% of stroke survivors received outpatient occupational therapy within the first year Rural and socially disadvantaged communities accessed rehabilitation evaluations at lower rates than general stroke survivors.

Conclusions

These findings describe the poor access to home health and outpatient rehabilitation for stroke survivors, particularly in traditionally underserved populations. These results will influence future economic evaluations of interventions aimed at improving access to care.

KEYWORDS:

• Access to care
• outpatient therapy
• home health therapy
• social inequities

List of abbreviation

PT	=	Physical therapy
OT	=	Occupational therapy
CPGs	=	Clinical practice guidelines
IRF	=	Inpatient rehabilitation facility
SNF	=	Skilled nursing facility
SVI	=	Social Vulnerability Index
CMS	=	Centers for Medicare and Medicaid Services
LDS	=	Limited Data Sets
DRG	=	Diagnosis Related Group
CPT	=	Current Procedural Terminology
SDA	=	Socially disadvantaged
SASI	=	Stroke Administrative Severity Index
NIHSS	=	National Institutes of Health Stroke Scale
mRS	=	Modified Rankin Scale
ICD	=	International Classification of Diseases
tPA	=	Tissue plasminogen activator
eVT	=	Endovascular thrombectomy
LOS	=	Length of stay
SD	=	Standard deviation
CIMT	=	Constraint-induced movement therapy

Disclosure statement

The authors report there are no competing interests to declare.

Additional information

Funding

The work was supported by the Health Resources and Services Administration [U66 RH31458-01-00]; National Center for Advancing Translational Sciences [TL1 TR001451, UL1 TR001450]; South Carolina Clinical and Translational Research Institute, Medical University of South Carolina [UL1 RR029882].