TOPLINE:

Fewer than one in four patients with stroke and fewer than one in seven with traumatic brain injury (TBI) were discharged from the hospital to an inpatient rehabilitation facility in the US between 2016 and 2019, with notable disparities across race, insurance type, and income level.

METHODOLOGY:

• The retrospective cohort study included 444,908 patients with acute neurologic injury (median age, 69 years; 46% women) from five states in the US from 2016 to 2019.
• Overall, 75% of patients had stroke, 24% TBI, and 1% traumatic spinal cord injury (TSCI).
• Outcomes included patients’ discharge disposition and factors associated with discharge to postacute rehabilitation facilities vs home and with discharge to inpatient rehabilitation vs a skilled nursing facility.

TAKEAWAY:

• Discharges to postacute rehabilitation facilities vs home were significantly higher in 2019 than in 2016 (adjusted odds ratio [aOR], 1.04; 95% CI, 1.02-1.06), but remained low overall, with 20.1% discharged to an inpatient rehabilitation facility, 26.4% to a skilled nursing facility, and 53.5% to home. Inpatient rehabilitation discharge was highest in TSCI (43.5%), followed by stroke (21.8%) and TBI (13.7%).
• Older patients (aOR, 1.04), women (aOR, 1.19), and non-Hispanic Black patients vs non-Hispanic White patients (aOR, 1.29) had significantly higher odds of discharge to a postacute rehabilitation facility vs home (P < .011 for all).
• Discharge to a skilled nursing facility vs inpatient rehabilitation was significantly less likely among older patients (aOR, 0.96), women (aOR, 0.83), and non-Hispanic Black patients (aOR, 0.90; P < .001 for all).
• Discharge to inpatient rehabilitation vs a skilled nursing facility was significantly more likely among those with private insurance vs Medicare (aOR, 1.73; P < .001), among those with higher vs lowest area-level income (aOR, 1.33; P < .001), and among Asian American and Pacific Islander patients (aOR, 1.11; P < .01), Hispanic patients (aOR, 1.07; P < .001), and those with other racial identities (aOR, 1.12; P < .001) vs non-Hispanic White patients.

IN PRACTICE:

“Inpatient rehabilitation facilities provide more intensive rehabilitation care, usually more than 3 hours per day, than skilled nursing facilities,” corresponding investigator Farhaan S. Vahidy, MBBS, PhD, TIRR Memorial Hermann, Houston, said in a news release.

“Our study found fewer people receive this type of rehabilitation than are likely eligible, with concerning disparities affecting historically marginalized communities, people with Medicaid, and those from lower-income areas,” he added.

SOURCE:

The study was led by Abdulaziz T. Bako, TIRR Memorial Hermann, Houston. It was published online on June 10 in Neurology.

LIMITATIONS:

The study had a retrospective design. State inpatient databases did not identify the specific acute inpatient unit of origin. The use of diagnostic codes and data on sex, race, or ethnicity from administrative records may have led to misclassification bias. The study data did not include direct measures of the severity of illness across various acute neurologic injury phenotypes.

DISCLOSURES:

The study did not receive any funding. The investigators reported having no relevant conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.