title: Derivation and validation of a discharge disposition predicting model after acute stroke.
abstract: BACKGROUND
  Discharge disposition planning is vital for poststroke patients. We investigated clinical factors associated with discharging patients to nursing homes, using the Taiwan Stroke Registry data collected from 39 major hospitals.
  
  
  METHODS
  We randomly assigned 21,575 stroke inpatients registered from 2006 to 2008 into derivation and validation groups at a 3-to-1 ratio. We used the derivation group to develop a prediction model by measuring cumulative risk scores associated with potential predictors: age, sex, hypertension, diabetes mellitus, heart diseases, stroke history, snoring, main caregivers, stroke types, and National Institutes of Health Stroke Scale (NIHSS). Probability of nursing home care and odds ratio (OR) of nursing home care relative to home care by cumulative risk scores were measured for the prediction. The area under the receiver operating characteristic curve (AUROC) was used to assess the model discrimination against the validation group.
  
  
  RESULTS
  Except for hypertension, all remaining potential predictors were significant independent predictors associated with stroke patient disposition to nursing home care after discharge from hospitals. The risk sharply increased with age and NIHSS. Patients with a cumulative risk score of 15 or more had an OR of 86.4 for the nursing home disposition. The AUROC plots showed similar areas under curves for the derivation group (.86, 95% confidence interval [CI], .85-.87) and for the validation group (.84, 95% CI, .83-.86).
  
  
  CONCLUSIONS
  The cumulative risk score is an easy-to-estimate tool for preparing stroke patients and their family for disposition on discharge.
authors.affiliation: Department of Neurology, Lotung Pohai Hospital, Lotung, Ilan, Taiwan.
authors.forename: Hung-Pin
authors.initials: HP
authors.lastname: Tseng
authors.affiliation: Department of Applied Economics and Management, National Ilan University, Ilan, Taiwan.
authors.forename: Feng-Jenq
authors.initials: FJ
authors.lastname: Lin
authors.affiliation: Department of Applied Economics and Management, National Ilan University, Ilan, Taiwan.
authors.forename: Pi-Tzu
authors.initials: PT
authors.lastname: Chen
authors.affiliation: Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan; Institute of Clinical Medical Science, China Medical University, Taichung, Taiwan.
authors.forename: Chih-Hsin
authors.initials: CH
authors.lastname: Mou
authors.affiliation: Department of Neurology, Far Eastern Memorial Hospital, New Taipei, Taiwan.
authors.forename: Siu-Pak
authors.initials: SP
authors.lastname: Lee
authors.affiliation: Department of Neurology, Min Sheng General Hospital, Taoyuan, Taiwan.
authors.forename: Chun-Yuan
authors.initials: CY
authors.lastname: Chang
authors.affiliation: Department of Neurology, Chung Shan Medical University Hospital, Taichung, Taiwan.
authors.forename: An-Chih
authors.initials: AC
authors.lastname: Chen
authors.affiliation: Department of Neurology, China Medical University Hospital, Taichung, Taiwan.
authors.forename: Chung-Hsiang
authors.initials: CH
authors.lastname: Liu
authors.affiliation: Department of Neurology, Show Chwan Memorial Hospital, Changhua, Taiwan.
authors.forename: Chung-Hsin
authors.initials: CH
authors.lastname: Yeh
authors.affiliation: Department of Neurology, Changhua Christian Hospital Yunlin Branch, Yunlin, Taiwan.
authors.forename: Song-Yen
authors.initials: SY
authors.lastname: Tsai
authors.affiliation: Department of Neurology, National Taiwan University Hospital Yunlin Branch, Yunlin, Taiwan.
authors.forename: Yu-Jen
authors.initials: YJ
authors.lastname: Hsiao
authors.affiliation: Department of Neurology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.
authors.forename: Ching-Huang
authors.initials: CH
authors.lastname: Lin
authors.affiliation: Department of Neurology, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan.
authors.forename: Shih-Pin
authors.initials: SP
authors.lastname: Hsu
authors.affiliation: Department of Neurology, Kuang Tien General Hospital Dajia Division, Taichung, Taiwan.
authors.forename: Shih-Chieh
authors.initials: SC
authors.lastname: Yu
authors.affiliation: Institute of Clinical Medical Science, China Medical University, Taichung, Taiwan.
authors.forename: Chung-Y
authors.initials: CY
authors.lastname: Hsu
authors.affiliation: Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan; Institute of Clinical Medical Science, China Medical University, Taichung, Taiwan. Electronic address: fcsung1008@yahoo.com.
authors.forename: Fung-Chang
authors.initials: FC
authors.lastname: Sung
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D008962:Models, Theoretical; D009735:Nursing Homes; D010351:Patient Discharge / Q000706:statistics & numerical data*; D018570:Risk Assessment; D012307:Risk Factors; D020521:Stroke / Q000628:therapy*; D055815:Young Adult
keywords: Discharge disposition; nursing home; risk score; stroke