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Factors contributing to practice variation in post-stroke rehabilitation

A J Lee¹, J H Huber, W B Stason

¹Health Economics Research, Inc., Waltham, MA 02154, USA.

Health Services Research

|June 1, 1997

Summary

Geographic variations in post-stroke care costs and utilization are significant. Most of this variation is not explained by patient or market factors, indicating other unmeasured influences on healthcare practices.

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Area of Science:

Health Services Research
Medical Economics
Stroke Rehabilitation

Background:

Post-stroke medical care utilization and costs exhibit considerable geographic variability.
Understanding the drivers of this variation is crucial for healthcare policy and resource allocation.

Purpose of the Study:

To analyze geographic variations in the utilization and cost of post-stroke medical care.
To identify patient and market characteristics that explain these practice variations across Metropolitan Statistical Areas (MSAs).

Main Methods:

Utilized a 20% random sample of Medicare beneficiaries hospitalized for stroke in 1991.
Employed weighted least squares regression to analyze post-stroke costs, utilization, and length of stay across 151 MSAs.
Regressed MSA-level averages of costs and utilization on patient and market characteristics.

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Main Results:

Patient characteristics explained less than one-third of practice variation across MSAs.
Market variables were generally less important in explaining practice variations.
One-half to two-thirds of the practice variation remained unexplained by measured patient and market factors.

Conclusions:

A substantial portion of inter-MSA variability in post-stroke rehabilitation service utilization and intensity is not attributable to patient differences.
Unmeasured factors likely account for a significant amount of the observed practice variations across different geographic areas.