Discharge disposition following acute ischemic stroke in the veterans health administration: A retrospective cohort...

The purpose of this study was to examine the discharge disposition of older adults who were hospitalized for an ischemic stroke in the Veterans Health Administration (VA).

This retrospective cohort evaluation included Veterans, admitted to one of 36 distinct medical centers, who discharged from the acute hospital to home, home with home health services, an inpatient rehabilitation facility (IRF), or skilled nursing facility (SNF). Unadjusted trends in the proportion of discharges to each setting by year was examined using the Cochrane-Armitage test for trend. The association of demographic, clinical, and facility characteristics with discharge disposition were examined using a multinomial logistic regression.

The cohort comprised 4,623 older Veterans with a mean (SD) age 75.3 (7.3) years; 72.9% went home, 6.6% discharged to an IRF, and 20.5% discharged to a SNF. There was a significant change in the proportion of patients discharged to a SNF (2019, 24.5%; 2020, 18.7%; and 2021, 19.8%, P = 0.007). Multiple clinical factors were consistently associated with discharge to SNF versus home, IRF versus home, and IRF versus SNF. Age 85 or older was significantly associated with higher odds of discharge to SNF versus home (OR 1.37, 95% CI [1.03, 1.80], P =0.02), and lower odds of discharge to an IRF versus SNF (OR 0.58, 95% CI0.35, 0.95], P=0.03).

The clinical presentation of individuals hospitalized for acute ischemic stroke was most strongly and consistently associated with discharge location. Demographic and facility variables were sparsely associated with discharge disposition across all settings.