Factors influencing utilization of postdischarge cognitive rehabilitation programs.

A decision to add a new treatment program has widespread and long-lasting implications for both the patient and the organization. Information about the interactions among the institution, the patient, and the treatment modality are seldom available. Cognitive rehabilitation is a relatively new treatment modality that is being adopted in a number of programs. This report examined characteristics of stroke patients that (1) precluded their selection for cognitive rehabilitation treatment and (2) were associated with patient refusal to participate in cognitive rehabilitation. The records of stroke patients treated in three rehabilitation facilities were examined for their ability to participate in an outpatient cognitive rehabilitation program. Due to stringent criteria for the research project, fewer than half of the stroke patient population were cognitively able to participate. Of eligible patients, many declined postdischarge cognitive rehabilitation. Several variables influenced patient participation. Female stroke patients were much less likely to participate than were male patients. In addition, distance from the medical facility providing cognitive rehabilitation was a major barrier to treatment participation. Individuals who opted to participate were well educated, affluent or both. The sample of cognitive rehabilitation patients was not, therefore, representative of the population. These results suggest that medical facilities considering the addition of a centralized outpatient postdischarge cognitive rehabilitation program should first evaluate the characteristics of the target population. Suggestions about the institutional considerations involved in making the decision to add a cognitive rehabilitation program are made.