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Are Stroke Survivors Discharged to the Recommended Postacute Setting?
Arch Phys Med Rehabil. 2020 07; 101(7):1190-1198.AP

Abstract

OBJECTIVE

To examine the processes and barriers involved in providing postdischarge stroke care.

DESIGN

Prospective study of discharge planners' (DP) and physical therapists' (PT) interpretation of factors contributing to patients' discharge destination.

SETTING

Twenty-three hospitals in the northeastern United States.

PARTICIPANTS

After exclusions, data on patients (N=427) hospitalized with a primary diagnosis of stroke between May 2015 and November 2016 were examined. Of the patients, 45% were women, and the median age was 71 years. DPs and PTs caring for these patients were queried regarding the selection of discharge destination.

INTERVENTIONS

None.

MAIN OUTCOME MEASURES

Comparison of actual discharge destination for stroke patients with the destinations recommended by their DPs and PTs.

RESULTS

In total, 184 patients (43.1%) were discharged home, 146 (34.2%) to an inpatient rehabilitation facility, 94 (22.0%) to a skilled nursing facility, and 3 (0.7%) to a long-term acute care hospital. DPs and PTs agreed on the recommended discharge destination in 355 (83.1%) cases. The actual discharge destination matched the DP and PT recommended discharge destination in 92.5% of these cases. In 23 cases (6.5%), the patient was discharged to a less intensive setting than recommended by both respondents. In 4 cases (1.1%), the patient was discharged to a more intensive level of care. In 2 cases (0.6%), the patient was discharged to a long-term acute care hospital rather than an inpatient rehabilitation facility as recommended. Patient or family preference was cited by at least 1 respondent for the discrepancy in discharge destination for 13 patients (3.1%); insurance barriers were cited for 9 patients (2.3%).

CONCLUSIONS

Most stroke survivors in the northeast United States are discharged to the recommended postacute care destination based on the consensus of DP and PT opinions. Further research is needed to guide postacute care service selection.

Authors+Show Affiliations

Department of Rehabilitation and Regenerative Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York, New York; Department of Rehabilitation Medicine, Weill Cornell Medicine, New York, New York; New York-Presbyterian Hospital, New York, New York. Electronic address: Js1165@cumc.columbia.edu.The American Heart Association/American Stroke Association, Eastern States, Albany, New York.Gaylord Specialty Healthcare, Wallingford, Connecticut.Baystate Medical Center, Springfield, Massachusetts.Select Medical, West Orange, New Jersey.Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina.The American Heart Association/American Stroke Association, Eastern States, Albany, New York.Department of Neurology, University of Massachusetts Medical School, Worcester, Massachusetts.Department of Emergency Medicine, Renaissance School of Medicine, Stony Brook University, Stony Brook, New York.The American Heart Association/American Stroke Association, Eastern States, Albany, New York.No affiliation info available

Pub Type(s)

Journal Article
Multicenter Study
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

32272107

Citation

Stein, Joel, et al. "Are Stroke Survivors Discharged to the Recommended Postacute Setting?" Archives of Physical Medicine and Rehabilitation, vol. 101, no. 7, 2020, pp. 1190-1198.
Stein J, Borg-Jensen P, Sicklick A, et al. Are Stroke Survivors Discharged to the Recommended Postacute Setting? Arch Phys Med Rehabil. 2020;101(7):1190-1198.
Stein, J., Borg-Jensen, P., Sicklick, A., Rodstein, B. M., Hedeman, R., Bettger, J. P., Hemmitt, R., Silver, B. M., Thode, H. C., & Magdon-Ismail, Z. (2020). Are Stroke Survivors Discharged to the Recommended Postacute Setting? Archives of Physical Medicine and Rehabilitation, 101(7), 1190-1198. https://doi.org/10.1016/j.apmr.2020.03.006
Stein J, et al. Are Stroke Survivors Discharged to the Recommended Postacute Setting. Arch Phys Med Rehabil. 2020;101(7):1190-1198. PubMed PMID: 32272107.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Are Stroke Survivors Discharged to the Recommended Postacute Setting? AU - Stein,Joel, AU - Borg-Jensen,Pamela, AU - Sicklick,Alyse, AU - Rodstein,Barry M, AU - Hedeman,Robin, AU - Bettger,Janet Prvu, AU - Hemmitt,Roseanne, AU - Silver,Brian M, AU - Thode,Henry C, AU - Magdon-Ismail,Zainab, AU - ,, Y1 - 2020/04/06/ PY - 2020/01/07/received PY - 2020/03/02/revised PY - 2020/03/02/accepted PY - 2020/4/10/pubmed PY - 2020/10/7/medline PY - 2020/4/10/entrez KW - Decision making KW - Patient discharge KW - Rehabilitation KW - Skilled nursing facilities KW - Stroke SP - 1190 EP - 1198 JF - Archives of physical medicine and rehabilitation JO - Arch Phys Med Rehabil VL - 101 IS - 7 N2 - OBJECTIVE: To examine the processes and barriers involved in providing postdischarge stroke care. DESIGN: Prospective study of discharge planners' (DP) and physical therapists' (PT) interpretation of factors contributing to patients' discharge destination. SETTING: Twenty-three hospitals in the northeastern United States. PARTICIPANTS: After exclusions, data on patients (N=427) hospitalized with a primary diagnosis of stroke between May 2015 and November 2016 were examined. Of the patients, 45% were women, and the median age was 71 years. DPs and PTs caring for these patients were queried regarding the selection of discharge destination. INTERVENTIONS: None. MAIN OUTCOME MEASURES: Comparison of actual discharge destination for stroke patients with the destinations recommended by their DPs and PTs. RESULTS: In total, 184 patients (43.1%) were discharged home, 146 (34.2%) to an inpatient rehabilitation facility, 94 (22.0%) to a skilled nursing facility, and 3 (0.7%) to a long-term acute care hospital. DPs and PTs agreed on the recommended discharge destination in 355 (83.1%) cases. The actual discharge destination matched the DP and PT recommended discharge destination in 92.5% of these cases. In 23 cases (6.5%), the patient was discharged to a less intensive setting than recommended by both respondents. In 4 cases (1.1%), the patient was discharged to a more intensive level of care. In 2 cases (0.6%), the patient was discharged to a long-term acute care hospital rather than an inpatient rehabilitation facility as recommended. Patient or family preference was cited by at least 1 respondent for the discrepancy in discharge destination for 13 patients (3.1%); insurance barriers were cited for 9 patients (2.3%). CONCLUSIONS: Most stroke survivors in the northeast United States are discharged to the recommended postacute care destination based on the consensus of DP and PT opinions. Further research is needed to guide postacute care service selection. SN - 1532-821X UR - https://www.unboundmedicine.com/medline/citation/32272107/Are_Stroke_Survivors_Discharged_to_the_Recommended_Postacute_Setting L2 - https://linkinghub.elsevier.com/retrieve/pii/S0003-9993(20)30173-8 DB - PRIME DP - Unbound Medicine ER -