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A comparison of acute ischemic stroke patients discharged to inpatient rehabilitation versus a skilled nursing facility: the Paul Coverdell National Acute Stroke Program

  • Priyadarshini Pattath
    Affiliations
    Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, United States

    Oak Ridge Institute for Science and Education, Oak Ridge, TN, USA
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  • Erika C. Odom
    Correspondence
    Corresponding author: Erika C. Odom, PhD, MS, LMSW, CDR, USPHS, Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 4770 Buford Hwy, Mail Stop S107-1, Atlanta, GA 30341.
    Affiliations
    Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, United States

    United States Public Health Service, Atlanta, Georgia, United States
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  • Xin Tong
    Affiliations
    Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, United States
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  • Xiaoping Yin
    Affiliations
    Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, United States
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  • Sallyann M. Coleman King
    Affiliations
    Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, United States

    United States Public Health Service, Atlanta, Georgia, United States
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  • Paul Coverdell National Acute Stroke Program team
Published:December 12, 2022DOI:https://doi.org/10.1016/j.apmr.2022.11.008

      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)
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