119 - Race- and Ethnicity-Based Health Disparities in Post-Stroke Rehabilitation

Objectives: This study seeks to evaluate racial disparities in rehabilitation after stroke by examining post-acute disposition, timing of admission to inpatient rehabilitation (IPR), discharge disposition following rehabilitation stay, and functional change throughout the clinical course. If disparities do exist, this study hopes to identify factors that may be contributing to these differences.

Design: A retrospective analysis of patients with new ischemic or hemorrhagic stroke who underwent consultation and evaluation by the inpatient rehabilitation team. Patient data was obtained via chart review and included demographic data in addition to rehabilitation data as outlined in the objective. Results analyzed by logistic regression models, proportional hazards models subgroup analysis, and cross tabulation. Statistical significance between racial and ethnic groups determined at p< 0.05 and significance of variable interactions at p< 0.01.

Results: Controlling for covariate effects of ethnicity, diabetes, stroke severity, and employment status, White patients were more likely to discharge to IPR after their acute inpatient stay (OR 0.37, p=0.001). There was no discrepancy based on race between recommended and actual discharge destination (p=0.12). The Non-white patients admitted to IPR were younger (p< 0.001), had a history of diabetes (p< 0.001), more severe NIH Stroke Scale (p< 0.001), and lower admission Functional Independence Measure (FIM) scores (p=0.022). There was no significant difference in the time to IPR recommendation between racial groups. There was also no difference in rehabilitation outcomes (FIM Efficiency) between racial groups.

Conclusions: Non-white patients with a new acute stroke diagnosis are more likely to be recommended appropriate for discharge home instead of inpatient rehabilitation. The Non-white patients admitted to IPR demonstrated higher NIH Stroke Scale scores and lower admission FIM scores than their White counterparts. While this is a multifactorial and socioeconomically complex issue, this analysis suggests the existence of racial disparities and space for implicit bias with regards to post-acute rehabilitation.