Background: “Assessment for rehabilitation” (AFR) is an acute stroke care quality measure that is included in clinical guideline recommendations. Previous reports from “Get With The Guidelines (GWTG)” and the Coverdell Registry have shown compliance rates as high as 90 to 94% in stroke patients. These studies showed that blacks, males, and older patients were more likely to receive AFR.
Methods: We abstracted data from ischemic stroke hospitalizations that occurred between 2003-2012 within REGARDS, a national US cohort study of blacks and whites aged > 45 at time of enrollment. The definition of AFR included any of the following: consult by rehab services, assessed by rehab team member, receipt of rehab during hospitalization. Independent patient and hospitalization characteristics associated with AFR were identified by logistic regression.
Results: Information on AFR was determined in 536 of 546 ischemic stroke hospitalizations. The median age was 73.8+ 8.6 years, 50% were women, 46.8% were black. Three-quarter of the patients (406/536) had AFR. In univariate analyses, participants who were older, black, those with higher modified Rankin Score (mRS) and those evaluated by a stroke team were more likely to be assessed for rehabilitation, while participants in the west region of the US were least likely to be assessed. After multivariable adjustment, those who were older, those with a higher mRS, and those evaluated by an acute stroke team remained more likely to be assessed, while there was no statistically significant association of race, sex, or region (Table).
Conclusions: The proportion of stroke patients assessed for rehabilitation was lower in this national sample compared to previous registry based reports. However these results corroborate prior findings that assessments are more common among older patients, blacks and those with more severe strokes. Further examination of patient and hospital characteristics is warranted.