Sandel M Elizabeth, Wang Hua, Terdiman Joseph, Hoffman Jeanne M, Ciol Marcia A, Sidney Steven, Quesenberry Charles, Lu Qi, Chan Leighton
Physical Medicine and Rehabilitation, Napa Solano Service Area, and Research and Training, Kaiser Foundation Rehabilitation Center, Vallejo, CA 94589, USA.
PM R. 2009 Jan;1(1):29-40. doi: 10.1016/j.pmrj.2008.10.012. Epub 2009 Jan 9.
To determine whether there are disparities in postacute stroke rehabilitation based on type of stroke, race/ethnicity, sex/gender, age, socioeconomic status, geographic region, or service area referral patterns in a large integrated health system with multiple levels of care.
Cohort study tracking rehabilitation services for 365 days after acute hospitalization for a first stroke.
The Northern California Kaiser Permanente Health System (approximately 3.3 million membership population)
A total of 11,119 patients hospitalized for acute stroke from 1996 to 2003. The cohort includes patients discharged from acute care after a stroke. Postacute care rehabilitation services were evaluated according to the level of care ever-received within the 365 days after discharge from acute care, including inpatient rehabilitation hospital (IRH), skilled nursing facility (SNF), home health and outpatient, or no rehabilitation services.
Not applicable.
Service delivery.
Patients discharged to an IRH had longer lengths of stay in acute care. Patients with hemorrhagic stroke were less likely to be treated in an IRH. Patients whose highest level of rehabilitation was SNF were older and more likely to be women. After adjusting for age and other covariates, women were less likely to go to an IRH than men. Asian and black patients were more likely than white patients to be treated in an IRH or SNF. Also more likely to go to an IRH were patients from higher socioeconomic groups, from urban areas, and from geographic areas close to the regional rehabilitation hospital.
These results suggest variation in care delivery and extent of postacute care based on differences in patient demographics and geographic factors. Results also varied over time. Some minority populations in this cohort appeared to be more likely to receive IRH care, possibly because of disease severity, family support systems, cultural factors, or differences in referral patterns.
在一个拥有多层次医疗服务的大型综合医疗系统中，确定基于卒中类型、种族/民族、性别、年龄、社会经济地位、地理区域或服务区域转诊模式的急性卒中后康复是否存在差异。
队列研究，跟踪首次卒中急性住院后365天的康复服务情况。
北加利福尼亚凯撒永久医疗系统（会员人口约330万）
1996年至2003年期间因急性卒中住院的11119名患者。该队列包括卒中后从急性护理出院的患者。根据急性护理出院后365天内所接受的护理级别评估急性后期护理康复服务，包括住院康复医院（IRH）、熟练护理设施（SNF）、家庭健康和门诊服务，或无康复服务。
不适用。
服务提供情况。
转入IRH的患者急性护理住院时间更长。出血性卒中患者在IRH接受治疗的可能性较小。康复级别最高为SNF的患者年龄较大，且女性居多。在调整年龄和其他协变量后，女性转入IRH的可能性低于男性。亚洲和黑人患者在IRH或SNF接受治疗的可能性高于白人患者。社会经济地位较高、来自城市地区以及居住在靠近区域康复医院地理区域的患者转入IRH的可能性也更大。
这些结果表明，基于患者人口统计学和地理因素的差异，护理服务的提供和急性后期护理的程度存在差异。结果也随时间而变化。该队列中的一些少数族裔人群似乎更有可能接受IRH护理，这可能是由于疾病严重程度、家庭支持系统、文化因素或转诊模式的差异。
