An examination of geographic access to outpatient stroke rehabilitation services in Tennessee, a stroke belt state

Background: While over half of US stroke patients were discharged to home, estimates of geographic access to outpatient stroke rehab facilities are unavailable. The objective of our study was to assess distance and travel time to the nearest outpatient stroke rehab facility in Tennessee, a high stroke prevalence state.Methods: We systematically scraped Google Maps with the terms stroke, rehabilitation, and outpatient to identify Tennessee stroke rehab facilities. We then averaged/aggregated Census block-level travel distance and travel time to determine the mean travel distance/time to a facility for each of the 95 Tennessee counties and the overall state. Comparisons of mean travel time/distance were made between rural and urban counties and between low, medium, and high stroke prevalence counties.Results: We found that 79% of facilities were in urban areas. Significantly higher median of mean travel times and distances (p values both <0.001) were observed in rural (22.0 miles, 31.6 min) versus urban counties (10.5 miles, 18.4 min). High (21.5 miles, 32.5 min) and medium (18.7 miles, 28.3 minutes) stroke prevalence counties, which often overlap with rural counties, had significantly higher median of mean travel times and distance than low stroke prevalence counties (7.3 miles, 14.5 min).Conclusions: Rural Tennessee counties were faced with high stroke prevalence, inadequate facilities, and significantly greater travel distance and time to access care. Additional efforts to address transportation barriers and accelerate telerehabilitation implementation are crucial for improving equal access to stroke aftercare in these areas.

Automated summary

This study assessed the geographic accessibility of stroke rehabilitation facilities in Tennessee. The study found that rural counties had significantly longer travel distances and times compared to urban counties. Counties with high and medium stroke prevalence also had higher travel times and distances compared to low stroke prevalence counties. Therefore, addressing transportation barriers and implementing tele-rehabilitation are crucial for improving access to stroke aftercare in these areas.