Discharge destination's effect on bounce-back risk in Black, White, and Hispanic acute ischemic stroke patients.
OBJECTIVE
To determine whether racial and ethnic effects on bounce-back risk (ie, movement to settings of higher care intensity within 30 d of hospital discharge) in acute stroke patients vary depending on initial posthospital discharge destination.


METHODS
Retrospective analysis of administrative data.


METHODS
Four hundred twenty-two hospitals, southern/eastern United States.


METHODS
All Medicare beneficiaries 65 years or more with hospitalization for acute ischemic stroke within one of the 422 target hospitals during the years 1999 or 2000 (N=63,679).


METHODS
Not applicable.


METHODS
Adjusted predicted probabilities for discharge to and for bouncing back from each initial discharge site (ie, home, home with home health care, skilled nursing facility [SNF], or rehabilitation center) by race (ie, black, white, and Hispanic). Models included sociodemographics, comorbidities, stroke severity, and length of stay.


RESULTS
Blacks and Hispanics were significantly more likely to be discharged to home health care (blacks=21% [95% confidence interval (CI), 19.9-22.8], Hispanic=19% [17.1-21.7] vs whites=16% [15.5-16.8]) and less likely to be discharged to SNFs (blacks=26% [95% CI, 23.6-29.3], Hispanics=28% [25.4-31.6] vs whites=33% [31.8-35.1]) than whites. However, blacks and Hispanics were significantly more likely to bounce back when discharged to SNFs than whites (blacks=26% [95% CI, 24.2-28.6], Hispanics=28% [24-32.6] vs whites=21% [20.3-21.9]). Hispanics had a lower risk of bouncing back when discharged home than either blacks or whites (Hispanics=14% [95% CI, 11.3-17] vs blacks=20% [18.4-22.2], whites=18% [16.8-18.3]). Patients discharged to home health care or rehabilitation centers demonstrated no significant differences in bounce-back risk.


CONCLUSIONS
Racial/ethnic bounce-back risk differs depending on initial discharge destination. Additional research is needed to fully understand this variation in effect.
Department of Medicine-Geriatrics Section, University of Wisconsin School of Medicine and Public Health, Madison, WI 53705, USA. ajk@medicine.wisc.edu
Amy J H
AJ
Kind
Maureen A
MA
Smith
Jinn-Ing
JI
Liou
Nancy
N
Pandhi
Jennifer R
JR
Frytak
Michael D
MD
Finch
D001741:Black or African American; D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000150:complications / Q000208:ethnology / Q000628:therapy; D015331:Cohort Studies; D005260:Female; D006630:Hispanic or Latino; D006699:Home Care Services; D006760:Hospitalization; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D012307:Risk Factors; D012866:Skilled Nursing Facilities; D020521:Stroke / Q000208:ethnology*; D000071939:Stroke Rehabilitation; D044465:White People