Stroke
Health Services Research
Measurement
Oral Presentation
Kent Simmonds, MPH
DO/PhD student
Michigan State University
East Lansing, Michigan
James Burke, MD, MS
Associate Professor
University of Michigan
Ann Arbor, Michigan
Mathew Reeves, PhD
Professor
Michigan State University
East Lansing, Michigan
Using Medicare Standard Analytic Files (2012-2013), we used multivariable logistic regression models to identify that a quarter of the 62,893 stroke patients who received care at Inpatient Rehabilitation Facilities were not discharged home. Race, pre-stroke living arrangements, function at discharge, and state of residence were factors strongly associated with discharge to a Skilled Nursing Facility (compared to Home).
Objective:
Identify factors which are independently associated with discharge to a Skilled Nursing Facility (SNF) compared to Home among acute stroke patients who received care at Inpatient Rehabilitation Facilities (IRFs).
Design:
Retrospective cohort study.
Setting :
Inpatient Rehabilitation Facilities.
Participants (or Animals, Specimens, Cadavers):
Medicare stroke IRF patients (N= 62,893) discharged to a SNF or Home (2012-2013).
Interventions : None.
Main Outcome Measure(s):
Discharge setting (SNF versus Home).
Results:
Of 62,893 patients, 55.8% were female, 79.2% were white, 11.9% were black, and 5.2% were Hispanic. The mean age was 78.9. A quarter (27%) of patients were discharged to an SNF, and 73% were discharged home. Independent predictors of discharge destination (SNF vs. home) were identified using multivariable logistic regression adjusting for patient (e.g. age, sex), clinical (e.g. stroke severity index, comorbidity index, length of stay), hospital (e.g. bed size) and geographic factors (e.g. urban/rural). The model had strong discrimination (c-statistic=0.88). Statistically significant (p<0.05) sociodemographic factors associated with SNF discharge included black (adjusted odds ratio [aOR: 0.56] and Hispanic [aOR: 0.65] race, versus white), male sex (aOR: 1.09) and lower education (aOR: 0.73). Significant pre-stroke factors included living alone (aOR: 3.20) or at home (aOR: 0.47). Increased motor function (aOR:0.59) (measured by the Functional Independence Measure) was more strongly associated with SNF discharge than increased cognitive function (aOR: 0.88). Poor bowel function (aOR: 1.9) was associated with SNF discharge. State of hospitalization was important as half of the states had aORs of 1.5 and ten states had aORs >2.0 or <0.5 (verus Florida).
Conclusions:
Approximately a quarter of IRF stroke patients are not discharged home. Race, pre-stroke living arrangements, function at discharge, and state of residence were factors strongly associated with SNF discharge.
