Contemporary trends and predictors of postacute service use and routine discharge home after stroke.

Prvu Bettger, Janet

McCoy, Lisa

Smith, Eric E

Fonarow, Gregg C

Schwamm, Lee H

Peterson, Eric D

England

2017-07-06T13:36:34Z

2017-07-06T13:36:34Z

2015-02-23

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.

https://www.ncbi.nlm.nih.gov/pubmed/25713291

jah3844

2047-9980

https://hdl.handle.net/10161/14994

eng

Ovid Technologies (Wolters Kluwer Health)

J Am Heart Assoc

10.1161/JAHA.114.001038

rehabilitation

stroke

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

Contemporary trends and predictors of postacute service use and routine discharge home after stroke.

Journal article

Prvu Bettger, Janet|0000-0001-9708-8413

Peterson, Eric D|0000-0002-5415-4721

https://www.ncbi.nlm.nih.gov/pubmed/25713291

2

Clinical Science Departments

Duke

Duke Clinical Research Institute

Institutes and Centers

Medicine

Medicine, Cardiology

Nursing

Orthopaedics

School of Medicine

School of Nursing

Published online

4