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)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: April 06, 2020
Footnotes
Disclosures: A.S. and B.M.R. are cochairs of the Northeast Cerebrovascular Consortium Rehabilitation and Recovery Workgroup. J.S. and B.M.S. are Past Chairs of the Northeast Cerebrovascular Consortium. J.S. reports grants from Revance, Inc., and Neurolution, outside the submitted work. B.M.S. reports compensation for Women’s Health Initiative outcomes adjudication; medicolegal malpractice review; and authorship for Ebix, MedLink, and Medscape. J.P.B. reports grants from PCORI and from AstraZeneca that were outside the submitted work. The other authors have nothing to disclose.
Supported by the Northeast Cerebrovascular Consortium and American Heart Association/American Stroke Association through staff support.
Identification
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© 2020 by the American Congress of Rehabilitation Medicine
