Background: Black patients have distinct disadvantages that are associated with poor functional outcomes. Physical therapy (PT) is an invaluable tool for improving functional outcomes including hospital-associated disability and physical deconditioning. However, Black patients on trauma surgery services or with traumatic brain injury are less likely to be offered post-acute rehabilitation. Older White patients have higher odds of receiving rehabilitation services in any setting (inpatient, outpatient, or home-based) compared to Black patients. It remains unknown whether racial differences in post-acute rehabilitation referral and utilization exist in patients hospitalized for acute medical illness and whether social disadvantage affects the association.
Methods: We analyzed admissions lasting > 48 hours on Hospital Medicine services between 1/1/18 – 5/6/22 at a large tertiary academic hospital. Baseline characteristics were compared using chi-squared or t-tests. Regression analysis was used to test for the association of Black race with PT recommendation for discharge to a post-acute care (PAC) facility for physical rehabilitation and discharge to PAC facility when recommended controlling for age, sex, length of stay, admission mobility score, mobility change (difference in admission and discharge mobility scores), social disadvantage as measured by the area deprivation index, and insurance type. We performed subanalyses by age (< 65 vs ≥ 65), functional impairment on admission (AMPAC ≤ 18 vs > 18), and social disadvantage [high (deciles 8, 9, or 10) vs low (deciles 1, 2, 3, or 4)].
Results: Patients were predominantly Black (82.2%). Black patients were younger (60.5 vs 62.1 years old), more likely to be male (53% vs 42.2), to reside in a neighborhood with high social disadvantage (37.4% vs 13.2%), to have public insurance (91.9% vs. 67.4%), and had lower mobility scores at admission (18.0 vs 19.2) and discharge (19.0 vs 20.1). In unadjusted analyses, Black race was associated with greater odds of recommendation for discharge to a PAC facility (OR 1.34, 95% CI [1.19, 1.51]) but lower odds of discharge to a PAC facility when recommended (OR 0.54, 95% CI [0.43, 0.67]). After adjustment, Black race was not statistically significantly associated with recommendation for discharge to a PAC facility but was still associated with reduced odds of discharge to a PAC facility when recommended in the overall cohort (OR 0.53, 95% CI [0.41, 0.67)] and for those < 65 (OR 0.50, 95% CI [0.31, 0.81]) and 65+ (OR 0.53, 95% CI [0.40, 0.71]). Odds were lower among those living in the neighborhoods with the least social disadvantage (OR 0.47, 95% CI [0.32, 0.69]). There was not a statistically significant association between Black race and discharge to PAC when recommended in those with the most social disadvantage.
Conclusions: Black patients may face distinct disadvantages that put them at risk for poor functional recovery after discharge from the hospital for acute medical illness. Hospitalists and those creating inpatient mobility protocols may want to consider these disadvantages to help facilitate discharge to a post-acute care facility for physical rehabilitation when it has been recommended for Black patients.