Improving Access to Stroke Rehabilitation and Recovery: A Policy Statement From the American Heart Association/American Stroke Association

Abstract

Stroke rehabilitation is an integral component of comprehensive stroke care. Inequities in access to stroke rehabilitation can further widen the disability gap and disproportionately affect underinsured patients, patients living in rural areas, and patients from underrepresented races and ethnicities. However, even insured patients face obstacles to receiving stroke rehabilitation. The prior authorization process, peer-to-peer reviews, and subsequent appeals to health care insurers for the provision of postacute rehabilitation increase length of the acute care stay, placing pressure on health systems to expedite the transition of care, to the detriment of appropriate postacute rehabilitation placement. This policy statement focuses on (1) the provision of quality stroke rehabilitation to prevent complications, facilitate recovery, and limit disability, (2) the creation of evidence-based policies to improve equitable access, effectiveness, and efficiency of postacute care, (3) the development and use of performance measures that are aligned with the American Heart Association/American Stroke Association Guidelines for Adult Stroke Rehabilitation and Recovery to incentivize optimal patient care, and (4) identification of research priorities targeted to improve stroke rehabilitation access. This policy statement is a call for positive and sustained action. Stroke rehabilitation is the lifeline of hope for survivors, their caregivers, and their communities in the days, months, and years after stroke. It is imperative that governments and other funding agencies balance the support needed for acute stroke and stroke rehabilitation treatment, and that organizations, including the American Heart Association/American Stroke Association-an unrelenting advocate for improved brain health-advance the importance of stroke rehabilitation throughout the continuum of care.

Keywords: AHA Scientific Statements; delivery of health care; public policy; quality of health care; stroke; stroke rehabilitation.