New study explores complex factors that may lead to health outcome disparities in stroke care

headshots: Charles Ellis, Candice Adams-Mitchell, Karen Hegland, Molly Jacobs
A UF PHHP team leads a new study to examine health disparities in stroke care. Top row: Dr. Charles Ellis and Dr. Candice Adams-Mitchell Bottom row: Dr. Karen Hegland and Dr. Molly Jacobs

By Jill Pease

Despite improved access to post-stroke rehabilitation care, racial disparities in health outcomes persist. A new University of Florida College of Public Health and Health Professions study intends to shed light on the factors that may contribute to the accessibility and quality of care that African American patients receive following a stroke.

Charles Ellis, Ph.D., professor and chair of the department of speech, language and hearing sciences in the UF College of Public Health and Health Professions, leads the five-year study funded by a $3.1 million grant from the National Institute on Deafness and Other Communication Disorders of the National Institutes of Health. The project will focus on two common conditions among people who have experienced a stroke: aphasia, which affects a person’s ability to express oral or written language, and dysphagia, which causes difficulty swallowing.

The new study brings together a diverse team of speech-language pathologists, economists and health services researchers from the University of Florida and the University of Colorado Denver to examine the complex factors that may contribute to racial disparities along the stroke care continuum, from the initial hospital stay, to rehabilitation and finally, to discharge.

Prior research, including by members of the study team, has demonstrated that African American patients with aphasia have greater levels of impairment than their white counterparts, Ellis said. Yet, their research also suggests that this disparity is not due to African American patients receiving less care or differences in their health insurance coverage.

“Interestingly, our previous studies of service utilization and cost of care indicate that African American stroke survivors with aphasia have longer lengths of  stays, receive more speech therapy rehabilitation visits, and have substantially greater cost of care in acute care settings than white patients,” Ellis said. “These findings suggest that disparities in aphasia and dysphagia outcomes are not simply the result of the quantity and timing of services provided.”

For the new study, the team will analyze Medicare claims data to examine clinical outcomes, health care service utilization patterns and measures of quality at the facilities where patients receive services.

“We will be able to follow stroke survivors with aphasia and/or dysphagia for one full year to determine which factors are most salient,” Ellis said. “We will explore factors related to the stroke survivor, where they receive care and the communities that they return to.”

Findings from the study will be used to inform interventions that remove barriers to care so that African American patients who have had a stroke have the best possible health outcomes.

In addition to Ellis, UF investigators on the team include Candice Adams-Mitchell, SLP.D., a clinical assistant professor of speech, language, and hearing sciences; Karen Hegland, Ph.D., an associate professor of speech, language, and hearing sciences; and Molly Jacobs, Ph.D., an associate professor of health services research, management and policy.