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Post-acute stroke rehabilitation utilization: Are there difference between rural-urban patients and taxonomies?

Jia H, Cowper Ripley DC, Tang Y, Vogel WB, Wu SS, Litt ER, Wilson LK, Chen GJ. Post-acute stroke rehabilitation utilization: Are there difference between rural-urban patients and taxonomies? Poster session presented at: VA HSR&D National Meeting; 2011 Feb 16; National Harbor, MD.


BACKGROUND:Timely and effective rehabilitation therapy improves stroke survivors' outcomes. However, limited information is available about rural-urban differences in rehabilitation utilization by Veterans with acute stroke. The Rural-Urban Commuting Areas (RUCA) and the Veterans Affairs Highly Rural (VAHR) are two taxonomies commonly used by VA researchers. OBJECTIVES:To define a national cohort of VA stroke patients into three categories of urban, rural, and isolated/highly rural by using the RUCA and VAHR codes, to compare the characteristics between the three groups of patients, and to assess the association between patients' post-acute stroke rehabilitation utilization and patients' rural-urban residential settings. METHODS:In this retrospective study, all patients were hospitalized for acute stroke within the VA healthcare system between calendar year 2001 and 2002. Rehabilitation utilization referred to any type of rehabilitation therapy received by the patients 12 months post-acute stroke hospitalization. Patients' urban, rural or isolated/highly rural status was determined using the RUCA and VAHR codes. Logistic regression models were fitted for the rehabilitation outcome, adjusting for sociodemographic and clinical factors. FINDINGS: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/VAHR, respectively. Compared with their urban counterparts, the 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 receiving intubation procedure. Compared with the rural patients, odds of receiving rehabilitation therapy were 1.2-times (RUCA) and 1.1-times (VAHR) by the urban patients, and 0.53-times (VAHR only) by the highly rural patients, after adjusting for the risk factors. These results were significant at p IMPACT:Further study is needed to examine the barriers for receiving less rehabilitation therapy by the rural and/or highly rural stroke patients in order to improve their post-stroke recovery. Researchers should be cautious when selecting a rural-urban taxonomy for their related studies.

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