Saladin LK; Medical University of South Carolina, Charleston, SC, USA; saladinl@musc.edu.

PURPOSE: The purpose of this study was to identify gender differences in the utilization of inpatient rehabilitation facilities (IRFs) post-stroke and to begin to identify significant factors that influence access to these facilities. One goal of Healthy People 2010 is to eliminate health disparities and improve access to quality health services. While there is a considerable volume of research demonstrating racial disparities in access to health care, there has been minimal research focused on gender disparities. This is especially true with respect to accessing services post-stroke. One health service that has been shown to optimize functional recovery and outcomes post-stroke is rehabilitation and research has demonstrated that rehabilitation provided at inpatient rehabilitation facilities results in better outcomes compared to rehabilitation provided in other settings. Therefore, it is important to identify gender disparities in access to IRF’s and to understand any factors that might influence this differential access. SUBJECTS: Data from 42,639 patients admitted to acute care facilities either from home or from emergency centers with a primary or secondary diagnosis of stroke were analyzed. METHODS: This was a retrospective study analyzing data from the Healthcare Cost and Utilization Project State Inpatient Database. Three years of data from Maryland and South Carolina were analyzed. Separate utilization rates for IRF’s were identified for males and females stratified by age and insurance type. ANALYSIS: Chi-square analysis determined significant differences between groups. Significant predictors of access to IRFs were identified using multivariate logistic regression models. The dependent variable was utilization of IRFs as indicated by discharge disposition. Independent variables included race, age, gender, insurance type, length of stay, number of diagnoses, hospital charges, ICU admission, physical therapy charges, physician specialty and urban versus rural acute care facility. RESULTS: Males were significantly more likely to utilize IRFs than females in Maryland but not in South Carolina. Additionally, in both states, females were significantly more likely to die in hospital and to be discharged to a nursing home. These findings were not attributable to age differences between men and women. Regression models demonstrating all of the significant factors associated with increased access to IRFs will be presented and discussed. CONCLUSIONS: Significant gender differences in utilization rates of IRFs were demonstrated at least in one state. These differences have the potential to contribute to gender differences in other related post-stroke outcomes such as function and quality of life and must be studied further. FUNDING SOURCE: None.

Copyright 2004 by the American Physical Therapy Association

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