Racial Differences in the Utilization of Inpatient Rehabilitation Services Among Elderly Stroke Patients

Abstract

Background and Purpose We undertook this study to ascertain whether elderly black and white patients who are hospitalized for stroke utilize inpatient physical and occupational therapy (PT/OT) services differently, adjusting for characteristics associated with use of these services. Methods We retrospectively reviewed medical records regarding the care received by a nationally representative sample of 2497 black and white Medicare patients, aged 65 years or older, who were hospitalized at any of 297 acute-care hospitals located in 30 communities within five states. Results Compared with whites, black stroke patients were younger and more likely to have Medicaid coverage, have an ischemic stroke, and have a motor deficit noted at the time of admission. There was no difference in either sex or level of consciousness on admission. Overall, a larger proportion of black stroke patients used inpatient PT/OT at some point during the hospitalization (66.3% versus 55.8%; P <.01). However, after adjustment for characteristics associated with use of PT/OT, there was no racial difference in either the likelihood of inpatient PT/OT use (adjusted relative risk, 1.06; 95% confidence limits, 0.89 to 1.27; P =.42) or time to initial contact (median: blacks, 6.6 days; whites, 7.4 days; P =.42). Adjusted analyses also indicated a similarity between the racial groups in the number of inpatient PT/OT days overall or as a proportion of the hospital stay. Conclusions Elderly black and white stroke patients who have Medicare coverage have similar patterns of use of inpatient PT/OT services.