on February 27, 2003
Published online before print February 27, 2003, doi: 10.1161/01.STR.0000060028.60365.5D
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Submitted on September 24, 2002
From the Epidemiologic Research and Information Center (R.D.H., J.W.S.); Center for Health Services Research in Primary Care, Durham VA Medical Center (R.D.H., H.B.B., D.B.M.); Division of General Internal Medicine, Department of Medicine (R.D.H., H.B.B., D.B.M.), and Department of Psychiatry (J.W.S., H.B.B.), Duke University Medical Center; and Center for Clinical Health Policy Research, Duke University (D.B.M.), Durham, NC. * To whom correspondence should be addressed. E-mail: rh266m{at}nih.gov.
Background and Purpose--The greater mortality and residual physical impairments among black stroke patients may be attributable to differential utilization of rehabilitation services. This report examines, within an equal-access healthcare system, racial differences in time to initiation of stroke rehabilitation services and in the trajectory of physical function recovery. Methods--This study was a secondary analysis of data from an inception cohort of 1073 stroke patients hospitalized between April 1995 and March 1997 and followed up for up to 1 year. Inpatient data came from medical record reviews; follow-up data came from telephone interviews at 1, 6, and 12 months after stroke. The study included consecutive acute ischemic or intracerebral hemorrhagic stroke patients from 9 VA medical centers. The main outcome measures were time to initiation of inpatient rehabilitation services and ability to perform activities of daily living. Results--There were no racial differences in receipt of inpatient rehabilitation services (blacks, 76%; whites, 70%) or in the proportion of patients referred within 3 days of admission (blacks, 43.5%; whites, 42.0%). Among patients who experienced delay in initiation of rehabilitation, only low-income blacks experienced worse functional recovery over 12 months. Conclusions--Low-income black stroke patients who experience delay in initiation of inpatient rehabilitation have a worse trajectory of functional recovery in the first year after stroke. Poverty-associated factors in the postdischarge setting may explain this phenomenon.
Accepted on October 10, 2002
Effects of Race and Poverty on the Process and Outcome of Inpatient Rehabilitation Services Among Stroke Patients
Ronnie D. Horner PhD*;
Key words: outcome • rehabilitation • stroke
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