Less than half of all stroke patients who are referred for rehabilitation—be it outpatient therapy or at-home care—actually receive it, according to preliminary research presented at the American Heart Association’s International Stroke Conference in Los Angeles.

Of 369 stroke patients enrolled in the COMPASS (COMprehensive Post-Acute Stroke Services) trial, 115 were referred to home-based health rehab services, but just 43.5 percent went through with the recommendation, study author Cheryl Bushnell, MD, MHS, and colleagues said. Of the 85 patients who were referred for outpatient rehabilitation, just 34.1 percent received care.

Bushnell and her team called each participant to gather information for the study.

“We don’t know the exact reasons why these patients did not receive rehabilitation, but we assume it has to do with the copay that is associated with outpatient therapy services, even for those who have insurance,” she said in an AHA release. “Home health, on the other hand, does not include copays, but there were still over half of those referred who did not receive it.”

According to the American Stroke Association, timely rehab is essential to successful recovery. Medicare can cover up to 60 days of home health services, but insurance limits on outpatient therapy generally top out around two or three weeks. In contrast, insurance companies will generally cover up to 100 days of inpatient rehab therapy.

Stroke rehabilitation can require the expertise of several doctors, since stroke can affect fine motor skills, speech, language, cognition, vision, emotional wellness and physical function, the ASA stated, which can push costs up. In addition, patients are faced with a limited timeframe to find post-acute care outside of the hospital room.

Bushnell’s team also found that non-white patients referred to outpatient rehabilitation were 78 percent less likely to to receive it than white patients, after adjusting for age, severity of stroke and disability. While the researchers said there could be a disparity in regards to post-stroke treatment by race, more data is needed before they can draw any conclusions.

“Clearly, we need more research to understand these factors,” Bushnell said.