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Are Stroke Survivors Discharged to the Recommended Postacute Setting?

Published:April 06, 2020DOI:https://doi.org/10.1016/j.apmr.2020.03.006

      Highlights

      • Among participating United States hospitals, most stroke survivors were discharged to:
      • The post-acute care destination deemed most appropriate by discharge planners and physical therapists.
      • Deciding to discharge patients to less intensive care settings than preferred was:
      • Mostly attributed to patient or family preference.
      • Sparingly attributed to insurance or other limitations.

      Abstract

      Objective

      To examine the processes and barriers involved in providing postdischarge stroke care.

      Design

      Prospective study of discharge planners’ (DP) and physical therapists’ (PT) interpretation of factors contributing to patients’ discharge destination.

      Setting

      Twenty-three hospitals in the northeastern United States.

      Participants

      After exclusions, data on patients (N=427) hospitalized with a primary diagnosis of stroke between May 2015 and November 2016 were examined. Of the patients, 45% were women, and the median age was 71 years. DPs and PTs caring for these patients were queried regarding the selection of discharge destination.

      Interventions

      None.

      Main Outcome Measures

      Comparison of actual discharge destination for stroke patients with the destinations recommended by their DPs and PTs.

      Results

      In total, 184 patients (43.1%) were discharged home, 146 (34.2%) to an inpatient rehabilitation facility, 94 (22.0%) to a skilled nursing facility, and 3 (0.7%) to a long-term acute care hospital. DPs and PTs agreed on the recommended discharge destination in 355 (83.1%) cases. The actual discharge destination matched the DP and PT recommended discharge destination in 92.5% of these cases. In 23 cases (6.5%), the patient was discharged to a less intensive setting than recommended by both respondents. In 4 cases (1.1%), the patient was discharged to a more intensive level of care. In 2 cases (0.6%), the patient was discharged to a long-term acute care hospital rather than an inpatient rehabilitation facility as recommended. Patient or family preference was cited by at least 1 respondent for the discrepancy in discharge destination for 13 patients (3.1%); insurance barriers were cited for 9 patients (2.3%).

      Conclusions

      Most stroke survivors in the northeast United States are discharged to the recommended postacute care destination based on the consensus of DP and PT opinions. Further research is needed to guide postacute care service selection.

      Keywords

      List of abbreviations:

      DP (discharge planner), GWTG-Stroke (Get With The Guidelines-Stroke), ICH (intracerebral hemorrhage), IQR (interquartile range), IRF (inpatient rehabilitation facilities), LTACH (long-term acute care hospital), NECC (Northeast Cerebrovascular Consortium), NIHSS (National Institutes of Health Stroke Scale), PT (physical therapist), SNF (skilled nursing facilities)
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