Social Determinants of Discharge Destination for Patients After Stroke With Low Admission FIM Instrument Scores

Abstract 

Nguyen TA, Page A, Aggarwal A, Henke P. Social determinants of discharge destination for patients after stroke with low admission FIM instrument scores.

Objective

To investigate the effects of immigrant status (via country of birth), marital status, and area-based socioeconomic status (SES) on discharge destination after stroke for those with low admission scores on the FIM instrument.

Design

Cross-sectional study.

Setting

Inpatient rehabilitation ward at an urban community hospital in Australia.

Participants

A total of 326 inpatients admitted for rehabilitation poststroke.

Intervention

Multidisciplinary rehabilitation.

Main Outcome Measure

Discharge home versus nursing home.

Results

A total admission FIM score of 75 or lower was associated with a higher probability of nursing home discharge. Married patients with a total FIM admission score of 75 or lower were significantly more likely to be discharged home, after adjusting for immigrant status, type and side of stroke, sex, and age (odds ratio, 6.07; 95% confidence interval, 1.65−22.40; P<.01). This effect was also observed for low motor and cognition components of FIM admission score. The effect of immigrant status did not remain significant after adjusting for marital status. Area-based SES and stroke characteristics did not substantially attenuate the relationship between immigrant status, marital status, and discharge location.

Conclusions

Marital status is a significant determinant of discharge destination. Immigrant status and area-based SES were not significant predictors of discharge disposition.

Key Words: Emigration and immigration, Marriage, Patient discharge, Rehabilitation, Stroke