title: Factors associated with home discharge among veterans with stroke.
abstract: OBJECTIVE
  To determine which patient-, treatment-, and facility-level characteristics were associated with home discharge among patients hospitalized for stroke within the Department of Veterans Affairs.
  
  
  METHODS
  Retrospective observational study.
  
  
  METHODS
  Veterans Affairs facilities nationwide.
  
  
  METHODS
  Veterans hospitalized for stroke during fiscal year 2007 to fiscal year 2008 (N=12,565).
  
  
  METHODS
  Not applicable.
  
  
  METHODS
  Discharge location after hospitalization.
  
  
  RESULTS
  There were 10,130 (80.6%) veterans discharged home after hospitalization for acute stroke. Married veterans were more likely than nonmarried veterans to be discharged home (odds ratio [OR]=1.23; 95% confidence interval [CI]=1.11-1.35). Compared with veterans admitted to the hospital from home, patients admitted from extended care were less likely to be discharged home (OR=.04; 95% CI=.03-.07). Compared with those with occlusion of cerebral arteries, patients with intracerebral hemorrhage (OR=.61; 95% CI=.50-.74) or other central nervous system hemorrhage (OR=.78; 95% CI=.63-.96) were less likely to be discharged home, whereas patients with occlusion of precerebral arteries (OR=1.36; 95% CI=1.07-1.73) were more likely to return home. Evidence of congestive heart failure (OR=.85; 95% CI=.76-.95), fluid and electrolyte disorders (OR=.86; 95% CI=.77-.96), internal organ procedures and diagnostics (OR=.87; 95% CI=.78-.97), and serious nutritional compromise (OR=.49; 95% CI=.40-.62) during hospitalization remained independently associated with lower odds of home discharge. Longer hospitalizations and receipt of rehabilitation services while hospitalized acutely were negatively associated, whereas treatment on more bed sections and rehabilitation accreditation of the facility were positively associated with home discharge. Region exerted a statistically significant effect on home discharge.
  
  
  CONCLUSIONS
  We found sociological, clinical, and facility-level factors associated with home discharge after hospitalization for acute stroke. Findings document the importance of considering a broad range of characteristics rather than focusing only on a few specific traits during discharge planning.
authors.affiliation: Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA. Electronic address: jkurichi@mail.med.upenn.edu.
authors.forename: Jibby E
authors.initials: JE
authors.lastname: Kurichi
authors.affiliation: Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA.
authors.forename: Dawei
authors.initials: D
authors.lastname: Xie
authors.affiliation: Veterans Affairs Medical Center, Albany, NY; Physical Medicine and Rehabilitation, Albany Medical College, Albany, NY.
authors.forename: Barbara E
authors.initials: BE
authors.lastname: Bates
authors.affiliation: Department of Veterans Affairs Health Services Research and Development/Rehabilitation Research and Development Rehabilitation Outcomes Research Center Research Enhancement Award Program North Florida/South Georgia Veterans Health System, Gainesville, FL; Department of Health Outcomes and Policy, College of Medicine, University of Florida, Gainesville, FL.
authors.forename: Diane Cowper
authors.initials: DC
authors.lastname: Ripley
authors.affiliation: Veterans Affairs Medical Center, Gainesville, FL; Department of Health Outcomes and Policy, College of Medicine, University of Florida, Gainesville, FL.
authors.forename: W Bruce
authors.initials: WB
authors.lastname: Vogel
authors.affiliation: Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA.
authors.forename: Pui
authors.initials: P
authors.lastname: Kwong
authors.affiliation: Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA; Department of Physical Medicine and Rehabilitation, University of Pennsylvania, Philadelphia, PA.
authors.forename: Margaret G
authors.initials: MG
authors.lastname: Stineman
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D010351:Patient Discharge / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012737:Sex Factors; D012959:Socioeconomic Factors; D000071939:Stroke Rehabilitation; D014481:United States; D014493:United States Department of Veterans Affairs; D014728:Veterans / Q000706:statistics & numerical data*
keywords: Outcomes research; Rehabilitation; Stroke; Veterans