Home Health Post Stroke: Rural and African American Medicare Beneficiaries Less Likely to Have Rehabilitation Specialist Visits

Purpose: The quality and intensity of post-acute care received after a cerebrovascular event (hereafter, stroke) can affect the patient’s functional recovery.  In rural areas, where specialized providers such as physical (PT) and occupational (OT) therapists are in short supply, home health patients may be less likely to receive rehabilitation specialist care. 

Method: We analyzed 2009 Medicare home health claims, restricted to white or African American beneficiaries (AA), age 65+, who experienced stroke within the past year, did not die, and had 1 or more home heath visits (n=15,741). Rurality was measured at the county level. We assessed whether the beneficiary had received at least one visit from a PT, OT, or either.  Adjusted analysis controlled for age, sex, number of visits, comorbidities, and dual eligibility (Medicare plus Medicaid).

Results: Urban white beneficiaries were most likely to have seen a PT (84.0%), followed by urban AA (82.0%), rural white (79.7%), and rural AA beneficiaries (70.5%; p >.002). For OT, only rural AA beneficiaries differed from urban white beneficiaries in bivariate analysis (urban white, 45.3%; rural AA, 34.2%, p=0.0002).  .  In adjusted analysis, both AA race (OR 0.792, 95% CI 0.696- 0.901) and rural residence (OR 0.691, CI 0.621- 0.769) were associated with reduced odds for PT care. Findings were similar for OT.

Conclusion:  Race and residence-based disparities were present in home health rehabilitation services received by stroke patients.  Research is needed to ascertain if these disparities are associated with poorer functional recovery.  Interventions to increase rural practitioner availability may be appropriate.