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Racial disparities in outcomes of inpatient stroke rehabilitation
Vijay K Bhandari1, Margot Kushel, Leonard Price
1School of Medicine, University of California, San Francisco, CA, USA.
Objective:
To determine whether race is associated with outcomes of inpatient stroke rehabilitation.
Design:
Retrospective cohort study.
Setting:
A community-based inpatient rehabilitation facility.
Participants:
Poststroke patients (N=1002) admitted to a community-based inpatient rehabilitation facility between 1995 and 2001.
Interventions:
Not applicable.
Main Outcome Measures:
Functional improvement at discharge from the rehabilitation facility, discharge disposition, and functional improvement at 3 months after discharge. Inpatient and follow-up data were collected from the facility's electronic patient database. We used the FIM instrument to assess functional status at admission, discharge, and follow-up.
Results:
In multivariable models, blacks achieved less functional improvement at discharge (-1.9 FIM points, P=.02) compared with whites and, despite worse FIM scores, were more likely to be discharged to home (adjusted odds ratio=1.7; 95% confidence interval, 1.1-2.5). Although Asian-American patients did not differ from whites in terms of functional improvement at discharge or disposition, they had less improvement at 3 months following discharge (-6.3 FIM points, P=.005).
Conclusions:
We identified racial disparities in poststroke outcomes in a community-based inpatient rehabilitation facility. Future research in stroke rehabilitation should explore the consistency of these findings across settings and if they are confirmed, identify explanatory mediators to better inform efforts to eliminate racial disparities.