Abstract
Objective
To compare the sociodemographic, clinical, and hospital related factors associated
with discharge of acute ischemic stroke (AIS) survivors to inpatient rehabilitation
(IRF) and skilled nursing facility (SNF) rehabilitation services.
Design
Retrospective descriptive study from the Paul Coverdell National Acute Stroke Program
(PCNASP) participating hospitals during 2016 to 2019.
Setting
9 Participating states from PCNASP in United States
Participants
130,988 patients with AIS from 569 hospitals.
Interventions
Not applicable
Main Outcome Measure
Discharge to IRF and SNF
Results
Patients discharged to a SNF had longer length of hospital stay, more comorbidities,
and higher modified Rankin scores compared to patients discharged to an IRF. Nine
characteristics were associated with being less likely to be discharged to an IRF
than an SNF: older age (85+ years old, adjusted odds ratio [AOR]=0.20 [confidence
interval [CI]=0.18- 0.21]), identifying as non-Hispanic Black (AOR=0.85 [CI=0.81-0.89]),
identifying as Hispanic (AOR=0.80 [CI=0.74-0.87]), having Medicaid/Medicare (AOR=0.73
[CI=0.70-0.77]), being able to ambulate with assistance from another person (AOR=0.93
[CI=0.89-0.97]), being unable to ambulate (AOR =0.73 [CI=0.62-0.87]) and having comorbidities,
prior stroke (AOR=0.69 [CI=0.66-0.73]), diabetes (AOR=0.85 [CI=0.82-0.88]), and myocardial
infraction/coronary artery disease (AOR=0.94 [CI=0.90-0.97]). Four characteristics
were associated with being more likely to be discharged to an IRF than an SNF: being
a man (AOR=1.20 [CI=1.16-1.24]), and having a slight disability (Rankin Score 2) (AOR=1.41
[CI=1.29-1.54]), being at larger hospitals (200-399 beds: AOR=1.31 [CI=1.23-1.40];
400+ beds: AOR=1.29 [CI=1.20-1.38]), and being at a hospital with stroke unit (AOR=1.12
[CI=1.07-1.17]).
Conclusion
This study found differences in demographic, clinical, and hospital characteristics
of AIS patients discharged for rehabilitation to an IRF versus SNF. The characteristics
of patients receiving rehabilitation services may be helpful for researchers and hospitals
making policies related to stroke discharge and practices that optimize patient outcomes.
Populations experiencing inequities in access to rehabilitation services should be
identified, and those who qualify for rehabilitation in IRF should receive this care
in preference to rehabilitation in SNF.
Key words
List of abbreviations:
AIS (acute ischemic stroke), AOR (adjusted odds ratio), GEE (generalized estimating equation), IRF (inpatient rehabilitation), NIHSS (National Institute of Health Stroke Scale), PCNASP (Paul Coverdell National Acute Stroke Program), 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
Accepted:
November 13,
2022
Received in revised form:
October 7,
2022
Received:
August 12,
2022
Publication stage
In Press Journal Pre-ProofFootnotes
Disclosure: none
Identification
Copyright
Published by Elsevier Inc. on behalf of the American Congress of Rehabilitation Medicine.
