title: Decomposing racial and ethnic disparities in the use of postacute rehabilitation care.
abstract: OBJECTIVE
  To determine the degree to which racial and ethnic disparities in the use of postacute rehabilitation care (PARC) are explained by observed characteristics.
  
  
  METHODS
  State inpatient databases (SIDs) for 2005 and 2006 from four diverse states were used to identify patients with stays for joint replacement, stroke, or hip fracture.
  
  
  METHODS
  Our primary outcomes were use of institutional PARC (versus discharge home) and, conditional on discharge to an institution, skilled nursing facility (versus inpatient rehabilitation facility) care. We modified the Oaxaca-Blinder decomposition method to account for the dichotomous outcome and multilevel nature of the data.
  
  
  METHODS
  Discharges from the four SIDs were included if the principal diagnosis (stroke, hip fracture) or procedure (joint replacement) was in the sample inclusion criteria.
  
  
  RESULTS
  Observed characteristics explained roughly half of the unadjusted differences in use of institutional PARC. Patient-level factors (clinical, age) were more explanatory of disparities in institutional PARC use, while hospital-level factors were more explanatory of skilled nursing facility versus inpatient rehabilitation facility care.
  
  
  CONCLUSIONS
  Adjustment for characteristics influencing PARC use both mitigated and exacerbated racial/ethnic disparities in use. The degree to which the characteristics explained the disparity varied across conditions and outcomes.
authors.affiliation: Department of Health Policy & Management, Cecil G. Sheps Center for Health Services Research, University of North Carolina, Chapel Hill, NC 27599, USA. mark_holmes@unc.edu
authors.forename: George M
authors.initials: GM
authors.lastname: Holmes
authors.forename: Janet K
authors.initials: JK
authors.lastname: Freburger
authors.forename: Li-Jung E
authors.initials: LJ
authors.lastname: Ku
mesh_terms: D001741:Black or African American / Q000706:statistics & numerical data; D000368:Aged; D019643:Arthroplasty, Replacement / Q000534:rehabilitation*; D005260:Female; D054625:Healthcare Disparities / Q000208:ethnology*; D006620:Hip Fractures / Q000534:rehabilitation*; D006630:Hispanic or Latino / Q000706:statistics & numerical data; D006699:Home Care Services / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012044:Regression Analysis; D012047:Rehabilitation Centers / Q000706:statistics & numerical data; D012866:Skilled Nursing Facilities / Q000706:statistics & numerical data; D000071939:Stroke Rehabilitation; D014481:United States; D044465:White People / Q000706:statistics & numerical data