Abstract A114: Low Utilization of Outpatient Rehabilitation for Older Veterans Post-Stroke: A Retrospective Cohort

Introduction: After a stroke, outpatient rehabilitation provides specialized care to restore function, prevent secondary complications, and support community reintegration. Prior evaluations of outpatient rehabilitation use post-stroke were limited to smaller cohorts or self-reported use. There are no contemporary, population-level evaluations of outpatient physical (PT) and occupational therapy (OT) use post-stroke, creating knowledge gaps around who is receiving care and if disparities exist. Purpose: The purpose of this study was to evaluate outpatient PT and OT use among older Veterans in the six months post-stroke. Methods: This retrospective cohort study included older adults (≥65 years) enrolled in the Veterans Health Administration (VA) and hospitalized for an ischemic or hemorrhagic stroke between January 1, 2017 and December 31, 2021. Outpatient PT and OT visits were measured over the 6 months post-hospitalization using the VA Corporate Data Warehouse and CMS Outpatient and Carrier files. Trends in outpatient PT and OT use by year were examined using a Cochran-Armitage test for trend. Factors associated with outpatient use were evaluated using a generalized linear regression model that adjusted for calendar year. Results: The cohort comprised 161,377 stroke hospitalizations and 133,420 individuals. The cohort had a mean ± SD age 78 ± 8 years, was 81.4% White and 15.2% Black, and 32.1% were rurally residing. Only 26.2% ever received outpatient PT and/or OT in the first 6 months after stroke. Among those with at least one visit, the median [IQR] number of visits was 4 [11] PT and 1 [6] OT visits. There was a significant decrease in the proportion receiving outpatient rehabilitation by year (P <0.001). This trend was observed for mild, moderate, and severe stroke severity (Figure 1). The strongest associations with receiving outpatient therapy were initial post-stroke rehabilitation in an inpatient rehabilitation facility (aOR 2.33, 95% CI [2.24, 2.42]) and stroke hospitalization at VA hospital (aOR 1.69, 95% CI [1.62, 1.76]). Dual Medicare-Medicaid eligibility had the lowest odds of receiving outpatient rehabilitation (aOR 0.61, 95% CI [0.57, 0.65], Figure 2). Conclusions: These results suggests that there are barriers to both initial and sustained use of outpatient rehabilitation post-stroke. This underscores the need to develop interventions to ensure patients receive outpatient rehabilitation at an appropriate dose to maximize outcomes.