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Institutionalization after stroke.

R Portelli1, D Lowe, P Irwin

  • 1Royal College of Physicians, London, UK.

Clinical Rehabilitation
|February 12, 2005
PubMed
Summary
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Discharge disability and older age are key factors predicting institutionalization after stroke. Early prediction for resource allocation is unreliable due to significant individual variation.

Area of Science:

  • Neurology
  • Gerontology
  • Health Services Research

Background:

  • Significant regional disparities exist in post-stroke institutionalization rates.
  • Understanding predictors of institutionalization is crucial for patient care and resource management.

Purpose of the Study:

  • Identify factors predicting institutionalization after stroke.
  • Evaluate the utility of institutionalization rates as a hospital quality indicator.

Main Methods:

  • Retrospective audit of 2778 stroke admissions across 79 hospitals in England, Wales, and Northern Ireland.
  • Data collection included demographics, case-mix, clinical outcomes, discharge organization, and residence at multiple time points.
  • Validation using data from the 1998 National Sentinel Audit of Stroke.

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Main Results:

  • 14% of home-dwelling patients were discharged to nursing or residential homes.
  • Discharge Barthel Index score explained 40% of institutionalization variation; age and length of stay increased this to 54%.
  • Admission factors (Glasgow Coma Score, age, mobility) explained 22% of variation; regional access to institutions also played a role.

Conclusions:

  • Disability at discharge and advanced age are primary determinants of institutionalization.
  • Reliable individual prediction of institutionalization for early resource allocation is not feasible.