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Contemporary trends and predictors of postacute service use and routine discharge home after stroke.
Abstract
BACKGROUND: Returning home after the hospital is a primary aim for healthcare; however,
additional postacute care (PAC) services are sometimes necessary for returning stroke
patients to their pre-event status. Recent trends in hospital discharge disposition
specifying PAC use have not been examined across age groups or health insurance types.
METHODS AND RESULTS: We examined trends in discharge to inpatient rehabilitation facilities
(IRFs), skilled nursing facilities (SNFs), home with home health (HH), and home without
services for 849 780 patients ≥18 years of age with ischemic or hemorrhagic stroke
at 1687 hospitals participating in Get With The Guidelines-Stroke. Multivariable analysis
was used to identify factors associated with discharge to any PAC (IRF, SNF, or HH)
versus discharge home without services. From 2003 to 2011, there was a 2.1% increase
(unadjusted P=0.001) in PAC use after a stroke hospitalization. Change was greatest
in SNF use, an 8.3% decrease over the period. IRF and HH increased 6.9% and 3.6%,
respectively. The 2 strongest clinical predictors of PAC use after acute care were
patients not ambulating on the second day of their hospital stay (ambulation odds
ratio [OR], 3.03; 95% confidence interval [CI], 2.86 to 3.23) and those who failed
a dysphagia screen or had an order restricting oral intake (OR, 2.48; 95% CI, 2.37
to 2.59). CONCLUSIONS: Four in 10 stroke patients are discharged home without services.
Although little has changed overall in PAC use since 2003, further research is needed
to explain the shift in service use by type and its effect on outcomes.
Type
Journal articleSubject
rehabilitationstroke
trends
Adult
Aged
Aged, 80 and over
Brain Ischemia
Female
Home Health Nursing
Hospitalization
Humans
Intracranial Hemorrhages
Length of Stay
Male
Middle Aged
Multivariate Analysis
Patient Discharge
Recovery of Function
Rehabilitation Centers
Risk Factors
Self Care
Skilled Nursing Facilities
Stroke
Stroke Rehabilitation
Treatment Outcome
Walking
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https://hdl.handle.net/10161/14994Published Version (Please cite this version)
10.1161/JAHA.114.001038Publication Info
Prvu Bettger, Janet; McCoy, Lisa; Smith, Eric E; Fonarow, Gregg C; Schwamm, Lee H;
& Peterson, Eric D (2015). Contemporary trends and predictors of postacute service use and routine discharge
home after stroke. J Am Heart Assoc, 4(2). 10.1161/JAHA.114.001038. Retrieved from https://hdl.handle.net/10161/14994.This is constructed from limited available data and may be imprecise. To cite this
article, please review & use the official citation provided by the journal.
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Show full item recordScholars@Duke
Eric David Peterson
Fred Cobb, M.D. Distinguished Professor of Medicine
Dr Peterson is the Fred Cobb Distinguished Professor of Medicine in the Division of
Cardiology, a DukeMed Scholar, and the Past Executive Director of the Duke Clinical
Research Institute (DCRI), Durham, NC, USA.
Dr Peterson is the Principal Investigator of the National Institute of Health, Lung
and Blood Institute (NHLBI) Spironolactone Initiation Registry Randomized Interventional
Trial in Heart Failure With Preserved Ejection Fraction (SPIRRIT) Trial He is also
the Principal I
This author no longer has a Scholars@Duke profile, so the information shown here reflects
their Duke status at the time this item was deposited.
Janet Prvu Bettger
Adjunct Associate in the Department of Orthopaedic Surgery
Dr. Bettger’s research is dedicated to establishing real world evidence aimed to improve
health care quality and policies that reduce the burden of disease and disability.
As a health services researcher and implementation scientist, her research extends
from observational studies to randomized and pragmatic trials. She was the Founding
Director of Duke Roybal Center for Translational Research in the Behavioral and Social
Sciences of Aging and the Founding Director of Undergraduate
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