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2011 HSR&D National Meeting Abstract

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2011 National Meeting

3044 — Post-Acute Stroke Rehabilitation Utilization: Are There Difference between Rural-Urban Patients and Taxonomies?

Jia H (Gainesville RORC-REAP), Cowper Ripley DC (Gainesville RORC-REAP), Tang Y (Gainesville RORC-REAP), Vogel WB (Gainesville RORC-REAP), Wu SS (Gainesville RORC-REAP), Litt ER (Gainesville RORC-REAP), Wilson LK (Gainesville RORC-REAP), Chen GJ (Huston CoE)

Objectives:
Limited information is available about rural-urban differences in rehabilitation utilization by Veterans with acute stroke. Rural-Urban Commuting Areas (RUCA) and Veterans Affairs’ Urban/Rural/Highly Rural (VAU/R/HR) are two taxonomies commonly used by VA researchers. In this study, we placed a cohort of VA stroke patients into three categories of urban, rural, and isolated/highly rural by using their RUCA and VAU/R/HR codes based on ZIP code of residence; compared characteristics between the three groups; and assessed association between patients’ post-acute stroke rehabilitation utilization and residential setting.

Methods:
All patients hospitalized for acute stroke within the VA healthcare system between calendar year 2001 and 2002 were examined. Rehabilitation utilization referred to any type of rehabilitation therapy received 12 months post-acute stroke hospitalization. Patients’ urban, rural or isolated/highly rural status was determined using the RUCA and VAU/R/HR codes. Logistic regression fitted models for the rehabilitation outcome, adjusting for sociodemographic (age, race/ethnicity, marital status, mortality, travel time to VA facility, and VA care priority) and clinical (admission source, discharge location, stroke type, comorbidity, length of hospital stay, and intubation use) factors.

Results:
Among the 8,296 stroke patients, 69.6%/61.1% was categorized as urban, 21.3%/37.5% as rural, and 9.1%/1.4% as isolated/highly rural by the RUCA/VAU/R/HR, respectively. Compared with their urban counterparts, rural and/or isolated/highly rural patients were significantly more likely to be older, white, married, living further from VA hospitals; hospitalized for stroke directly from home; and not intubated. Compared with the rural patients, odds of receiving rehabilitation therapy were higher (OR = 1.2 RUCA) and (OR = 1.1 VAU/R/HR) by the urban patients, and lower (OR = 0.5 VAU/R/HR only) by highly rural patients, after adjusting for the risk factors (p < 0.05).

Implications:
With both taxonomies, rural patients were less likely to receive post-acute stroke rehabilitation therapy than their urban counterparts. Using the VA taxonomy, highly rural stroke patients were less likely to receive post-acute stroke rehabilitation than their rural counterparts. Different taxonomy may lead to different rural-urban classification yields and different yields may lead to different outcomes and conclusions.

Impacts:
Further study is needed to examine the barriers for receiving less rehabilitation therapy by rural and/or highly rural stroke patients to improve post-stroke recovery. Researchers should be cautious when selecting a rural-urban taxonomy for their studies.


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