title: Contemporary trends and predictors of postacute service use and routine discharge home after stroke.
abstract: 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.
  
  
  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.
authors.affiliation: Duke University School of Nursing, Duke Clinical Research Institute, Durham, NC (J.P.B., L.M.C., E.D.P.).
authors.forename: Janet
authors.initials: J
authors.lastname: Prvu Bettger
authors.affiliation: Duke University School of Nursing, Duke Clinical Research Institute, Durham, NC (J.P.B., L.M.C., E.D.P.).
authors.forename: Lisa
authors.initials: L
authors.lastname: McCoy
authors.affiliation: University of Calgary, Calgary, Alberta,, Canada (E.E.S.).
authors.forename: Eric E
authors.initials: EE
authors.lastname: Smith
authors.affiliation: University of California, Los Angeles, CA (G.C.F.).
authors.forename: Gregg C
authors.initials: GC
authors.lastname: Fonarow
authors.affiliation: Massachusetts General Hospital, Boston, MA (L.H.S.).
authors.forename: Lee H
authors.initials: LH
authors.lastname: Schwamm
authors.affiliation: Duke University School of Nursing, Duke Clinical Research Institute, Durham, NC (J.P.B., L.M.C., E.D.P.).
authors.forename: Eric D
authors.initials: ED
authors.lastname: Peterson
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000150:complications / Q000534:rehabilitation; D005260:Female; D064650:Home Health Nursing / Q000706:statistics & numerical data*; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D020300:Intracranial Hemorrhages / Q000150:complications / Q000534:rehabilitation; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010351:Patient Discharge / Q000706:statistics & numerical data / Q000639:trends*; D020127:Recovery of Function; D012047:Rehabilitation Centers / Q000706:statistics & numerical data*; D012307:Risk Factors; D012648:Self Care / Q000706:statistics & numerical data*; D012866:Skilled Nursing Facilities / Q000706:statistics & numerical data*; D020521:Stroke / Q000145:classification; D000071939:Stroke Rehabilitation; D016896:Treatment Outcome; D016138:Walking / Q000706:statistics & numerical data
keywords: rehabilitation; stroke; trends