Back to Annual Meeting Page		American Public Health Association 133rd Annual Meeting & Exposition December 10-14, 2005 Philadelphia, PA

Abstract #105052

Martha L. Walker, PT, MS¹, Dianne V. Jewell, PT, PhD², Robert L. Hurley, PhD³, Dolores G. Clement, DrPH³, Dayanand Naik, PhD⁴, and Daniel L. Riddle, PT, PhD². (1) School of Physical Therapy, Old Dominion University, 129 Spong Hall, Norfolk, VA 23529, 757.683.3309, mlwalker@odu.edu, (2) Department of Physical Therapy, Virginia Commonwealth University, PO Box 980224, Richmond, VA 23298, (3) Department of Health Administration, Virginia Commonwealth University, PO Box 980203, Richmond, VA 23298, (4) Department of Mathematics and Statistics, Old Dominion University, Computing and Computational Sciences Building, Norfolk, VA 23529

Background: Clinical guidelines recommend early mobilization for patients after stroke to prevent complications. Guidelines also recommend discharge to an inpatient rehabilitation facility (IRF), nursing home or skilled nursing facility (NH), or home, depending on patients' rehabilitation needs and tolerances. Therapy services are most intense in IRF settings. Ideally, these guidelines are followed based on patient need rather than on other factors such as reimbursement or ethnicity. The purpose of this study was to examine access to inpatient physical therapy and discharge disposition following stroke for patients with Medicaid as their only source of payment. Aday and Andersen's Behavioral Model was adapted as a theoretical framework of access to care. Methods: This retrospective analysis included 3,754 records from adults with Medicaid aged 18-64 treated for stroke at Academic Health Center hospitals. Patient records were drawn from the University HealthSystem Consortium Clinical DataBase from 1999 – 2002. These records were matched with data from the American Hospital Association, the Area Resource File, and state Medicaid Generosity Index from Zuckerman et al. Dependent variables were utilization of PT services (yes/no) and discharge disposition to one of three settings: IRF, NH, or home. Independent variables included patient characteristics, institutional characteristics, area resources, and relative Medicaid generosity (Index). Data Analysis: Logistic regression analyses were used to determine odds of receiving PT and of discharge to an IRF, NH or home. Results: Seventy percent of patients with Medicaid received PT in the hospital following stroke. Factors associated with receiving PT included higher Medicaid Index, longer hospital stay, having a neurologist as a physician, and being older. Patients in high Index states had nearly 4 times the odds of receiving PT compared to those in low Index states. Most patients were discharged home; however patients in high Index states had more than 7 times the odds of being discharged to an IRF versus home compared to those in low Index states. Increased Medicaid Index resulted in more discharges to IRFs rather than NHs for Whites, more discharges to NHs for Hispanics, and little change in discharge disposition of Blacks. Conclusions: Clinical guidelines for early mobilization post-stroke are followed most of the time with patients with Medicaid. Patients in states with higher Medicaid reimbursement are more likely to receive PT following stroke. Medicaid reimbursement also influences the setting of post-stroke rehabilitation. All racial/ethnic groups do not benefit similarly from increased Medicaid generosity.

Learning Objectives: At the conclusion of the session, the participant will be able to

• Recognize the role that physical therapists play and the settings in which they work in rehabilitation following stroke.
• List 5 possible complications that may be prevented by early mobilization following stroke.
• Articulate factors influencing access to physical therapy and discharge disposition for patients with Medicaid following stroke.
• Assess the effect that Medicaid payment generosity has on access to PT following stroke for patients of different racial/ethnic groups who have Medicaid as a third party payer.

Presenting author's disclosure statement:

I wish to disclose that I have NO financial interests or other relationship with the manufactures of commercial products, suppliers of commercial services or commercial supporters.