325587
Relationship between geographic availability of rehabilitation venues and post-stroke discharge location in the Brain Attack in Surveillance in Corpus Christi (BASIC) Project
Rehabilitation at an inpatient rehabilitation facility (IRF) has been shown to be associated with better post-stroke functional outcomes than rehabilitation at a skilled nursing facility (SNF), particularly among those with more severe disability. However, non-clinical factors such as geographic availability may influence choice of rehabilitation venue for the patient. Our objective was to investigate how relative geographic availability of IRFs and SNFs affected post-stroke discharge location within a bi-ethnic community among stroke survivors of diverse ages.
Methods
Stroke survivors were identified from 2011-2013 through the population-based Brain Attack Surveillance in Corpus Christi (BASIC) Project in Nueces County, Texas, a bi-ethnic, mostly urban community with a population of 340,000. Discharge location and home address was identified for each survivor through medical records; only those discharged to an IRF or SNF were included. Addresses of IRFs and SNFs providing stroke rehabilitation were identified by phone/internet and geocoded. Relative geographic availability was defined as: 1) ratio of distance to nearest IRF to distance to nearest SNF; and 2) difference between number of SNFs and IRFs within a 5 mile radius of the survivor’s home. Associations between relative availability measures and discharge location (IRF versus SNF) were assessed using logistic regression models adjusted for ethnicity, gender, age, insurance status, and initial stroke severity.
Results
Among 796 survivors, 325 (41%) were discharged to an IRF (n=118) or SNF (n=207). Mean age was 72 years and 60% were Mexican American. Three IRFs and 21 SNFs were identified. The median distances to an IRF or SNF were 2.3 miles (SD=6) and 1.1 miles (SD=4), respectively. The average count of rehabilitation facilities within a 5-mile radius was 2 IRFs (SD=1) and 12 SNFs (SD=5). As the ratio of IRF to SNF distances increased (IRFs are located farther away), odds of discharge to an IRF decreased (OR=0.94, 95% CI: 0.89, 1.00). For every 1 additional SNF more than IRF within a 5 mile radius, odds of discharge to an IRF also decreased (OR=0.92, 95% CI: 0.87, 0.98).
Conclusions
Even in this urban community, the likelihood of discharge to an IRF decreased as the relative geographic availability of SNFs increased. Additional research is necessary to understand how this may affect post-stroke outcomes, including ethnic disparities.
Learning Areas:
EpidemiologyProvision of health care to the public
Learning Objectives:
Evaluate how geographic availability of rehabilitation facilities affects discharge location after stroke in a bi-ethnic community.
Keyword(s): Strokes, Accessibility
Qualified on the content I am responsible for because: My research seeks to identify, explain, and reduce racial/ethnic and socioeconomic health disparities. For my postdoctoral studies, I worked with data from the Brain Attack Surveillance in Corpus Christi (BASIC) Project to investigate the potential contribution of the availability of rehabilitation facilities to ethnic differences in post-stroke outcomes.
Any relevant financial relationships? No
I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.