Urban-Rural Differences in Service Utilization and Costs of Care for Racial-Ethnic Groups Hospitalized with Post-Stroke Aphasia

Publication date: Available online 10 August 2018

Source: Archives of Physical Medicine and Rehabilitation

Author(s): Rose Y. Hardy, Richard C. Lindrooth, Richard K. Peach, Charles Ellis

Abstract

Objective

Although residence is a key contributor to cost and utilization in stroke patient care, its contribution to the care of persons with aphasia (PWA) is unknown. The objective of this study was to use discharge-level hospital inpatient data to examine the influence of patient residence (rural vs. urban) and race-ethnicity on service utilization and cost of care among PWA.

Design

Cross-sectional

Setting

Administrative data from acute care hospitals in the state of North Carolina

Participants

Individuals with post-stroke aphasia

Interventions

N/A

Main Outcome Measures

length of stay, speech-language pathology service utilization, costs of care

Methods

2011-2012 Healthcare Cost and Utilization Project (HCUP) State Inpatient Database (SID) data were analyzed to examine the impact of rural/urban residence to lengths of stay (LOS), Speech-Language Pathology (SLP) service utilization, as well as total inpatient and SLP service costs. These outcomes were further analyzed across both residence and racial groups (Non-Hispanic White and Non-Hispanic Black). Outcomes were analyzed using generalized linear models (GLM).

Results

Both rural and urban Black PWA experienced longer average LOS after controlling for demographics, illness severity, and the hospital where they received care. Rural Blacks experienced longer LOS, received greater SLP services, and incurred greater average total hospital costs than their rural White counterparts after adjusting for differences in their demographics and stroke/illness severity. The differences were attenuated after controlling for the hospital where they received care.

Conclusions

For PWA, race-ethnicity has a larger impact on average total medical costs, SLP service utilization, and LOS than residence. It is unclear how and why Blacks with aphasia have greater service utilization and costs in acute care, yet their aphasia outcomes are worse. Future studies are required to explore potential factors such as quality of care.

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