Discharge Patterns for Ischemic and Hemorrhagic Stroke Patients Going From Acute Care Hospitals to Inpatient and Skilled Nursing Rehabilitation.
Ickpyo Hong, Amol Karmarkar, Winston Chan and 6 others
PMID 29595584WHAT IT FOUND
Across 122,084 Medicare patients, discharge to intensive rehabilitation versus skilled nursing varied widely by hospital, not just by stroke severity.
Patients sent to skilled nursing were older, female, and had more comorbidities and lower function. Hospital-level patterns drove these decisions more than clinical factors alone.
Key findings
01Patients discharged to skilled nursing facilities were older, female, had more comorbidities, and lower self-care and mobility scores than those discharged to inpatient rehabilitation facilities.
02Considerable variation existed in how acute care hospitals discharged stroke patients to inpatient rehabilitation versus skilled nursing, even after adjusting for patient and facility characteristics.
03Higher motor function scores at admission were associated with discharge to inpatient rehabilitation, while higher self-care scores and Medicaid eligibility were associated with discharge to skilled nursing.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTs
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What it does not show
The study only included IRF and SNF settings, so findings do not apply to home health, long-term acute care, or outpatient rehabilitation. Functional scores were measured at admission to the post-acute facility, not at discharge from the acute hospital, which may not reflect the patient's status during the actual discharge decision. Cognitive function could not be reliably compared across settings due to low precision of the assessment tools used in skilled nursing facilities. Rater differences (therapists in IRFs versus nurses in SNFs) may have influenced the functional scores. Unmeasured social factors, such as living situation, marital status, and caregiver availability, were not included in the analysis but likely influence discharge decisions.
Declared interests
The authors declared no conflicts of interest. The study was supported by the National Institutes of Health and the U.S. Government.
The easy way to misread this
Do not assume that discharge to a skilled nursing facility indicates a lack of potential for rehabilitation. The study shows that hospital-level variation and non-clinical factors, such as Medicaid eligibility and distance, significantly influence these decisions, often masking the patient's true clinical needs.