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Race and Medicare-Medicaid Dual Enrollment Disparities in Access to Quality and Intensity of Post-Acute Rehabilitation Care and Health Outcomes in Patients with Stroke

Award Number: R01MD017719
ORGANIZATION: NATIONAL CENTER ON MINORITY HEALTH AND HEALTH DISPARITIES
OPDIV: NIH
AWARD CLASS: DISCRETIONARY
AWARD ACTIVITY TYPE: SCIENTIFIC/HEALTH RESEARCH (INCLUDES SURVEYS)
PERIOD OF PERFORMANCE START DATE: 09/11/2022
PERIOD OF PERFORMANCE END DATE: 11/30/2027

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Race and Medicare-Medicaid Dual Enrollment Disparities in Access to Quality and Intensity of Post-Acute Rehabilitation Care and Health Outcomes in Patients with Stroke - Variation in stroke-related care remains among the most compelling health service concerns in the United States. Stroke patients account for about 20% of all inpatient rehabilitation facility (IRF) admissions. However, there is limited research to date exploring patient-centered outcomes associated with the quality and intensity of IRF-based rehabilitation services among stroke patients who are racial/ethnic minority groups (African Americans and Hispanics) and are dual eligible for Medicare and Medicaid. Our proposal uses an integrative mixed methods design to study how individual- and provider-level factors contribute to disparities in IRF quality rating and amount of therapy, and subsequently, the combined effect of the two on patient health outcomes. The qualitative aim will identify facilitators and barriers to IRF selection among racial/ethnic minority groups (African Americans and Hispanics) and those with dual eligibility after stroke and the impact of the selection of quality IRFs on patient perceptions of IRF quality of care. This study will use 100% Medicare claims and assessment data (2017-2022), and perspectives from patients/caregivers, hospital discharge planners, and rehabilitation clinicians from different regions to understand selection processes of IRF and outcomes. We will utilize the Medicare Inpatient Standard Analytical File, Beneficiary Summary, Inpatient Rehabilitation Facilities Patient Assessment Instrument, Provider of Service, and publicly available IRF Medicare compare data. Patients with ‘index stroke’ admitted directly to IRFs from acute hospitals will serve as our primary cohort. For the first three aims, a) change in functional status, b) 30-day hospital readmission, and c) community discharge will serve as primary outcomes, adjusting for patient-, hospital-, and market-level characteristics. For the fourth, qualitative aim, patient perception of IRF quality and perceived functional recovery will be primary dependent variables for assessing the impact of variation in rehabilitation care.


Issue Date FY	Funding FY	Legal Entity Name	Legal Entity Address	Legal Entity City	Legal Entity State	Legal Entity Zip Code	Legal Entity COUNTY	Legal Entity COUNTRY	Assistance Listing	Award Code	Budget Year	Action Date	Action Type	Action Amount

Issue Date FY: 2026 ( Subtotal = $600,488 )
2026	2026	UNIVERSITY OF UTAH	201 PRESIDENTS CIR	SALT LAKE CITY	UT	84112	SALT LAKE	USA	Minority Health and Health Disparities Research	000	5	1/2/2026	NON-COMPETING CONTINUATION	$600,488
														Subtotal = $600,488

Issue Date FY: 2025 ( Subtotal = $801,945 )
2025	2025	UNIVERSITY OF UTAH	201 PRESIDENTS CIR	SALT LAKE CITY	UT	84112	SALT LAKE	USA	Minority Health and Health Disparities Research	001	4	7/31/2025	NON-COMPETING CONTINUATION	$80,392
2025	2025	UNIVERSITY OF UTAH	201 PRESIDENTS CIR	SALT LAKE CITY	UT	84112	SALT LAKE	USA	Minority Health and Health Disparities Research	000	4	12/2/2024	NON-COMPETING CONTINUATION	$721,553
														Subtotal = $801,945

Issue Date FY: 2024 ( Subtotal = $591,788 )
2024	2024	UNIVERSITY OF UTAH	201 PRESIDENTS CIR	SALT LAKE CITY	UT	84112	SALT LAKE	USA	Minority Health and Health Disparities Research	005	3	6/14/2024	NON-COMPETING CONTINUATION	$0
2024	2024	UNIVERSITY OF UTAH	201 PRESIDENTS CIR	SALT LAKE CITY	UT	84112	SALT LAKE	USA	Minority Health and Health Disparities Research	004	3	5/24/2024	NON-COMPETING CONTINUATION	$70,479
2024	2024	UNIVERSITY OF UTAH	201 PRESIDENTS CIR	SALT LAKE CITY	UT	84112	SALT LAKE	USA	Minority Health and Health Disparities Research	000	3	12/11/2023	NON-COMPETING CONTINUATION	$521,309
2024	2022	UNIVERSITY OF UTAH	201 PRESIDENTS CIR	SALT LAKE CITY	UT	84112	SALT LAKE	USA	Minority Health and Health Disparities Research	003	2	12/14/2023	CHANGE OF GRANTEE / TRAINING INSTITUTION / AWARDING INSTITUTION	$1,970
2024	2022	UNIVERSITY OF UTAH	201 PRESIDENTS CIR	SALT LAKE CITY	UT	84112	SALT LAKE	USA	Minority Health and Health Disparities Research	001	2	12/11/2023	CHANGE OF GRANTEE / TRAINING INSTITUTION / AWARDING INSTITUTION	$0
2024	2022	NORTHERN ARIZONA UNIVERSITY	601 S KNOLES DR RM 220	FLAGSTAFF	AZ	86011	COCONINO	USA	Minority Health and Health Disparities Research	002	1	12/14/2023	NEW	-$1,970
														Subtotal = $591,788

Issue Date FY: 2023 ( Subtotal = $0 )
2023	2022	UNIVERSITY OF UTAH	201 PRESIDENTS CIR	SALT LAKE CITY	UT	84112	SALT LAKE	USA	Minority Health and Health Disparities Research	001	2	5/26/2023	CHANGE OF GRANTEE / TRAINING INSTITUTION / AWARDING INSTITUTION	$778,592
2023	2022	NORTHERN ARIZONA UNIVERSITY	601 S KNOLES DR	FLAGSTAFF	AZ	86011	COCONINO	USA	Minority Health and Health Disparities Research	000	1	5/26/2023	NEW	-$778,592
														Subtotal = $0

Issue Date FY: 2022 ( Subtotal = $780,562 )
2022	2022	NORTHERN ARIZONA UNIVERSITY	601 S KNOLES DR ROOM 220	FLAGSTAFF	AZ	86011	COCONINO	USA	Minority Health and Health Disparities Research	000	1	9/11/2022	NEW	$780,562
														Subtotal = $780,562

Grand Total All Awards = $2,774,783

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Race and Medicare-Medicaid Dual Enrollment Disparities in Access to Quality and Intensity of Post-Acute Rehabilitation Care and Health Outcomes in Patients with Stroke

Award Number: R01MD017719

ORGANIZATION: NATIONAL CENTER ON MINORITY HEALTH AND HEALTH DISPARITIES

OPDIV: NIH

AWARD CLASS: DISCRETIONARY

AWARD ACTIVITY TYPE: SCIENTIFIC/HEALTH RESEARCH (INCLUDES SURVEYS)

PERIOD OF PERFORMANCE START DATE: 09/11/2022

PERIOD OF PERFORMANCE END DATE: 11/30/2027

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