Evaluation of Post-Acute Care Access and Outcomes: Influence of Social Determinants of Health on Urban and Rural Rehabilitation Service Areas Before and After COVID-19

ABSTRACT This project is instrumental in evaluating predictors of access and outcomes of post-acute care (PAC) and how Social Determinants of Health (SDH) across rural and urban Rehabilitation Service Areas (RSA) influence access and outcomes pre- and post-COVID pandemic. SDH are critically understudied drivers of access and outcomes of PAC. The proposed project leverages the AHRQ SDH dataset coupled with multiple years of Medicare claims data for beneficiaries receiving post-acute care to study access and outcomes of rehabilitation services in the context of SDH. Our specific research aims are to: 1. Evaluate RSA level PAC access for inpatient rehabilitation, skilled nursing, and home health related to acute hospital discharges for stroke, hip fracture, and joint replacement and: a) how the association is moderated by urban and rural areas; b) how the association is moderated by racial and ethnic minority resident density; c) how the association is moderated by COVID. 2. Characterize SDH based on area social, economic, education, physical, and healthcare context variables and evaluate a) the association between SDH and access to PAC settings across RSAs for those with stroke, hip fracture, and joint replacement; b) how this association is modified by Covid; c) how this association is modified by urban rural context. 3. Evaluate the association between SDH variables and successful community discharge and readmission among those with stroke, hip fracture, and joint replacement and: a) how the associations are moderated by urban and rural areas; b) how the associations are moderated by racial and ethnic minority resident density; c) how the associations are moderated by COVID. Impact and Need: This project has potential to impact both policies related to post-acute care delivery and the day-to-day operations of post-acute care management. Equity in care has been at the forefront of healthcare discussions over the past several years highlighted by noted disparity issues with the COVID pandemic. Disparities continue to disproportionately affect racial minorities across all aspects of rehabilitation, supporting the need for more research examining both individual and community factors to address care and outcome inequities. The project takes a broad look at SDH for older adults’ access and outcomes for PAC in urban and rural areas pre and post the COVID pandemic and will inform future use of individual and ecological SDH variables for examining PAC access and outcomes. Findings will inform policy makers about the influence of ecological social determinants of health have on post-acute care. With this information, policy makers can adjust reimbursement formulae, reduce barriers by creating incentives to improve availability and accessibility of post-acute care in areas where PAC utilization is positively and negatively influenced by social determinants of health, and set policies aimed at addressing the root causes behind inequities due to SDH.