So they've given up on even trying to get survivors recovered to return home. Tyranny of low expectations in full display here, hope you're OK with not recovering.
Predictors of Discharge Destination After Stroke
Abstract
Background
Determining
the discharge destination after acute stroke care is important to
prevent long-term disabilities and improve cost efficiency.
Objective
The
aim of this study was to investigate where stroke patients are
discharged to after acute treatment and to identify personal, social,
stroke-related, and clinical predictors of discharge destination.
Methods
The
present study included a secondary exploratory analysis of a
prospective observational study. Patients with acute ischemic stroke,
transient ischemic attack, or intracerebral hemorrhage were recruited
consecutively over a 15-month period. A hierarchical multinomial
logistic regression was performed to identify predictors of the primary
outcome of discharge destination.
Results
We
included 1026 stroke patients (48.7% female) with a mean age of 73.3
years (standard deviation 12.9 years) in the analysis. Overall, 55% of
the patients were discharged home, 33% to a rehabilitation center, 3% to
a residential facility, and 8% to another acute care hospital.
Predictors that statistically significantly influenced the odds of the
discharge destination were age, living situation pre-stroke, living
location pre-stroke, stroke type, stroke severity, treatment type, and
length of stay. Higher stroke severity was associated with discharge to
all four inpatient facilities.
Conclusions
In
line with previous research, predictors such as stroke severity and
living situation pre-stroke significantly influenced the odds of the
discharge destination. In contrast, pre-existing conditions and
functional impairment pre-stroke had no significant impact on the
primary outcome. This discrepancy could be due to a rather functional
study sample before stroke and the use of clinical and patient-reported
outcome measures.
Introduction
People
aged 25 and above have a 25% global lifetime risk of suffering from
stroke which is associated with long-term consequences and causes
disabilities such as motor control impairments, cognitive and language
impairments, and emotional disturbances.1–5
Inpatient
or outpatient rehabilitative care follows acute stroke care. As
patients are affected to varying degrees by disabilities after stroke,
the type of follow-up care needed differs.6
For follow-up care, timely discharge to rehabilitation facilities or
home with outpatient care has been shown to improve patients’ chances of
recovery.7,8
In contrast, a rapid discharge without previous discharge arrangements
is often associated with discontinued care and a delay in discharge is
associated with increased mortality.8,9
Additionally, finding appropriate follow-up care strongly impacts the
time and cost-efficiency of stroke care, which is important considering
limited time resources at the hospital and high stroke care costs.9,10
In their review, Thorpe et al11
revealed that a discharge home becomes more likely with a better
outcome on scoring systems for the assessment of acute stroke such as
the National Institutes of Health Stroke Scale (NIHSS).12
However, they concluded that outcome measures are not sufficient to
predict discharge destination. Patients with low performance scores were
more likely to be discharged to rehabilitation, and patients with high
performance scores were more likely to be discharged home, but discharge
destination could not be predicted well for patients with mid-range
scores.11
In these cases, additional factors are needed to enable the prediction
of the discharge destination. In another review, support at home, living
with others, being married, and living at home before stroke onset
indicated a greater likelihood of a discharge home.13
Moreover, while the impact of age and sex was less clear, a better
pre-stroke functional and post-stroke cognitive status increased the
likelihood of being discharged home.14
In conclusion, different reviews recommend further research on age,
sex, type of stroke, patient-specific biopsychosocial factors, other
stroke-specific outcome measures, and global socioenvironmental
determinants.11,13-15
Therefore,
we aimed to assess where stroke patients are discharged after acute
treatment and to identify personal, pre-stroke, stroke-related, and
clinical predictors of discharge destination.
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