The state-of-the-science: access to postacute care rehabilitation services. A review

Abstract

Objective: To identify and summarize potential factors that influence access to postacute care (PAC) rehabilitation services.

Data sources: Ovid Medline and agency-specific (eg, RAND Corp, Research Triangle Institute, U.S. Department of Health and Human Services) searches, using combinations of the terms health services accessibility, delivery of healthcare, access to care, post-acute, postacute, and access. Names of prominent authors were also searched to retrieve their relevant articles.

Study selection: The initial search resulted in 823 articles published between 1980 and 2006. After we reviewed titles and abstracts, we obtained and examined 49 potential sources. Our final sample of 35 studies had descriptions and/or analyses of measures that might serve as indictors of access to PAC settings.

Data extraction: Key information abstracted from each article and document included author(s), year of publication, patient groups, sample size, health care setting, and a brief summary of the access-related issues in PAC.

Data synthesis: Studies varied by patient group, care setting, and access categories. Indicators of access to PAC rehabilitation services were classified into 4 categories: financial (46%), personal (31%), structural (26%), and attitudinal (23%). Many studies assessed more than 1 category.

Conclusions: We identified categories of information that can be used to develop a monitoring system for PAC services. The inclusion of access indicators in existing health report cards and quality indicator systems should be further explored.