Allocation of rehabilitation services: who gets a home evaluation.
OBJECTIVE
The purpose of this study was to (a) identify and describe the subpopulation of rehabilitation inpatients who receive specialized occupational therapy home evaluation services, and (b) examine these data for evidence of inequalities in access to services based on patient gender, race, age, and health insurance status.


METHODS
An archival review was conducted of all inpatient admissions (7,871) to a large urban rehabilitation hospital between January 1, 1994, and December 31, 1998. We had complete data on 7,791 of these patients of whom 6,038 were eligible to receive a home evaluation. Patient demographic data and Functional Independence Measure (FIM) data were obtained in electronic form from the hospital information system.


RESULTS
Analysis showed that 12.4% (749/6038) of eligible inpatients received an in-home evaluation, and those who did were significantly more dependent (as measured by the FIM) than those who did not (p < 0.0001). We found no evidence of inequalities in access to this specialized rehabilitation service on the basis of gender, race, age, and type of medical insurance after controlling for level of functional independence.


CONCLUSIONS
This study found no evidence of inequalities in the allocation of home evaluation services. However, it raises the larger question of how we determine whether inequalities exist. A proper assessment of inequalities in service provision requires that we know the principles by which these services should be allocated and have appropriate measures of the application of these principles. For programmatic and policy reasons, more research is needed to develop well-defined principles of resource allocation, and adequate measures of their impact so we can know whether resources and services are distributed in the way we intend.
Neufeld
Stewart
S
Institute of Gerontology, Wayne State University, Detroit, Michigan 48202, USA.
Lysack
Cathy
C
D000046:Academic Medical Centers; D000203:Activities of Daily Living / Q000145:classification; D000328:Adult; D000368:Aged; D004185:Disability Evaluation; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006301:Health Services Needs and Demand / Q000706:statistics & numerical data; D018575:Home Care Services, Hospital-Based / Q000706:statistics & numerical data*; D006801:Humans; D019458:Insurance Coverage / Q000706:statistics & numerical data; D008297:Male; D008432:Mathematical Computing; D008824:Michigan; D008875:Middle Aged; D009788:Occupational Therapy / Q000706:statistics & numerical data*; D010343:Patient Admission / Q000706:statistics & numerical data*; D011203:Poverty / Q000706:statistics & numerical data; D012046:Rehabilitation / Q000706:statistics & numerical data*; D012047:Rehabilitation Centers / Q000706:statistics & numerical data; D040841:Resource Allocation / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012959:Socioeconomic Factors; D014505:Urban Population / Q000706:statistics & numerical data