Racial/Ethnic Differences in FIM™ Scores and Length of Stay for Underinsured Patients Undergoing Stroke Inpatient Rehabilitation

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Abstract

Objective:

To explore racial/ethnic differences in FIM™ data from admission to discharge in underinsured patients undergoing inpatient stroke rehabilitation.

Design:

This is a retrospective analysis of the Uniform Data System for Medical Rehabilitation (UDSMR®) database of an inpatient rehabilitation unit of a county hospital in a large urban city. Data included 171 adult patients admitted to the stroke rehabilitation unit between January 2000 and October 2003. Main outcome measures included admission and discharge total FIM™ score, FIM™ gain, FIM™ efficiency, and length of stay (LOS). Data were analyzed using χ2 analyses, t tests, univariate analysis of variance, binary logistic regression, and hierarchical multiple regression.

Results:

Data from 68 Hispanic, 83 black, and 20 white patients were included in the study. Univariate tests revealed that race/ethnicity groups differed significantly on admission FIM™ score (F = 5.38, P < 0.005), FIM™ gain (F = 4.35, P < 0.014), and FIM™ efficiency (F = 3.42, P < 0.035). Post hoc pairwise comparisons revealed that Hispanics had lower admission FIM™ scores than blacks (58.9 vs. 68.9). However, Hispanics had higher FIM™ gain scores than blacks (26.8 vs. 21.5). Race/ethnicity was not significantly related to age, gender, side of stroke, type of stroke, time from onset of stroke to rehabilitation admission, discharge FIM™ score, or LOS. Multiple regression analyses revealed that after controlling for all other available factors, race/ethnicity accounted for a significant amount of additional variance in admission FIM™ score (5.8%) and FIM™ efficiency (4.6%), but not in discharge FIM™ score, FIM™ gain, or LOS. Race/ethnicity was not predictive of discharge disposition.

Conclusions:

Differences in functional independence at admission to poststroke rehabilitation and the average daily improvement in function are related, in part, to patients' race/ethnicity. Differences in change in functional independence from admission to discharge (FIM™ gain) are not related to race/ethnicity once other factors, particularly admission FIM™ score, are taken into account. Future studies should identify reasons why Hispanics have lower admission FIM™ scores because demographic and stroke-related variables were not related to ethnicity yet have outcomes similar to blacks and whites at discharge.

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