1204 - The Lay Of The Land: A Framework for Modeling Rehabilitation Access Equity

Access to rehabilitation facilities is essential for long-term functional recovery and social participation for people with disabilities, yet geographic and socioeconomic disparities continue to limit this access. While national data exist, most sources report disparities separately from utilization of rehabilitation services, making it difficult to assess structural equity in a comprehensive way. In this study, two new indices, Access Equity Index (AEI) and Vulnerability Index (VI), are designed and validated. These two indices quantify state-level rehabilitation equity by integrating utilization, infrastructure, and vulnerability into a unified framework.

Design: The AEI incorporated three components: reach rate (rehabilitation beneficiaries ÷ disabled population), facility density (IRF, SNF, and HHA facilities per 10,000 disabled population), and disability prevalence. The VI included poverty rate, uninsured rate, and inverted median household income. Inputs were normalized to a 0–100 scale. Principal component analysis refined weights within each index. AEI weights: facility density (36%), reach rate (32%), and disability prevalence (32%). VI weights: poverty (39%), income (41%), and uninsured rate (20%). An overall equity score was calculated as a 50/50 blend of AEI and inverted VI. Data were drawn from CMS and the U.S. Census Bureau.

Results:

The indices identified wide variation in access equity across states. States with strong access but high vulnerability were categorized as fragile equity, and those with low access and high vulnerability were categorized as crisis zones. Facility density and socioeconomic disadvantage were dominant contributors to overall scores. Scatterplots of AEI versus VI highlighted intuitive quadrant groupings of geographic and structural disparities.

Conclusions:

The AEI + VI framework measures state-level rehabilitation access equity and highlights disparities. Expansion to county-level data and additional variables, paired with interactive visualization, will strengthen advocacy, policymaking, and targeted resource allocation.