Protocol for exploring pathways to equitable outcomes in post-stroke aphasia and dysphagia

Area of Science:

• Neurology
• Public Health
• Speech-Language Pathology

Background:

• Racial disparities in stroke outcomes are well-documented but their causes remain unclear.
• Structural barriers, including provider bias and community factors, may contribute to these disparities.
• Existing strategies have not effectively mitigated these observed inequities in stroke recovery.

Purpose of the Study:

• To identify the mechanisms driving racial disparities in aphasia and dysphagia recovery post-stroke.
• To examine patient, provider, health system, and administrative factors influencing recovery over 12 months.
• To move beyond traditional disparity measures by analyzing the continuum of care.

Main Methods:

• Utilizing Medicare fee-for-service claims data for a 100% sample of stroke patients.
• Following patients for 12 months post-discharge to track post-acute care transitions and speech-language pathology (SLP) utilization.
• Employing regression decomposition to analyze the relationship between race and treatment location, transition timing, and care quality.

Main Results:

• The study aims to quantify the impact of differential endowments (e.g., access, education) and decision-making differences on stroke recovery outcomes.
• Regression decomposition will elucidate factors contributing to observed health disparities.
• Findings will link functional communication and swallowing improvements to specific post-acute treatments.

Conclusions:

• Racial disparities in aphasia and dysphagia outcomes are hypothesized to stem from unequal service quantity/timing and community-level structural differences.
• This research will offer a comprehensive understanding of healthcare utilization and outcomes across racial groups.
• Identifying these mechanisms is crucial for developing targeted interventions to reduce stroke-related health inequities.