For stroke victims, demographics just may be their destiny. An NAU researcher is working to identify that pattern and change it.
Amit Kumar, an assistant professor in Northern Arizona University’s College of Health and Human Services recently received an R01 grant from the National Institute on Minority Health and Health Disparities to study the relationship between race/ethnicity, poverty and stroke treatment and recovery.
The five-year, $3.8 million award will enable Kumar to investigate how stroke victims’ race and income level factor into their post-stroke rehabilitation care and overall health outcomes. Research in this arena has uncovered a disturbing trend—right now, the two most pronounced disparities in stroke recovery occur in racial and ethnic minorities and adults with low socioeconomic status, which Kumar has codified as those covered by both Medicare and Medicaid. Studies have shown that having pre-existing comorbid conditions leads to poor health outcomes. Being a minority and from a poor socioeconomic status are akin to a pre-existing comorbid condition in health care.
“Growing up in a low-income farming family in the Bihar state of India, one of the world’s poorest regions, my family members had to travel for 15 hours to New Delhi for better care,” Kumar said. “I have also seen the prevalence of caste-based discrimination in India, which have some overlapping similarities to race-based discrimination. The persistent, systemic inequalities that affect the daily lives and health of minorities are a well-known epidemic with no vaccine.”
Kumar aims to fill in the gap of the quality and amount of rehabilitation care in in-patient facilities and how a patient who was hospitalized after an acute stroke and how that post-stroke care looks different for people of different ethnicities and socioeconomic status. Further, they don’t exactly know how different care amplifies the disparity.
“Identifying these disparities in care represent opportunities for health care providers to mitigate disparities in patient outcomes,” Kumar said. “Better, more equitable patient outcomes mean more stroke victims make a quicker, more extensive recovery.”
His big data-centric research will examine how individual- and provider-level factors contribute to these disparities in the quality and amount of care; the primary cohort will be patients who have been diagnosed with a stroke and admitted to inpatient rehab facilities directly after getting stroke care in a hospital. Kumar will use data from Medicaid and Medicare claims, patient assessments and interviews with patients, caregivers, hospital discharge planners and rehabilitation clinicians to identify mechanisms around disparities and, equally important, uncover solutions to improve equity in post-acute rehabilitation care.
Given the variation in the availability of post-acute rehabilitation services and outcomes, one of the first things to consider is which post-acute rehabilitation hospital is right for your loved one and located in your area. Choosing the right inpatient rehabilitation facility requires an informed decision. Dr. Kumar aims to provide information that helps improve decision-making about choosing post-acute rehabilitation facilities, thus improving equitable, high-quality stroke care, and reducing the burden of stroke-related disability. He also expects this work to provide valuable resources for policymakers and consumers in their decision-making processes.
This project will address priority issues in the U.S. health care delivery system among historically underserved populations through a three-pronged approach: advancing the scientific understanding of the causes of health disparities; identifying causal pathways that can reduce health disparities for highly vulnerable stroke patients; and identifying facilitators and barriers to quality of care in high-need, high-cost patients.
“Racial disparities in stroke-related care remain among the most compelling health service concerns in the United States,” Kumar said. “The purpose of this proposal is to examine mechanisms that may contribute to disparities in access to and use of quality of rehabilitation care by racial/ethnic minorities and dual eligible patients and effects on patient-centered outcomes in patients with stroke.”
Kumar’s work, which has included many studies in the area of health equity for people in underserved populations, has been supported through the Center for Healthy Equity Research at NAU. In this research, he will continue to work directly with affected groups in examining the disproportionate impact of disease on minority and other health disparity populations.
“The unprecedented events following George Floyd’s death and pandemic further exposed or even worsened inequities for some communities,” Kumar said. “We need to acknowledge that all communities do not equally benefit from existing healthcare practices, and we need intentional efforts to reduce—and, ultimately, eliminate—disparities in health and in its determinants, including social determinants. This project is one such effort to study and help integrate health equity into the post-acute rehabilitation care.”
Heidi Toth | NAU Communications
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