PROJECT SUMMARY
Racial disparity 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 minorities 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 minorities and those with dual eligiblility 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 disparities in
rehabilitation care.
