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Updated: Apr 13, 2026
Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
Factors Associated With Differences in the Recommended Versus Actual Discharge Location After Stroke
Kimberly J Waddell1, Ruiqi Yan2, Lin Xu2
1Department of Physical Medicine and Rehabilitation, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA; Corporal Michael J. Crescenz VA Meical Center, Philadelphia, PA; Penn Medicine Nudge Unit, Center for Health Care Trnsformation and Innovation, University of Pennsylvania Health System, Philadelphia, PA; Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA.
Objectives:
Discharge planning during an acute stroke hospitalization requires a coordinated effort to ensure patients receive the most appropriate posthospital care. We identified and described discrepancies in recommended versus actual postdischarge care after stroke.
Design:
This retrospective cohort study used the final acute hospital discharge recommendation by physical and occupational therapy as the recommended discharge disposition. We identified those who were discharged to a different care setting than was recommended and characterized sociodemographic, clinical, and facility factors associated with this discrepancy using a multinomial logistic regression.
Setting:
Acute care.
Participants:
Individuals hospitalized for an ischemic or hemorrhagic stroke between January 1, 2018, and December 31, 2024. The cohort (N=7545) comprised stroke hospitalizations.
Interventions:
Not applicable.
Main Outcome Measures:
The recommended and actual discharge disposition.
Results:
TThe mean (SD) age was 67 (14) years, 45.2% White and 42.0% Black. Overall, 1182 (15.6%) discharges were discrepant: 950 (80.4%) went to a lower intensity care setting, and 232 (19.6%) went to a higher intensity setting. The strongest associations with a discrepant discharge were a Sunday discharge (odds ratio [OR], 1.53; 95% CI, 1.10-2.11), Medicare fee-for-service (OR, 1.43; 95% CI, 1.14-1.79), or Medicare Advantage insurance (OR, 1.34; 95% CI, 1.08-1.68), and dependent prestroke ambulation (OR, 1.38; 95% CI, 1.14-1.68). These were also the factors most associated with increased odds of discharge to a lower intensity setting. A severe stroke (OR, 0.80; 95% CI, 0.67-0.96) and physiatry consult (OR, 0.75; 95% CI, 0.64-0.89) were associated with significantly lower odds of a discrepant discharge. Hemorrhagic stroke, increased function during admission, and greater social vulnerability were associated with increased odds of discharge to a higher intensity setting.
Conclusions:
The factors most associated with differences in recommended versus actual postacute care were unrelated to clinical need. Addressing these underlying factors will help ensure patients receive the recommended care to maximize outcomes.
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