Utilization of rehabilitation services in stroke: A study utilizing the Health and Retirement Study with linked Medicare claims data.

OBJECTIVES: To describe Medicare fee-for-service beneficiaries who utilized post-stroke rehabilitation services and identifies the strongest predictors of utilization after the initial stroke care episode.

DESIGN: Pooled, cross-sectional design using data from 1998-2010 from the Health and Retirement Study (HRS) with linked Medicare claims data.

SETTING: NA PARTICIPANTS: Stroke survivors who were Medicare fee-for-service beneficiaries and participated in the Health and Retirement Study (HRS) were included (n=515).

MAIN OUTCOME MEASURE: Utilization of rehabilitation services up to 10 years following stroke was the primary outcome with logistic regression used to predict utilization. Covariates included demographic factors, baseline functional status, health conditions, personal lifestyle factors and social support.

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p>RESULTS: Rehabilitation service utilization was 21.6%, 6.8%, 15.8%, 16.5%, and <16% in years 2, 4, 6, 8, and 10 respectively. Age was the primary factor predicting use of rehabilitation in the first 10 years post-stroke (OR: 1.14; p=0.001). Recurrent stroke (OR: 1.64; p=0.051) was also significantly associated with utilization while unspecified incident stroke at incident trended towards significance (OR:2.17; p=0.077). None of the other factors was a significant predictor of participation in rehabilitation services in this period.

CONCLUSION: A small number of Medicare fee-for-service beneficiaries who are stroke survivors utilize rehabilitation services in the first 10 years post-stroke. Of those who do, age is the primary driver of utilization. We analyzed a multitude of factors that might influence utilization, but other factors not available in these data also need to be explored.

http://www.ncbi.nlm.nih.gov/pubmed/31421093?dopt=Abstract