Are Stroke Survivors Discharged to the Recommended Post-Acute Setting?

Abstract Objective To examine the processes and barriers involved in providing post-discharge stroke care. Design Prospective study of discharge planners (DPs) and physical therapists’ (PTs) interpretation of factors contributing to patients’ discharge destination. Setting Twenty-three hospitals in the northeastern United States. Participants After exclusions, data on 427 patients hospitalized with a primary diagnosis of stroke between 05/2015 to 11/2016 were examined. 45% of patients were female; median age was 71. DPs/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 to the destination(s) recommended by their DPs and PTs. Results 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 recommended discharge destination in 355 (83.1%) cases; of these, the actual discharge destination matched the DP/PT recommended discharge destination in 92.5%. 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 (when inpatient rehabilitation facility was recommended). Patient/family preference was cited by at least one respondent for discrepancy in discharge destination for 13 patients (3.1% of 355 cases); insurance barriers were cited for 9 patients (2.3% of 355 cases). Conclusions Most stroke survivors in the Northeast are discharged to the recommended post-acute care destination based on the consensus of DP and PT opinions. Further research is needed to guide post-acute care service selection.