Date of Award

2022

Embargo Period

8-15-2022

Document Type

Dissertation

Degree Name

Doctor of Philosophy (PhD)

College

College of Health Professions

First Advisor

Kit N. Simpson

Second Advisor

Michelle Woodbury

Third Advisor

Eyad Almallouhi

Fourth Advisor

Annie N. Simpson

Abstract

Barriers to rehabilitation for stroke survivors exist despite evidence supporting improvements in independence and quality of life. Telerehabilitation is emerging as a viable option to improve costs and access. While there is growing evidence for telerehabilitation efficacy, the associated costs are unknown. Additionally, to inspire changes in reimbursement and policy, more evidence of access disparities is needed. The overall objective of this project is to provide depth to the costs, treatment approaches, and access to care for stroke survivors. We completed three separate projects to address our objective. Our time-driven, activity-based costing analysis compared marginal costs in the care delivery process for telerehabilitation versus outpatient rehabilitation. Though there are many benefits to telerehabilitation, improvements in care delivery efficiency are necessary to improve widespread adoption. Next, we examined the first-year costs for stroke survivors and associated acute interventions. Costs increase with stroke severity Finally, we explored stroke survivor access to rehabilitation and stratified by stroke severity and rural/nonrural and socially disadvantaged communities. Stroke survivors have inconsistent access to community-based rehabilitation. Socially disadvantaged and rural communities receive less and different approaches to rehabilitation. These findings support a future study exploring the cost-effectiveness of implementing a telerehabilitation program versus traditional outpatient care.

Rights

All rights reserved. Copyright is held by the author.

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