Factors Associated With Continuum of Acute to Postacute Care in Stroke

Acute to postacute care continuum for individuals with stroke significantly influences functional recovery, quality of life, and healthcare utilization. Prior studies have focused largely on older adults with stroke, limiting generalizability for the younger population.

This study is aimed at identifying patient- and hospital-level factors associated with postacute discharge destination following acute stroke hospitalization.

This study is a retrospective cohort study.

This study was set in acute care hospitals in Virginia (2017-2021).

Participants are adults ≥ 18 years hospitalized with a primary diagnosis of ischemic or hemorrhagic stroke identified in the Virginia All-Payer Claims Database.

There were no interventions applicable.

Postacute care discharge destination was categorized as home, home health, skilled nursing facility (SNF), inpatient rehabilitation facility (IRF), or other. Patient-level variables included age, sex, race, insurance, comorbidity burden, stroke type, length of stay, and hospital-acquired complications. Facility-level variables included hospital size, ownership, stroke center status, and county-level clinical care rankings. Multivariable logistic regression models estimated associations between patient and hospital factors and postacute care discharge destination.

Older age, higher comorbidity burden, presence of hospital-acquired complications, and longer length of stay were associated with increased likelihood of discharge to post-acute care, particularly IRF and SNF. Male patients were less likely than females to be discharged to home health (OR = 0.90, 95%CI = 0.85-0.95) or to SNF (OR = 0.91, 95%CI = 0.87-0.96). Black patients had higher odds of discharge to home health (OR = 1.13, 95%CI = 1.05-1.22), IRF (OR = 1.10, 95%CI = 1.02-1.19), and SNF (OR = 1.13, 95%CI = 1.05-1.21) compared with White patients. Medicaid beneficiaries had higher odds of discharge to post-acute care settings compared with commercially insured patients, including home health (OR = 1.34, 95%CI = 1.17-1.54), IRF (OR = 1.20, 95%CI = 1.05-1.38), and SNF (OR = 1.17, 95%CI = 1.02-1.34).

Postacute care after stroke is associated with both clinical complexity and sociodemographic factors. These findings highlight potential differences and variations in postacute care and support the need for standardized discharge processes that can integrate medical and social determinants of health to optimize long-term recovery.