Highlights
- •Frailty was a significant predictor of discharge location poststroke.
- •More frail patients were discharged to skilled nursing facilities.
- •Nonfrail patients were 71% more likely to be discharged to inpatient rehabilitation.
Abstract
Objective
To examine the effect of frailty on poststroke discharge location with respect to
stroke severity and create a risk-adjusted model for understanding the effects of
frailty on discharge to an inpatient rehabilitation facility.
Design
Retrospective cohort.
Setting
A 2014 5% Medicare sample.
Participants
Patients hospitalized for a first-time acute ischemic stroke (N=7258).
Interventions
Not applicable.
Main Outcome Measures
A prehospitalization 6-month baseline was used to calculate a frailty score. Logistic
regression to predict odds of discharge to inpatient rehabilitation was used to calculate
for 3 levels of baseline frailty, controlling for patient demographics, stroke severity,
and comorbidities.
Results
About 1603 patients were discharged to inpatient rehabilitation. Patients who were
nonfrail (odds ratio [OR] 1.716; 95% confidence interval [95% CI], 1.463-2.013) or
prefrail (OR 1.519; 95% CI, 1.296-1.779) were more likely to be discharged to inpatient
rehabilitation. The final logistic regression model had a C-statistic of 0.63. Most
of the patients discharged to inpatient rehabilitation were nonfrail (44.2%) and had
moderate strokes (38.9%). Individuals who were frail and suffered a moderate (OR 0.78;
95% CI, 0.558-1.091) or severe stroke (OR 0.509; 95% CI, 0.358-0.721) were less likely
to be discharged to an inpatient rehabilitation facility.
Conclusions
A lack of a claims-based measure for prestroke functional ability makes it difficult
to understand discharge decision-making patterns for individuals’ poststroke. Prestroke
frailty was found to have a significant effect on predicating inpatient rehabilitation
discharge after an acute stroke when controlling for stroke severity, comorbidities,
and age. Further investigation is warranted to examine differences in rehabilitation
utilization based on frailty and to quantify the effect of rehabilitation on frailty
status in individuals poststroke.
Keywords
List of abbreviations:
95% CI (95% confidence interval), ADL (activities of daily living), FCI (Functional Comorbidity Index), IRF (inpatient rehabilitation facility), OR (odds ratio), SASI (Stroke Administrative Severity Index), SNF (skilled nursing facility)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: March 25, 2019
Footnotes
Supported in part by the VA Office of Research and Development (ORD), with additional support from the VA/ORD Rehabilitation R&D Service (grant no. 1I01RX001935) and support from the National Institutes of Health (grant no. NIH P20 GM109040). Supported in part by the South Carolina Clinical and Translational Research Institute, with an academic home at the Medical University of South Carolina, through NIH–NCATS (grant no. UL1 TR001450), the Telehealth Center of Excellence (grant no. HRSA U66RH31458), and Promotion of Doctoral Studies I Scholarship from the Foundation for Physical Therapy Research. Data for the study were provided through support for the CEDAR core funded by the MUSC Office of the Provost.
Disclosures: none.
Identification
Copyright
© 2019 by the American Congress of Rehabilitation Medicine
