Intensity of Rehabilitation Service Utilization In Subacute Care: Does Race Make a Difference?

Purpose This study grew out of the following question: If African Americans in the community use fewer rehabilitation services, would this also be true in a subacute setting? Because every patient in this study was covered by Medicare, they all should have equal access to rehabilitation services. This leads to a further question, whether African American patients will utilize these services as intensely as Caucasian patients. The proposed study is intended to lay a foundation for future research by examining the relationship between the subacute patient's race and the intensity of rehabilitation use as wells as the other factors that predict such use. Findings from this research will not only contribute to the conceptual knowledge about intensity of rehabilitation utilization in subacute nursing facilities, but also will help to identify those patients who are at risk for less use of rehabilitation services. Based on Andersen's Behavioral Model of Health Care Utilization, I hypothesize that: 1. Caucasian patients will use rehabilitation services more intensely than African American patients. 2. Other factors that predict increased intensity of utilization of rehabilitation services will include being female, being older, having more education, having more people reside in the household, increased availability and adequacy of social support, fewer number of medications at admission, lower depression score, and higher occupational therapy and physical therapy evaluation scores at admission.

Methods To be eligible to participate in this study, participants had to be at least 65 years old, English-speaking, and newly admitted into subacute. The participant was then given a structured, in-person interview at admission that lasted about one hour. Data was also obtained from the medical records at admission and discharge. To obtain the results, descriptive statistics, bivariate correlations, and two hierarchical regression models were run and analyzed.

Results After examining a correlations matrix, the independent variables included in the final model were race, age, emotional social support availability, occupational therapy evaluation score at admission, and physical therapy evaluation score at admission. In one regression analysis it was determined that race was not a significant predictor of intensity of occupational therapy use. The R2 (0.24) was significant for Block 2 (age, emotional social support availability, occupational therapy score at admission). Twenty-four percent of the variance in intensity of occupational therapy use was predicted by age, emotional social support availability, and occupational therapy evaluation score at admission. In the second regression analysis it was determined that the race was again, not a significant predictor of intensity of physical therapy use. The R2 (0.37) values were significant for Block 2 (age, emotional social support availability, physical therapy evaluation score at admission). Thirty-seven percent of the variance in intensity of physical therapy use was predicted by age, emotional social support availability, and physical therapy evaluation score at admission.

Implications Because race did not make a difference in this study, the results are important because they demonstrate that the factors that predict intensity of rehabilitation use differ in subacute care than in the community.