Predictors of Discharge Destination After Stroke

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

Theresa Schrage, MSc https://orcid.org/0000-0001-9684-1856 t.schrage@uke.de, Götz Thomalla, MD, […], and Levente Kriston, PhD+4View all authors and affiliations

OnlineFirst

https://doi.org/10.1177/15459683231166935

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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