Exploring Pathways to Equitable Outcomes in Post-Stroke Aphasia and Dysphagia

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PROJECT SUMMARY/ABSTRACT Evidence suggests quality of care has substantially improved in the in the US has over last 25 years. However, wide variability exists in the quality of care that some patient groups receive. Some suggest that structural barriers in within healthcare systems and in post-discharge community settings translate into racial-ethnic disparities in outcomes for conditions such as aphasia and dysphagia. To date, studies have not examined the role structural barriers play role in disparities in outcomes. In this study we propose to test the hypothesis that structural barriers at various stages of the post-stroke treatment condition for conditions like aphasia and dysphagia contribute to differences in quality of rehabilitation care and subsequently to racial-ethnic differences in aphasia and dysphagia outcomes. The objective of this study is to examine how healthcare institutions and healthcare provider practices impacts the receipt of quality rehabilitative care and whether it translates into racial disparities in post-stroke outcomes. The objective of this project will be achieved by the completion of the following specific aims: Aim 1: Determine how availability, accessibility, and quality of post-stroke acute inpatient care contribute to disparate outcomes of individuals with aphasia and dysphagia. We hypothesize that processes embedded in healthcare settings and communities where stroke survivors live will dictate: a) access to specific types of care, b) the path of care progression, and c) intensity of care. Aim 2: Determine how the timing and transition of care contribute to disparate outcomes of individuals with aphasia and dysphagia. We hypothesize that processes embedded in healthcare settings will lead to variations in the timing and transition from acute to post-acute care of stroke survivors with aphasia and dysphagia as they move across different facilities/systems of care. Aim 3: Determine how the post-discharge community environments contribute to disparate outcomes of individuals with aphasia and dysphagia. We hypothesize that personal, social, and community measures of prosperity and disadvantage will contribute to racial disparities in outcomes among individuals with aphasia and dysphagia. To complete this study we will use Medicare claims data which will enable us to track the care of stroke survivors with aphasia and dysphagia across the entire continuum of care.