Factors associated with discharge to home versus discharge to institutional care after inpatient stroke rehabilitation.

Abstract:

OBJECTIVE:To examine sociodemographic and clinical characteristics independently associated with discharge home compared with discharge to a skilled nursing facility (SNF) after acute inpatient rehabilitation. DESIGN:Retrospective cohort study. SETTING:Three tertiary accredited acute care rehabilitation facilities. PARTICIPANTS:Adult patients with stroke (N=2085). INTERVENTIONS:Not applicable. MAIN OUTCOME MEASURES:Not applicable. RESULTS:Of 2085 patients with stroke treated at 3 centers over a 4-year period, 78.2% (n=1631) were discharged home and 21.8% (n=454) discharged to an SNF. Findings from a multivariable logistic regression analysis indicated that patients were less likely to be discharged home if they were older (odds ratio [OR], .98; 95% confidence interval [CI], .96-.99), separated or divorced (compared with married; OR, .61; 95% CI, .48-.79), or with Medicare health insurance (compared with private insurance; OR, .69; 95% CI, .55-.88), or had dysphagia (OR, .83; 95% CI, .71-.98) or cognitive deficits (OR, .79; 95% CI, .77-.81). The odds of being discharged home were higher for those admitted with a higher motor FIM score (OR, 1.10; 95% CI, 1.09-1.11). The following were not associated with discharge disposition: sex, race, prestroke vocational status, availability of secondary health insurance, number of days from stroke onset to rehabilitation facility admission, stroke type, impairment group, cognitive FIM on admission, other stroke deficits (aphasia, ataxia, neglect, or speech disturbance), stroke complications of hyponatremia or urinary tract infection, or comorbid conditions. CONCLUSIONS:One in 5 patients with stroke were discharged to an SNF after inpatient rehabilitation. On admission, several sociodemographic and clinical characteristics were identified that could be considered as important factors in early discussions for discharge planning.

journal_name

Arch Phys Med Rehabil

authors

Nguyen VQ,PrvuBettger J,Guerrier T,Hirsch MA,Thomas JG,Pugh TM,Rhoads CF 3rd

doi

10.1016/j.apmr.2015.03.007

subject

Has Abstract

pub_date

2015-07-01 00:00:00

pages

1297-303

issue

7

eissn

0003-9993

issn

1532-821X

pii

S0003-9993(15)00255-5

journal_volume

96

pub_type

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