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 (N=4381) with poststroke aphasia.
Interventions
N/A.
Main Outcome Measures
Length of stay (LOS), speech-language pathology (SLP) service utilization, costs of
care.
Methods
The 2011-2012 Healthcare Cost and Utilization Project State Inpatient Database data
were analyzed to examine the effect of rural or urban residence on LOS, 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 model.
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 or illness severity. The differences were attenuated
after controlling for the hospital where they received care.
Conclusions
For PWA, race-ethnicity has a larger effect 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.
Keywords
List of abbreviations:
GLM (generalized linear model), HCUP (Healthcare Cost and Utilization Project), HSR (health services research), ICD-9 (International Classification of Diseases and Health Related Problems, Ninth Revision), LOS (length of stay), PWA (persons with aphasia), RUCA (rural-urban commuting area), SLP (speech-language pathology)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: August 10, 2018
Footnotes
Disclosures: none.
Identification
Copyright
© 2018 by the American Congress of Rehabilitation Medicine
