title: Factors associated with discharge to home versus discharge to institutional care after inpatient stroke rehabilitation.
abstract: OBJECTIVE
  To examine sociodemographic and clinical characteristics independently associated with discharge home compared with discharge to a skilled nursing facility (SNF) after acute inpatient rehabilitation.
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  Three tertiary accredited acute care rehabilitation facilities.
  
  
  METHODS
  Adult patients with stroke (N=2085).
  
  
  METHODS
  Not applicable.
  
  
  METHODS
  Not applicable.
  
  
  RESULTS
  Of 2085 patients with stroke treated at 3 centers over a 4-year period, 78.2% (n=1631) were discharged home and 21.8% (n=454) discharged to an SNF. Findings from a multivariable logistic regression analysis indicated that patients were less likely to be discharged home if they were older (odds ratio [OR], .98; 95% confidence interval [CI], .96-.99), separated or divorced (compared with married; OR, .61; 95% CI, .48-.79), or with Medicare health insurance (compared with private insurance; OR, .69; 95% CI, .55-.88), or had dysphagia (OR, .83; 95% CI, .71-.98) or cognitive deficits (OR, .79; 95% CI, .77-.81). The odds of being discharged home were higher for those admitted with a higher motor FIM score (OR, 1.10; 95% CI, 1.09-1.11). The following were not associated with discharge disposition: sex, race, prestroke vocational status, availability of secondary health insurance, number of days from stroke onset to rehabilitation facility admission, stroke type, impairment group, cognitive FIM on admission, other stroke deficits (aphasia, ataxia, neglect, or speech disturbance), stroke complications of hyponatremia or urinary tract infection, or comorbid conditions.
  
  
  CONCLUSIONS
  One in 5 patients with stroke were discharged to an SNF after inpatient rehabilitation. On admission, several sociodemographic and clinical characteristics were identified that could be considered as important factors in early discussions for discharge planning.
authors.affiliation: Department of Physical Medicine and Rehabilitation, Carolinas Medical Center, Charlotte, NC. Electronic address: vu.nguyen@carolinashealthcare.org.
authors.forename: Vu Q C
authors.initials: VQ
authors.lastname: Nguyen
authors.affiliation: School of Nursing, Duke University, Durham, NC.
authors.forename: Janet
authors.initials: J
authors.lastname: PrvuBettger
authors.affiliation: Department of Physical Medicine and Rehabilitation, Carolinas Medical Center, Charlotte, NC.
authors.forename: Tami
authors.initials: T
authors.lastname: Guerrier
authors.affiliation: Department of Physical Medicine and Rehabilitation, Carolinas Medical Center, Charlotte, NC.
authors.forename: Mark A
authors.initials: MA
authors.lastname: Hirsch
authors.affiliation: Department of Physical Medicine and Rehabilitation, Carolinas Medical Center, Charlotte, NC.
authors.forename: J George
authors.initials: JG
authors.lastname: Thomas
authors.affiliation: Department of Physical Medicine and Rehabilitation, Carolinas Medical Center, Charlotte, NC.
authors.forename: Terrence M
authors.initials: TM
authors.lastname: Pugh
authors.affiliation: Department of Physical Medicine and Rehabilitation, Carolinas Medical Center, Charlotte, NC.
authors.forename: Charles F
authors.initials: CF
authors.lastname: Rhoads
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004185:Disability Evaluation; D005260:Female; D006304:Health Status; D006801:Humans; D007297:Inpatients; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010351:Patient Discharge / Q000706:statistics & numerical data*; D020127:Recovery of Function; D012047:Rehabilitation Centers / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012307:Risk Factors; D012737:Sex Factors; D012866:Skilled Nursing Facilities / Q000706:statistics & numerical data*; D012959:Socioeconomic Factors; D000071939:Stroke Rehabilitation; D013997:Time Factors; D055815:Young Adult
keywords: Outcome assessment (health care); Rehabilitation; Stroke