PM&R
Volume 1, Issue 1 , Pages 29-40 , January 2009

Disparities in Stroke Rehabilitation: Results of a Study in an Integrated Health System in Northern California

  • M. Elizabeth Sandel, MD

      Affiliations

    • Physical Medicine and Rehabilitation, Napa Solano Service Area, and Research and Training, Kaiser Foundation Rehabilitation Center, 975 Sereno Drive, Vallejo, CA 94589.⁎
    • Corresponding Author InformationAddress correspondence to: M.E.S.
    • ,
  • Hua Wang, PhD

      Affiliations

    • Kaiser Foundation Rehabilitation Center, Vallejo, CA⁎
    • ,
  • Joseph Terdiman, MD, PhD

      Affiliations

    • Kaiser Permanente Division of Research, Oakland, CA⁎
    • ,
  • Jeanne M. Hoffman, PhD

      Affiliations

    • University of Washington, Seattle, WA⁎
    • ,
  • Marcia A. Ciol, PhD

      Affiliations

    • University of Washington, Seattle, WA⁎
    • ,
  • Steven Sidney, MD

      Affiliations

    • Kaiser Permanente Division of Research, Oakland, CA⁎
    • ,
  • Charles Quesenberry, PhD

      Affiliations

    • Kaiser Permanente Division of Research, Oakland, CA⁎
    • ,
  • Qi Lu, MS

      Affiliations

    • Kaiser Permanente Division of Research, Oakland, CA⁎
    • ,
  • Leighton Chan, MD, MPH

      Affiliations

    • National Institutes of Health, Bethesda, MD⁎

Received 22 September 2008 ,Accepted 24 October 2008.

References 

  1. American Heart Association. www.americanheart.org/downloadable/heart/1200078608862HS_Stats%202008.final.pdfAccessed December 15, 2008
  2. Centers for Disease Control and Prevention. www.cdc.gov/nchs/data/nvsr/nvsr56/nvsr56_10.pdfAccessed December 15, 2008
  3. Cooper R, Cutler J, Desvigne-Nickens P, et al. Trends and disparities in coronary heart disease, stroke, and other cardiovascular diseases in the United States: Findings of the National Conference on Cardiovascular Disease Prevention. Circulation. 2000;102:3137–3147
  4. The Permanente Medicine Guideline: Stroke. Oakland, CA: The Permanente Medical Group; 2008.
  5. Smedley BD, Stith AY, Nelson AR. Unequal Treatment: Confronting Racial and Ethnic Disparities in Healthcare. Washington, DC: National Academies Press; 2002;
  6. Marmot MG. Understanding social inequalities in health. Perspect Biol Med. 2003;46(3 Suppl):S9–S23
  7. Ayala C, Greenlund KJ, Croft JB, et al. Racial/ethnic disparities in mortality by stroke subtype in the United States, 1995–1998. Am J Epidemiol. 2001;154:1057–1063
  8. Ayala C, Croft JB, Greenlund, et al. Sex differences in US mortality rates for stroke and stroke subtypes by race/ethnicity and age; 1995;–1998. Stroke 2002;33:1197–1201
  9. Stansbury JP, Jia H, Williams LS, Voegl WB, Duncan PW. Ethnic disparities in stroke: Epidemiology, acute care, and postacute outcomes. Stroke. 2005;36:374–387
  10. Kissela B, Schneider A, Kleindorfer , et al. Stroke in a biracial population: The excess burden of stroke among blacks. Stroke. 2004;35:426–431
  11. Jones MR, Horner RD, Edwards LJ, et al. Racial variation in initial stroke severity. Stroke. 2000;31:563–567
  12. Horner RD, Hoenig H, Sloane R, Rubenstein LV, Kahn KL. Racial differences in utilization of inpatient rehabilitation services among elderly stroke patients. Stroke. 1997;28:19–25
  13. Horner RD, Swanson JW, Bosworth HB, et al. Effects of race and poverty on the process and outcome of inpatient rehabilitation services among stroke patients. Stroke. 2003;34:1027–1031
  14. Kelly PJ, Furie KL, Shafqat S, Rallis N, Chang Y, Stein J. Functional recovery following rehabilitation after hemorrhagic and ischemic stroke. Arch Phys Med Rehabil. 2003;84:968–972
  15. Mayer-Oakes SA, Hoenig H, Atchison KA, Lubben JE, De Jong F, Schweitzer SO. Patient-related predictors of rehabilitation use for community-dwelling older Americans. J Am Geriatr Soc. 1992;40:336–342
  16. Gregory PC, Morozova HE, Kuhlemeier KV. Do racial disparities exist in access to inpatient stroke rehabilitation in the state of Maryland?. Am J Med Phys Rehabil. 2006;85:814–819
  17. Goldstein LB, Matchar DB, Hoff-Linquist J, Samsa GP, Horner RD. Veterans Administration Acute Stroke (VASt) Study: Lack of race/ethnic-based differences in utilization of stroke-related procedures or services. Stroke. 2003;34:999–1004
  18. Bhandari VK, Kushel M, Price L, Schillinger D. Racial disparities in outcomes of inpatient stroke rehabilitation. Arch Phys Med Rehabil. 2005;86:2081–2086
  19. Hoenig H, Duncan PW, Horner RD, et al. Structure, process, and outcomes in stroke rehabilitation. Med Care. 2002;40:1036–1047
  20. SAS Institute Inc., Base SAS® 9.13 Procedures Guide, Second Edition, Volumes 1, 2, 3, and 4. Cary. NC: SAS Institute Inc.; 2006; SAS/STAT 9.1 User's Guide. Cary, NC: SAS Institute Inc.; 2004.
  21. Deutsch A, Granger C, Heinemann A. Post stroke rehabilitation: Outcomes and reimbursement of inpatient rehabilitation facilities and subacute rehabilitation programs. Stroke. 2006;37:1477–1482
  22. Gordon NP. Educational attainment as a mediating influence on racial/ethnic health disparities, or why it is important to capture education as a categorical variable in the electronic medical record. Poster presented at: Bay Area Clinical Symposium; November 16, 2007; San Francisco, CA.
  23. National Institute of Neurological Disorders and Stroke. Neurology information for doctors and other clinicians. http://www.ninds.nih.gov/doctors/Accessed November 3, 2008
  24. Institute for Health Policy. Racial and ethnic health disparities: influences, actors, and policy. http://kpihp.org/publications/docs/disparities.pdfAccessed November 3, 2008
  25. Buntin MB, Garten AD, Paddock S, Saliba D, Totten M, Escarce JJ. How much is post-acute care use affected by its availability?. Health Serv Res. 2005;40:413–434
  26. Kramer AM, Kowalsky JC, Lin M, Grigsby J, Hughes R, Steiner JF. Outcome and utilization differences for older persons with stroke in HMO and fee for service systems. J Am Geriatr Soc. 2000;48:726–734
  27. Baicker K, Chandra A, Skinner JS. Geographic variation in health care and the problem of measuring racial disparities. Perspect Biol Med. 2005;48(1 Suppl):S42–S53
  28. Stansbury J, Reid KJ, Reker DM, Duncan PW, Marshall CR, Rittman M. Why ethnic designation matters for rehabilitation research: Comparing VA administrative data and clinical records. J Rehabil Res Dev. 2004;4:269–278
  29. Buntin MB. Access to postacute rehabilitation. Arch Phys Med Rehabil. 2007;88:1488–1493
  30. Berg K, Intrator O. Postacute care following stroke or hip fracture. J Aging Health. 1999;11:27–48
  31. McCall N, Korb J, Petersons A, Moore S. Reforming Medicare payment: Early effects of the 1997 Balanced Budget Act on postacute care. Milbank Q. 2003;81:277–303
  32. Buntin M, Escarce J, Hoverman C, Paddock S. Effects of payment changes on trends in access to post-acute care. Technical Report. Santa Monica, CA: RAND Corporation; 2005;
  33. Ward D, Severs M, Dean T, Brooks N. Care home versus hospital and own home environments for rehabilitation of older people (Cochrane Review). In: The Cochrane Library, Issue 1, 2004. Chichester, UK: John Wiley & Sons, Ltd.; 2004.

 Disclosure Key can be found on the Table of Contents and at www.pmrjournal.org

 This study was supported with funding from the Centers for Disease Control and Prevention. Additional resources were provided by the Intramural Research Program (Clinical Center) of the National Institutes of Health, the Centers for Medicare and Medicaid Services, and Kaiser Permanente.

PII: S1934-1482(08)00022-1

doi: 10.1016/j.pmrj.2008.10.012

PM&R
Volume 1, Issue 1 , Pages 29-40 , January 2009

Article Tools

* Image Usage & Resolution