Contemporary trends and predictors of postacute service use and routine discharge home after stroke.
dc.contributor.author | Prvu Bettger, Janet | |
dc.contributor.author | McCoy, Lisa | |
dc.contributor.author | Smith, Eric E | |
dc.contributor.author | Fonarow, Gregg C | |
dc.contributor.author | Schwamm, Lee H | |
dc.contributor.author | Peterson, Eric D | |
dc.coverage.spatial | England | |
dc.date.accessioned | 2017-07-06T13:36:34Z | |
dc.date.available | 2017-07-06T13:36:34Z | |
dc.date.issued | 2015-02-23 | |
dc.description.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. | |
dc.identifier | ||
dc.identifier | jah3844 | |
dc.identifier.eissn | 2047-9980 | |
dc.identifier.uri | ||
dc.language | eng | |
dc.publisher | Ovid Technologies (Wolters Kluwer Health) | |
dc.relation.ispartof | J Am Heart Assoc | |
dc.relation.isversionof | 10.1161/JAHA.114.001038 | |
dc.subject | rehabilitation | |
dc.subject | stroke | |
dc.subject | trends | |
dc.subject | Adult | |
dc.subject | Aged | |
dc.subject | Aged, 80 and over | |
dc.subject | Brain Ischemia | |
dc.subject | Female | |
dc.subject | Home Health Nursing | |
dc.subject | Hospitalization | |
dc.subject | Humans | |
dc.subject | Intracranial Hemorrhages | |
dc.subject | Length of Stay | |
dc.subject | Male | |
dc.subject | Middle Aged | |
dc.subject | Multivariate Analysis | |
dc.subject | Patient Discharge | |
dc.subject | Recovery of Function | |
dc.subject | Rehabilitation Centers | |
dc.subject | Risk Factors | |
dc.subject | Self Care | |
dc.subject | Skilled Nursing Facilities | |
dc.subject | Stroke | |
dc.subject | Stroke Rehabilitation | |
dc.subject | Treatment Outcome | |
dc.subject | Walking | |
dc.title | Contemporary trends and predictors of postacute service use and routine discharge home after stroke. | |
dc.type | Journal article | |
duke.contributor.orcid | Prvu Bettger, Janet|0000-0001-9708-8413 | |
duke.contributor.orcid | Peterson, Eric D|0000-0002-5415-4721 | |
pubs.author-url | ||
pubs.issue | 2 | |
pubs.organisational-group | Clinical Science Departments | |
pubs.organisational-group | Duke | |
pubs.organisational-group | Duke Clinical Research Institute | |
pubs.organisational-group | Institutes and Centers | |
pubs.organisational-group | Medicine | |
pubs.organisational-group | Medicine, Cardiology | |
pubs.organisational-group | Nursing | |
pubs.organisational-group | Orthopaedics | |
pubs.organisational-group | School of Medicine | |
pubs.organisational-group | School of Nursing | |
pubs.publication-status | Published online | |
pubs.volume | 4 |
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