Racial and ethnic disparities in post-acute care service utilization after stroke.
Ji Won Lee, Christine DeForge, Bridget Morse-Karzen and 6 others
PMID 39862622WHAT IT FOUND
After stroke, Black patients were more likely than White patients to receive home health or skilled nursing, while Hispanic patients received more home health but less inpatient rehab.
Lower socioeconomic status, Medicaid or no insurance, urban residence, and service availability were associated with facility discharge.
Key findings
01Black individuals were more likely than White individuals to go home with home health in all four studies that included them, and Hispanic individuals were more likely in most of four studies; more than half of 12 studies that included Black individuals found higher skilled nursing or nursing home discharge, while only two of seven including Hispanic individuals did.
02For inpatient rehabilitation, half of studies that included Black individuals found Black individuals more likely than White individuals to be discharged there, while only two of eight studies that included Hispanic individuals found Hispanic individuals more likely.
03Lower socioeconomic status, no insurance or Medicaid insurance, urban residence, post-acute care supply, and hospital characteristics were associated with increased institutional post-acute care utilization among racial and ethnic minority individuals.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
Included studies grouped post-acute care services and race or ethnicity differently, so direct comparisons were not possible. The review is limited to U.S. studies, so findings may not apply to other health systems. Time trends were secondary and may have limited utility for interpreting disparities. Included studies did not consistently specify ischemic, hemorrhagic, or other stroke types. This made severity and appropriate level of care hard to judge. Hospice and palliative care were not included, although end-of-life care is increasingly used after stroke. All studies were included regardless of quality score. Many important social determinant factors, such as community context, education, food security, implicit provider bias, and hospital disproportionate share status, were rarely or not measured.
Declared interests
The authors declared no conflicts of interest. The article is marked as supported by NIH extramural research funding.
The easy way to misread this
Do not conclude that race or ethnicity alone caused the discharge differences. The review reported associations from cohort and cross-sectional studies, and low socioeconomic status, insurance status, urban residence, post-acute care supply, and hospital characteristics were also associated with institutional discharge.