Factors Associated With Differences in the Recommended Versus Actual Discharge Location After Stroke

Area of Science:

• Neurology
• Healthcare Management
• Rehabilitation Medicine

Background:

• Effective discharge planning is crucial for optimal post-stroke recovery.
• Coordinated care transitions are essential to ensure patients receive appropriate post-hospitalization services.
• Discrepancies in discharge planning can lead to suboptimal patient outcomes.

Purpose of the Study:

• To identify and describe discrepancies between recommended and actual post-discharge care settings for stroke patients.
• To characterize sociodemographic, clinical, and facility factors associated with discharge recommendation versus actual disposition mismatches.
• To understand the drivers of suboptimal discharge planning in acute stroke care.

Main Methods:

• Retrospective cohort study analyzing discharge recommendations from physical (PT) and occupational therapy (OT).
• Identified patients discharged to a different care setting than recommended.
• Utilized multinomial logistic regression to analyze factors associated with discharge discrepancies.

Main Results:

• 15.6% of 7545 stroke hospitalizations had discrepant discharges (80.4% to lower intensity, 19.6% to higher intensity).
• Sunday discharge, Medicare insurance, and pre-stroke ambulation dependence were associated with higher odds of discrepancy.
• Severe stroke and physiatry consults were associated with lower odds of discrepancy; hemorrhagic stroke and social vulnerability increased odds of higher-intensity discharge.

Conclusions:

• Discharge discrepancies after stroke are frequently driven by non-clinical factors such as discharge timing and insurance type.
• Addressing systemic factors unrelated to clinical need is vital for aligning actual care with recommended post-acute plans.
• Improving discharge planning coordination can enhance patient outcomes and ensure appropriate care transitions.